Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does ...

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Part of a series. We are all aging every day, but mostly we ignore, do not recognize or deny it. Then all of a sudden, we look in the mirror and realize that older age has found us. Even then each person deals with aging differently. There is Dr. Seuss’ "Cat in the Hat" who sees nothing but adversity in aging. There are others who accept aging but ...

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John Grover is a nice guy. He's fifty-five, short, a little chubby, and he has a neatly trimmed red beard. He's the kind of guy whose eyes light up the moment you walk into the room; The kind of guy who remembers your kids' names, their ages, and their interests. I'd met him a few times before. He'd come in once to refill his blood pressure medication because he couldn't ...

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I recently had the opportunity to be the informal medical navigator for a friend with an acute psychiatric crisis. This previously “normal” friend lives alone, is a high-functioning professional and was unable to sleep, to eat, to finish a coherent thought or to carry on his business for several weeks. I was called to help after an embarrassing public meltdown. The first problem was finding a doctor who would deal with ...

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About 25 million people are in recovery from substance use disorder (SUD), while approximately 100 million people live in chronic pain. With our nation fixated on the estimated 60,000 opioid-related overdose deaths in 2016, you might expect the interests of both groups to be in conflict. Consider two anecdotes. Paul is living with chronic pain from a car accident nine years ago. His ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, ...

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It's 2:02 p.m. when my pager beeps. I pull it out and read: "Juan may have just passed. Going in now." As a social worker in the region's only cancer specialty hospital, I provide emotional support for patients and their families — including talking about their wishes for end-of-life care. Juan is a sixty-five-year-old Ecuadorian man with stage 4 pancreatic cancer. I've known him for about a year. Polite and easy to ...

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For millennia, blood-letting was the standard of care for many diseases; today it is a joke, evoked only to mock our predecessors.  But it is time to dismount our high horse and realize that there is at least one infection that we still primitively try to drain from the body, not from the bloodstream, but from the colon.  This is our friend Clostridium difficile. According to the CDC, there are about ...

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A patient with chronic pain and a physician walk into an exam room. This could be the set-up for a punchline, but in our current medical climate, it's more often the first step in an elaborate dance that leaves both parties feeling frustrated, belittled, and ignored. Often, this is a first-time appointment rather than an established therapeutic relationship. From the patient's perspective, here's what happens: They've been putting off this visit for ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 82-year-old woman is evaluated for a 2-week history of left-sided headaches with pain on chewing, accompanied by achiness in the shoulders and hips. She has no other pertinent personal or family history. She takes no medications. On physical examination, temperature is 38.1 °C (100.6 °F), blood pressure ...

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