Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks' gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS). She has had multiple uncomplicated painful crises treated at home with hydration, nonopioid analgesia, and incentive spirometry. She requires hospital management for these episodes approximately twice per year. ...

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Perhaps, doctors struggle more than most with memories that mark sad moments in their careers. For me, one of the most indelible was of a wonderful young man with chronic myeloid leukemia (CML). When I started my oncology career in the early 1970s, CML was almost always fatal. It would start with a chronic phase, which was treated with pretty simple medications. But those medications didn’t cure the disease. The “almost always” ...

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A 54-year-old man is evaluated during follow-up consultation regarding laboratory studies completed for a life insurance policy. He reports no symptoms. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 131/76 mm Hg, pulse rate is 88/min, and respiration rate is 15/min. No splenomegaly is noted. Laboratory studies: Hemoglobin 8.9 g/dL (89 g/L) Leukocyte count 3000/µL (3.0 × 109/L) with 30% neutrophils, 10% monocytes, and 60% lymphocytes Mean corpuscular volume 105 fL Platelet count 75,000/µL ...

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Most people are surprised to hear that the way doctors are recertified every ten years is through a multiple choice test. “Really?” they’ll say. “You take a multiple choice test? As a doctor?” Unfortunately, after all these years that's the most efficient way we can think of to evaluate professionals. But the method is so flawed. And your ability to answer questions on the multiple choice test isn't necessarily linked with ...

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Pathologists ensure the safety of the blood supply.  Here's how they do it.  Created by the College of American Pathologists.

"If it walks like a duck and quacks like a duck, it is probably a duck. " At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three grandchildren. She had no history of significant surgery, and took only a single pill for blood pressure. The only health tragedy in her life was the death of her last child, an ...

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This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump.  The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security. He is looking increasingly likely to be nominated by the Republican Party.  Many, however, ...

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"I hereby authorize xxx, my patient, to donate plasma up to two times per week." I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma. By the time the fourth form came, I realized ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications. On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated for fatigue and intermittent abdominal discomfort of 2 months' duration and occasional dark urine. Medical and family histories are unremarkable. Her only medication is an oral contraceptive pill. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/74 mm Hg, pulse rate is 68/min, and ...

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The refusal of blood products by the Jehovah’s witnesses has often been cited as a great example of patient religious freedom triumphing over the traditional paternalism of medicine. Patients are free to refuse transfusion even at the risk of death. Many hospital-based physicians have, at one time or another, been witness to the demise of a patient refusing blood products, perhaps a preventable demise. Patient autonomy is held to be ...

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We, like many in the hemophilia community, were excited to see extended half-life (EHL) factor VIII and IX products start coming to market over the last few months. These products -- and expected future products -- promise equivalent or greater prophylactic bleeding control with fewer infusions, and so could greatly enhance patients' quality of life. Yet, as we noted in our recent editorial in Haemophilia, we are greatly concerned that ...

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I enter through the sliding doors, my flip-flops slapping the linoleum as I search for the information desk.  “Can you point me towards the apheresis center?” I ask, noticing my voice rise a notch.  I am clearly uncomfortable.  My feet feel naked and exposed without my Dansko clogs, and I can’t remember the last time I wore jeans in a hospital.  Two medical students scurry by, their stethoscopes bouncing around ...

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medpagetodayFrom MedPage Today:

  1. Breast Ca Patients Need Better Cardiac Monitoring. Breast cancer patients received suboptimal cardiac monitoring during treatment with trastuzumab (Herceptin).
  2. FDA: Smokeless Tobacco Warning Stays. The FDA denied a petition by two tobacco companies to ease up on the warnings around smokeless tobacco.
  3. King v. Burwell: What Color ...

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From new longer-acting drugs to promising gene therapy trials, much is changing in the treatment of hemophilia, the inherited bleeding disorder in which the blood does not clot. I will mark Hemophilia Awareness Month by discussing research and treatment progress, as well as remaining challenges. 1. Many more treatment products are being introduced, including some that last longer. In people with hemophilia, a “factor” -- or blood ...

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medpagetodayFrom MedPage Today:

  1. A Case of C. Diff: Did a N.J. School Overreact? Administrators at a New Jersey middle school said they faced a major health scare that required them to shut down for nearly a week and hire biohazard specialists to disinfect the school. The culprit? A case of Clostridium difficile.

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I was on call over a holiday weekend and Friday night at 10 o'clock I was paged by the emergency department about a nosebleed. A man in his 30s had a bloody nose Friday morning and over the course of the day had developed red spots all over his legs. The ED checked his blood and his platelet count was near zero. Blood looks red because of the oxygen-carrying red blood cells, ...

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ZDoggMD's latest parody.  This time he takes aim at Garth Brooks in "Friends With Low Platelets." "I’m not big on thrombopoiesis. Think I’ll skip on down to plasmapheresis. 'cause I got friends … with low platelets." Classic.

Autonomy is a bedrock ethical principle in medicine that has supplanted medical paternalism.  Patients have a right to make their own medical decisions and are entitled to know the advantages and drawbacks of all reasonable options.  Clearly, informed consent cannot be given if the patient is only partially informed or has been given a slanted presentation by the physician. When a patient does not have the capacity to provide consent, then ...

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