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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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. A couple of months ago I received a Facebook invitation to “like” a page. That was not unusual, and usually the pages are on silly or obscure topics, but this page was different. The name of the page was New Kidney for Stu. Stuart Himmelstein, MD, ...

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If you want to understand what ails the U.S. health care system, look no farther than the dialysis industry. A recent New York Times article, "UnitedHealthcare Sues Dialysis Chain Over Billing," provides a pre-made case study. In brief, a chain of dialysis clinics, American Renal Associates, pushed poor people out of government coverage and into private insurance with UnitedHealthcare so that the clinics could bill $4,000 per treatment rather than $200. A ...

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Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me. ...

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dreamrct The most valuable assignment I received in fellowship was to write a few textbook chapters. I wrote on sodium, calcium, potassium, phosphorus, and magnesium for three different chapters. I had already developed deep knowledge of electrolytes writing "The Fluid and Electrolyte Companion," but writing these chapters forced me to look beyond how things work and dive into how we know how things ...

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Yesterday my friend Sophie asked me to accompany her to a Miami hospital intensive care unit to see her older brother, Guillermo. He'd been admitted the previous night with seizures and cardiac arrhythmia. Joined by my husband, we made our way to the ICU. When she saw Guillermo lying immobile, swollen and unresponsive, with a breathing tube in his mouth and other tubes snaking into his chest from IV poles, Sophie ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated for a 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms. On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration ...

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medpagetodayFrom MedPage Today:

  1. Time to Retire Lithotripsy for Kidney Stones? More than 30 years ago, extracorporeal shock wave lithotripsy (ESWL) had a highly anticipated, much-ballyhooed introduction as a nonsurgical therapy for kidney stones. Obviating the need to cut the skin or insert a device into the body, ESWL would use acoustic shock waves to ...

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medpagetodayFrom MedPage Today:

  1. Nephrologists Iffy About Dialysis in Expectant Moms. A third of nephrologists reported being somewhat to very uncomfortable caring for a pregnant patient on hemodialysis despite a growing number having to do so.
  2. What Makes an Opioid Stronger or Weaker Than Morphine? A February 2015 report from the Centers for ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable. On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. ...

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