Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man variable 2-hour postprandial blood glucose is evaluated during a routine follow-up examination. He has type 2 diabetes mellitus. Review of his blood glucose log demonstrates fasting blood glucose values ranging from 120 to 160 mg/dL (6.7-8.9 mmol/L) and variable 2-hour postprandial blood glucose values ranging from ...

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I just had a conversation with a physician and faculty member at my school. He started the conversation like this: “It’s alright if you disagree with me, and I can disagree with you too. Good academic discourse should allow people to disagree with each other.” He then allowed me to question him and explain my perspectives for over an hour as he explained his answers, helped clarify some points, and gave ...

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It was my first day of orientation at medical school. In a hallway stood a coat rack overflowing with white garments. I set down my accumulated papers, reached for a hanger and — for the first time ever — shrugged first one arm and then the other into a white coat. It was too large, but I had no other options. The unisex coats ran from XXS to XXL, but the ...

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There is a wealth of information about your health circulating in your blood. For people with diabetes, accessing that information can be a matter of life or death. For nearly 30 years, the prevailing technology for checking the blood sugars of someone with diabetes has been the fingerstick. People with diabetes are often asked to stick their fingers and check their blood multiple times a day to assess whether their blood ...

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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 in follow-up after recent abnormal findings on intraoperative liver biopsy. Two days ago he underwent right colon resection for a large villous adenoma with high-grade dysplasia. At the time of surgery, an abnormal-appearing liver was noted and biopsy was performed. His medical history is ...

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It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection checkup. She was a 73-year-old female with a history of diabetes. She was elegant and soft-spoken. Prior to examining her wound, which had been worsening, I asked her what her A1c number is. She wondered what an A1c number was, and I explained that ...

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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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