I met Mr. B during my week on the endocrine service of my internal medicine rotation. My attending told me we were being consulted for this patient’s high sugars and a foot ulcer, and asked me to take the history. I walked into Mr. B’s room and was immediately struck by its stench. Mr. B had undergone a resection of his bladder tumor the day before and as a result was ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a new skin rash of 10 days' duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable. On physical examination, vital signs are ...

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I was in the hospital when I heard the word “apple.”  Without hesitating, I reached into my pocket to see if I had my phone.  But the person speaking was referring to the fruit, not the product.  This got me thinking: “Has technology and our products now become more important than our health?” Technology surrounds us and has become a large part of how we live on a daily basis. I’m ...

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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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