Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and ...

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When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in ...

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The recent Germanwings tragedy has called commercial aviation's concept of fitness for flight into question.  Although the official mishap investigation has not yet concluded, available information at the time of this writing points to an intentional crashing of the plane by the 27-year-old co-pilot, Andreas Lubitz. Reports from the co-pilot’s medical records allege he had previously experienced episodes of depression and carried diagnoses for other psychosomatic disorders.  Antidepressants and torn medical memorandums stating that ...

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In medical school, class is scheduled for approximately 30 hours a week. This includes lectures on basic life sciences, histology, anatomy, and clinical examination skills. In addition, my first semester included approximately three hours of classroom time a month devoted to a supplemental curriculum called Health Systems and Policy, which covers the legal aspects of health care, public policy, and, briefly, health disparities. Now, in my second semester, these efforts ...

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The tenets engendered by cancer have been slowly elucidated throughout the years. The hallmarks of cancer have been well documented by Douglas Hanahan and Robert Weinberg in Hallmarks of Cancer: The Next Generation. Some of these features are well known and are inclusive of sustained proliferative signaling, evading growth suppressions, and others clearly outlined in their review. These cellular processes have been discovered by basic science researchers and subsequently, modern ...

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She was lying there stretched out, her mouth open, her eyelids sealed, her fingers straight, immobile, and paler than an image made of wax.  From out of her eyes came two streams of tears flowing slowly down onto the pillow … For forty-three days, Charles did not leave her.  He neglected his patients; he sat up every night, he was constantly taking her pulse, applying sinapisms, cold-water compresses.  He sent Justin to ...

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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 is evaluated for shortness of breath of 3 months' duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history. On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated for pain on the radial aspect of the right wrist that occurs with use of the thumb. The pain has been present for 2 weeks. He has never had this pain before and has not had any trauma. He works as a computer programmer and plays video ...

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An increasing amount of parents are choosing to delay or spread out vaccines for their infants and toddlers. Dr. Allison Kempe and her colleagues at the University of Colorado School of Medicine found that in a typical month, 93 percent of pediatricians and family physicians reported that some parents of children less than 2 years of age requested to spread out their vaccines. The findings, published in the April 2015 edition ...

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People like tests. You get numbers, and maybe a printout, and there’s science and blood and things just feels more ... serious, when testing is done. You can picture Marcus Welby (or perhaps a more modern physician), looking solemn, declaring “We’d better run some tests.” Are medical tests magical and mysterious, and can they unlock the secrets of life? Usually, no. And among the worst and most misunderstood tests we do are ...

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