Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing ...

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We stand outside in the heat. We swat at the occasional persistent mosquito. We try to ignore the sweat beading down our foreheads and the backs of our necks. We retreat to the deepest recesses of shade we can find. We wish for a hint of a wisp of a smidgen of a breeze. We hold court on life and love. We laugh and tease and are determined to have ...

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I recognized a glitch in my electronic medical record's decision support software when it prompted me to consider prostate and colorectal cancer screening in a 93-year-old man, who, though remarkably vigorous for his age, was unlikely to live for the additional 10 years needed to benefit from either test. Although deciding not to screen this patient was easy, determining when to stop cancer screening in older patients is often more ...

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Aggressive control of blood pressure has saved millions of lives and has prevented millions of people from experiencing heart attacks, strokes, and kidney failure, among other things. Admittedly, controlling blood pressure is not the sexy part of medical care, but when primary care doctors like me help people get their blood pressure under control, we do just as much good as any of our colleagues who practice as cardiovascular surgeons. ...

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Life as a resident doctor can bring some of the most memorable patients encounters of our career. After all, this is the time in our training when we are the most naïve, vulnerable and most importantly impressionable. There is a certain patient scenario, however, which has changed the way I view one the most important experiences a patient can have: labor. Let me explain. I get paged for an epidural.  Once I ...

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When it comes to cancer, I'm neither physician nor patient, nor even a policy expert.  But being both a critical thinker and a feminist, I'm struck by what the juxtaposition of two seemingly unrelated new oncology studies, published in highly respected medical journals a month apart, can tell us about how gender shapes the way we perceive (or misperceive) illness, and the impact that has on patients' well-being. On April 14, ...

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I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have ...

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Two weeks before my oldest cousin’s twenty-third birthday, he shot and killed himself. It scarred our family. The kind of jagged, gnarled scar, like a poorly-filled pothole, that -- even though it’s been nearly twenty years -- you still run your fingers across from time to time and feel the sting of a fresh wound. We weren’t all that close, but as a 14 year old, sorting through my own perceptions ...

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Dr. Brian Goldman, in his blog for CBC radio, wrote about the new article in the Canadian Medical Association Journal (CMAJ) on the sex ratio after induced abortion in Ontario, (i.e., sex selective abortion). The article in the CMAJ confirms what is no surprise to me as an OB/GYN, that the ratio of male to female births for a third child born to women who emigrated to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated for a 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of urinary hesitancy or incomplete emptying. The patient has primary progressive multiple sclerosis. Medications are dalfampridine and vitamin D. On physical evaluation, temperature is 36.8 °C (98.2 °F), blood pressure ...

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