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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“I only have 10 percent of my eyesight remaining, but that’s not the problem. I am looking for mercy.” My eyes drifted back and forth between Abu-Adnan’s face squinting into the distance, and the shuffling prayer beads swaddled in his right hand. I fizzled with frustration as my cochlea’s raced to transcribe his traumatic story into an appropriate emotional response. This 65-year-old Syrian refugee from the Golan Heights pleaded me for a ...

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When our daughter Florence was born, we were shocked that a tiny, seven-pound beauty could turn our household (and our entire lives) upside down. Why was it so difficult to deal with one human being, when we often took care of a department full of ill patients? How could someone so cute induce a state of perpetual anxiety, forcing us to question every single action we took? It was disconcerting 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 fatigue, anorexia, polyuria, and nocturia of several weeks' duration. She had otherwise felt well until the onset of her current symptoms. Medical history is significant for autoimmune pancreatitis diagnosed 1 year ago, treated with a prednisone taper that was completed 8 months ago with resolution ...

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They said, "Do everything." She knew something was wrong. And by the time she was 85 she had forgotten the names of her children, the town she raised them in, even the name of her deceased husband. In her 70s she was diagnosed with Alzheimer's. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would breathe ...

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