I had my first outpatient surgical procedure when I was still in high school and needed a plantar wart removed from the sole of my foot. As the doctor injected the area with a local anesthetic, he explained he did these procedures all the time, and I wouldn't feel a thing. After a short wait, he began to dig out the deeply embedded wart with a hooked scalpel. With the first ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including ...

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It was Albert Einstein’s “biggest blunder.” Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the heavenly bodies together. In Einstein’s time, the universe was thought to be stationary. A universe that was anything but stagnant was an inconceivable idea since celestial matter would spin out of control, ...

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On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia. A few jaws literally dropped, and there was an awkward silence, then polite applause. Afterwards several of my colleagues came up to talk with me privately and were offended and/or curious as to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing ...

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Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school. That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring. My first patient of the day was ...

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Jeffrey Lurie is the owner of my beloved Philadelphia Eagles.   He pays the players.  He picks the coaches.  But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays.  The coach should do that. So why is it different in health care? I have a patient who was diagnosed with polymyositis.  Polymyositis is an autoimmune disease that causes inflammation of muscles ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated for a 6-month history of gout. He was doing well on colchicine and allopurinol but developed hypersensitivity to allopurinol, which resolved with cessation of the agent. He then began to have more frequent gout flares; two flares occurred in the past month and were treated with prednisone. ...

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