He was a young patient with AIDS and Pneumocystis jiroveci pneumonia (PJP). Maybe that should have scared me from the start, but it didn’t. In hindsight, I keep wondering when the fear really set in. But downstairs under the glaring lights and the swooshing bustle in the ER, I only remember that he looked slightly bored as he took shallow, quick breaths. There was no blood, no screams of pain. ...

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All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old man is evaluated in follow-up for heartburn of 7 years' duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette ...

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Adapted from Understanding Antidepressants. In his often-quoted beginning of Anna Karenina, Tolstoy wrote, "All happy families are alike; each unhappy family is unhappy in its own way."  If we stretch this notion a little -- going from families to individuals, and from unhappiness to depression -- we come up ...

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A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. It's officially that time of year. Summer is in full-swing, and all of America is getting ready to take a much-needed holiday. However, some Americans, particularly those who suffer from chronic pain, often dread getting away. They are afraid their chronic pain might prevent ...

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I stood in line at the grocery store waiting to pay for my items. The woman behind me, who would be categorized as obese, was eyeing some of the snacks so conveniently placed in the checkout aisle. She grabbed a meal bar and analyzed it for a few seconds, then said aloud to me: “You ever had one of these? They’re pretty good. And they’re gluten-free, that’s how you know they’re healthy.” Healthy. What ...

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STAT_LogoDear Doctor, Please help me understand why so few of you have chosen to treat people with opioid addictions. I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of care for individuals ...

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I loved my endocrinology block in medical school. It was one of my favorite units. One hormone acts on another gland, which either induces a positive feedback releasing its successor hormone or a negative feedback blocking its predecessor. It was step-by-step. It was straightforward. I loved the material so much that I reached out to an endocrinologist to shadow her. I wanted to see the power of what we were learning ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. ...

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I recently listened to DDx, a new podcast from Figure1. In their third episode, a 37-year-old man presents to the emergency department in the middle of the night with persistent vomiting and retching. He is highly vocal and agitated. Upon questioning, he reveals that he experiences these episodes frequently and previous investigations have all been inconclusive. His skin is noted to be flushed and his father ...

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