Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated for a 6-year history of typical gastroesophageal reflux symptoms treated on an as-needed basis with a proton pump inhibitor. However, the frequency of his reflux symptoms has recently increased and his episodes do not respond to treatment as completely as in the past. An upper endoscopy is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated during a routine examination. He is concerned about his general health and risk of diabetes mellitus. He has no medical problems. Both parents and his sister have type 2 diabetes mellitus. On physical examination, temperature is normal, blood pressure is 130/79 mm Hg, pulse rate is 66/min, and ...

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The sun rises and the sun sets. It seems like the sun rotates around the Earth. Cancer cells rise and are killed by surgery, radiation and chemotherapy. It seems like cancer is a disease. But the sun does not rotate around the Earth, and cancer is not a disease. The many kinds of cancer cells are the products of the disease neoplasia that can emerge in our bodies’ organs and tissues. Strange ...

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Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with prostate cancer screening, other than the overdiagnosis (and resulting unnecessary treatment) of clinically insignificant tumors. Since routine prostate-specific antigen screening had been going on for nearly two decades by then, we expected to ...

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When I was in kindergarten, my school bus used to drop me off at the hospital where my mother worked.  My older sister and I would sit quietly in my mom’s office and do our homework while she finished up her work.  Most of my friends would get stickers or McDonald’s for their good behavior, but if my sister and I were on our best behavior, my mom would reward ...

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I was a first-year medical student, starting my first afternoon at an outpatient clinic as part of an introductory course in clinical medicine. My white coat was freshly washed; I had a rainbow of pens in one coat pocket, and my shiny name tag dangled from the other. I only hoped that I was as prepared as I looked. I entered Mrs. Carr’s room. A fifty-five-year-old woman, she sat gingerly at ...

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As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of neurohormonal changes that work in concert to nudge the ...

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After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient's estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline's new risk calculator had not been validated ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman comes to the office for advice regarding maintaining bone health. She has no history of fracture. The patient recently had a lumpectomy and radiation therapy to treat breast cancer, is currently taking tamoxifen, and will begin taking an aromatase inhibitor in 2 months. She underwent menopause at age 52 ...

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The mortality from colorectal cancer has decreased substantially in the U.S. during the past decade. While some of the improvement is due to better cancer treatment and reduced risk factors, the largest proportion is thought due to screening. The concept that early detection saves lives has now become well recognized. The harms of screening -- particularly among individuals with limited life expectancy -- are less well appreciated. Royce et al. recently published a ...

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