Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old pregnant woman is evaluated for a cardiac murmur identified on examination by her obstetrician. She is asymptomatic. She is in her 24th week of pregnancy. Medical history is unremarkable, and there is no family history of heart disease. She takes prenatal vitamins and no other ...

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"Annie, Annie, are you OK?" Many of us learned to resuscitate a person who has collapsed using Annie, the mannequin based on a death mask of a young woman who had drowned in the Seine in Paris in the 19th century. Bystander cardiopulmonary resuscitation (CPR) has become increasingly accepted and expected as the years have passed, and we have even begun to make affordable machines to deliver a life-saving shock (defibrillation) ...

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As we enter into the hospital each day, our goal is giving patients the best care we can provide. We get a list of patients that we will take care of each day, and as we get that list, we start thinking about what we should monitor in terms of their physical exam, lab results, and vital signs to ensure that their hospital course runs smoothly for the day. However, ...

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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 seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no ...

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When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming. In the last year, I have noted many mid-career physicians are leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned at nearly
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Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient -- as opposed to the doctor -- as the driver of medical decision is, quite curiously, just beginning to be recognized in a ...

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Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures. If you are a heart ...

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"Help!" I yelled out of our open apartment door. I was seven years old, and my family had recently emigrated from Egypt to the U.S. We'd been feeling elated that week because, after months of interviews, my father had matched into a pediatric residency. That morning, he'd awoke feeling nauseated. My mother and sister went to buy some soothing food. I noticed that he'd vomited in the bathroom; now he was feeling ...

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Unparalleled reductions in cholesterol levels are now possible with a new class of cholesterol medicine, a PCSK9 antibody, reported in one of the large national cardiology meetings recently. But this latest example of high-tech cholesterol treatment comes with a staggering price-tag, $14,000 a year for the new genetically engineered injectable.  As a preventive cardiologist, I began to wonder if this is the best way to spend our money. A few caveats ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. ...

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