Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years. On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and ...

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The latest celebrity to use the internet like a a public speculum is Khloe Kardashian. I know this because my phone blew up recently with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down. But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office ...

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Behind every door in my clinic, is human suffering.  It hangs like a mist; I can see the living ghosts of my patients through it. As an oncologist who treats primarily pancreatic cancer, many of my patients will be dead within a year of our first meeting.  I knew this would be the case when I chose my specialty. Pancreas cancer is one of the last frontiers in cancer therapeutics:  a ...

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recent research paper from the University of Virginia may pound the final nail into the coffin of the long-standing medical dogma which rigidly labels diseases as "organic" or "psychiatric."  UVA researchers have discovered a complex network of lymphatic vessels which service the brain, prompting a serious update of the concept of a highly selective “blood-brain barrier.” When asked about methods to study the immune response of the brain and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique ...

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She fit into the palm of his hand. That long nine months. Waiting desperately for that baby they thought they could never have. Jeff, football player from his high school days, met the love of his life, Bridget, at the school party. She was smart and beautiful; Jeff was big and burley, but as kind and gentle as a kitten. They hung out through their college days.. And finally said their ...

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We are assembling too many panels of people in the name of health these days. Too many. They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them. I might have been wrong. There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken. I was wrong because ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the ...

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For many people with chronic disease, the toughest thing is convincing themselves they’re not crazy. This is especially true for those with an illness with no clear etiology. For millions of people around the world suffering from multiple sclerosis, lupus, fibromyalgia, chronic abdominal pain, ALS, rheumatoid arthritis, certain types of cancer, chronic fatigue syndrome, and hundreds of other illnesses, just making it through the day is overwhelming. Not only do many of ...

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I have been an OB/GYN hospitalist at a busy suburban community hospital for almost one year. I truly love my job. However, I've noticed something unexpected that's prompted me to pause. There are several physicians -- good, clinically competent, kind physicians -- who frequently perform episiotomies. Routine episiotomy is not recommended. In my training and eight years of practice prior to becoming a hospitalist I rarely saw it used. So ...

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