Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated during a routine appointment and asks for advice on cardiac risk assessment. He does not have any current cardiac symptoms, exercises 4 days per week, and has never smoked. He has no chronic health issues and takes no medications. He has no known drug allergies. Results of ...

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ama_logoThe medical profession must play a lead role in reversing the opioid epidemic that, far too often, has started from a prescription pad. For the past 20 years, public policies -- well-intended but now known to be flawed -- compelled doctors to treat pain more aggressively for the comfort of our patients. But today’s crisis plainly tells us we must be ...

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It was 2 a.m. on a typically hectic Friday overnight shift in the emergency department. A young woman, Kelly, checked into triage, accompanied by her older boyfriend Jim, who explained that Kelly had abdominal pain and some vaginal bleeding. Jim wanted her checked out and maybe some pain medicine to help her rest at home. Kelly had no identification. She appeared younger than her stated age of 18. I also noticed track marks ...

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"If it walks like a duck and quacks like a duck, it is probably a duck. " At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three grandchildren. She had no history of significant surgery, and took only a single pill for blood pressure. The only health tragedy in her life was the death of her last child, an ...

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A reader writes: “Grunting baby syndrome. Is this really a thing? My 6-week-old son grunts, strains, and writhes from approximately 3 to 6 a.m. every night. Most of the time he sleeps through it. My GP suspects reflux but ranitidine has not helped. Also, he’s very happy/calm all day rarely fusses or cries. My Google searching came across grunting baby syndrome. Is that a real thing? When do babies grow out of ...

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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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