Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years ago. Her HbA1c levels since diagnosis have ranged from 6.4% to 7.3%, with the most recent value at 7.3%. She reports eating a carbohydrate-consistent diet ...

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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 with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between ...

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CMS is changing note requirements, among other changes.  Bob Doherty has a wonderful summary: "Medicare's historic proposal to change how it pays physicians." As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction.  To me the most important change is a focus on notes: “Allowing medical decision making to be ...

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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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In mid-February, thousands flocked to the opening of Black Panther, a highly anticipated film for a multitude of reasons. The most salient of these is its depiction of an African king as Marvel’s and cinematic screen’s first culturally-affirming black superhero. In fact, Black Panther’s success is due to its emergence as a counter-narrative to painful and dysfunctional representations of black life. By normalizing the presence of black royals, diplomats, and ...

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Too often, residents want you to address something, so they don't have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID. For me, one example seemed rather routine: a diabetic with another medical illness. It wasn't terribly well defined in the hospital records, but included atrial fibrillation and congestive failure at presentation. At day nine, with pressure from the DRG lady ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin. On physical examination, the patient is afebrile, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated during a periodic health maintenance visit. His friend was recently diagnosed with type 2 diabetes mellitus, and the patient expresses interest in being screened. He is asymptomatic and reports no symptoms of polyuria or polydipsia. He exercises regularly. Medical and family histories are unremarkable. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 27-year-old woman is evaluated for management of her type 1 diabetes mellitus. She was diagnosed 10 years ago. She has no known complications from her diabetes. She eats a healthy diet and exercises an average of 60 minutes per day in the evening. She takes insulin glargine and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history ...

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