Psychosomatic. I learned not to use that word forty years ago, after I'd told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!” Well, maybe I should've been more circumspect. I hadn't realized until then that people can understand “psychosomatic” in a different way than I do. I'd meant what ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking. His occupation does not require repetitive bending. He played football in college and experienced left knee trauma during sports participation; he underwent left meniscectomy and stopped playing ...

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It was an interesting fortnight for the debate about the treatment of appendicitis. On November 1, David Agus, a medical oncologist, and director of the University Of Southern California's Center for Applied Molecular Medicine, had some thoughts about how appendicitis should be treated. He cited the Finnish randomized trial of antibiotics vs. surgery and said a 70 percent cure rate was good enough. In a brief article on the Fortune magazine website, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated in follow-up for a right-sided pleural effusion. He initially presented with increasing dyspnea and a constant dull ache on his right side. He also has lost 9.1 kg (20.0 lb) over the last 6 months. Medical history is otherwise unremarkable, and he takes no medications. He ...

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This is a story of a very special patient. A story that may change your outlook on life. When I first met her, there was an interesting aura that surrounded her. An aura of positivity and contentment. She was listening to her favorite band on her iPhone and humming along. Her carefree countenance was perfectly paired with the jovial tunes. I had admitted her to the hospital for an infected bedsore. She ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for difficult-to-treat migraine. She has had severe headaches, usually on the first day of menses, since menarche. The pain is hemicranial, pulsatile, and associated with severe nausea and vomiting but no aura. She frequently awakens with the attack already in progress. Ibuprofen was helpful in controlling ...

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For the first couple of years of medical school, the constant stream of exams and the anxiety that came along with each one seemed never-ending. I told myself that it was worth sacrificing my personal health to better the lives of others. I put off addressing my own mental health needs to keep advancing to the next level of education. I let stress manifest itself in new ways that my body ...

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Spanking is an extremely common form of corporal punishment, generally used against a child in response to a perceived bad behavior. It is an old-fashioned form of punishment that has the potential to cause more harm than good. It is clear that spanking may be effective in causing immediate obedience, but this effect is short-lived. Corporal punishment has been associated with adverse effects in childhood, such as causing the child to ...

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When I was a little, I used to love puzzles. You could find me with pen in hand, sprawled out on my bedroom floor, nose buried deep in word searches or my Highlights magazine. I wanted to know how things worked. I loved building block sets and making up games with my older brother during summer vacations. Over the years, that curiosity eventually morphed into my current profession as a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated for a diagnosis of acute kidney injury. He was diagnosed with gastroesophageal reflux disease 3 weeks ago and was prescribed omeprazole. Several days ago he noticed lower extremity swelling and decreased frequency of urination. Laboratory evaluation showed a serum creatinine level of 2.2 mg/dL (194.5 µmol/L). ...

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