Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman undergoes follow-up evaluation in the office. She was evaluated in the emergency department 3 nights ago with fever and flank pain following 2 days of dysuria. A urine culture and two sets of blood cultures were collected. She was given intravenous ceftriaxone and discharged with a 7-day ...

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Google that phrase, and you will come up with lots of hits. The following is a partial list of things that have been found to have more germs than a toilet seat: Kitchen cutting boards, sponges and sinks, refrigerators, spatulas, pet food bowls, clean laundry, smartphones, electronic tablets, computer keyboards, carpets, faucet handles, handbags, can openers, ice served in restaurants, menus, reusable shopping bags, TV remotes, ...

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The common practice in this country (although not everywhere -- Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. ...

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In October of 2016, I returned to Bernard Mevs Hospital in Port Au Prince, Haiti. Hurricane Matthew, a category 4 hurricane, had touched down near Jeremie only four days prior. Hurricane Matthew caused significant devastation with over 2 million people directly affected, and over 500 reported deaths.  As local health care facilities in southwest Haiti had limited capabilities to care for pediatric trauma patients, Bernard Mevs had arranged transport ...

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There is a pervasive tendency to turn to medicine looking for magic. Patients and health care professionals alike generally expect medicine to be able to cure diseases, alleviate symptoms, and relieve suffering. Historically, medicine has met and exceeded these expectations in a variety of ways. However, in some cases, these expectations can cause a blurring of the lines between hope and reality, resulting in false "promises" and preventable disappointment. You may be ...

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Ten years ago it would not have been worth my time to write about measles nor yours to read about it. In the year 2000, thanks to a very effective 2-shot childhood vaccination program using a combined measles-mumps-rubella (MMR) vaccine, the U.S. was declared free of this potentially lethal disease. However, by the end of April this year, just over 700 cases have been reported by the CDC; the largest ...

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While the vast majority of measles cases in the U.S. and worldwide are occurring in unvaccinated children, a fair percentage is also occurring in adults.  With more-widespread transmission of measles, it’s becoming more important for all of us – yes, that includes parents – to make sure we’re well-protected. Measles is probably the single most contagious infection that humans face. The key to preventing the return of widespread measles is in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old man is evaluated in the office during a routine visit. Medical history is significant for HIV diagnosed at age 25 years, hypertension, and hyperlipidemia. He is a current smoker. Medications are chlorthalidone, tenofovir-emtricitabine, and raltegravir. On physical examination, the patient is afebrile, and blood pressure is 126/74 mm ...

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When writing medical notes, some clinicians include an appreciation of their patient's personality and disposition in their opening line (the "chief complaint"), or when they're wrapping up (in the "assessment and plan"), or in both locations. You know — it goes like this: "CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …" or: "A/P:  To summarize, Mr. Jones is a delightful 89-year-old man presenting with …" or: "CC:  This lovely 74-year-old retired school teacher was in her usual state of health ...

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When Dr. Fleming found penicillin mold in his Petri dishes in 1928, he had no idea of the impact he — and it — would have on global health. Penicillin and the antibiotic revolution that it triggered have saved countless lives and change world history. Less than a century later, though, antibiotics occupy a space between savior and sinner. This complicated reputation is mostly due to how ...

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