Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased ...

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The really incredible advances in the treatment of hepatitis C bring to life several relevant questions as we move forward into 2015. First, who should be treating hepatitis C patients (primary care providers, gastroenterologists, infectious disease specialists)? Second, can we really afford to use these new treatments? I recently discussed this topic with my GI and hepatology colleagues in AGA Perspectives, the bi-monthly opinion magazine of the
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Even I am not immune to influenza. In Northeastern Ohio, there have been more hospitalizations and school closings this year from influenza. And, let me tell you, as a family physician who also sees patients in the hospital and the office, we have seen a lot more respiratory illnesses versus last year. No, I'm not one of those Dr. Oz hypocrites who skip the influenza vaccine. We already know the 
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This past week I spoke with a patient who noted that since his wife’s death six months ago, he had lost 40 pounds, slept a maximum of four hours nightly, and stopped enjoying activities he used to take pleasure in. He found it difficult to concentrate at work, and getting out of bed each morning was described as his greatest struggle. While relaying this story, the man was on the ...

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As a pathologist, I recognize the importance of every diagnosis. Behind each slide is a patient, a family, a network of family and friends. A string of dominoes that is set into motion with my diagnosis. All treatment begins with a diagnosis. Each day I make these diagnoses, but on holidays, it takes on even more meaning. As the rest of the world is celebrating the season, coming together, medicine ...

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Recently, at a holiday meal with my extended family, it came to light that neither of my typically developing teenage children really knows how to tie his or her shoes. It seems that for the past decade or so, both have been using the “bunny ears” technique introduced to preschoolers for tying their shoes. My children appear never to have moved on from there to the mature “around the tree” ...

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Last August, the American Academy of Pediatrics (AAP) issued a statement regarding school start times, really a plea to all middle and high schools to start the school day no earlier than 8:30 a.m. The statement emerged as a result of accumulating evidence showing that earlier school start times effectively restrict an adolescent’s ability to get regular healthful sleep. The timing of the AAP’s statement came on the heels of another sentinel event ...

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new study about physical activity, obesity, and mortality has been propagating so many headlines and so much commentary, it's pretty much a given that if you are seeing this, you have seen something like: "Inactivity kills more than obesity." As is generally true in such cases, few of the people opining about the study seem to have actually read it. I suppose that's understandable -- once you get to particulars ...

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Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast.  She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer.  This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast ...

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When babies are born prematurely, they often lack surfactant: a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive ...

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