Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 20-year-old male college student on the wrestling team is evaluated for a superficial skin infection. He has a history of several episodes of folliculitis and furunculosis over the past year that has required systemic treatment. His recurrent infections were treated with various oral antibiotics, including cephalexin, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has ...

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It was a small deer tick, hidden by the crus helix, embedded in the cymba conchae, the crevice just above the ear canal of my seven-year-old patient halfway through my Saturday clinic. He was worried that it would hurt. His parents hadn’t wanted to try removing it on their own. I had a hard time even seeing the small tick as it was sitting at an angle where I saw it ...

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Nearly 30 years ago, I attended the labor of a Vietnamese woman on an island off the coast of Thailand. The woman had malaria. She died a few hours after giving birth to her stillborn child. That experience has never left me. It has fueled in me a passion for global health, and especially for alleviating suffering and death from tropical diseases such as malaria. It is also worth remembering, however, that ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old woman is evaluated for a 2-month history of a painless right neck mass. Medical history is unremarkable, and she takes no medications. She is a lifelong nonsmoker. On physical examination, vital signs are normal. A 5-cm right anterior neck mass is palpated. The remainder of the examination is unremarkable. An initial ...

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I want you to know about colds, and integrity. Every day I see a hand full of colds. Viral upper respiratory infections. Bronchitis. Coughing, sneezing, congestion, fever. You come to me because you are miserable, and I appreciate that you trust my advice. I want you to know that I can commiserate with you. I don’t want you to feel miserable either. Truthfully, as odd as this sounds, I wish could find ...

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Two months into my private practice career, I was assigned a “no doc” patient, a term referring to a child without a regular physician.  This one, in fact, did have a pediatrician, who called me to say “the family fired our group because we have not been able to diagnose the illness in their six-week-old son. He is your responsibility now.” If I have learned anything over the last 15 years, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated for right-sided chest discomfort and cough of 2 weeks' duration. His chest discomfort is described as a vague, painful sensation on the right. The cough occasionally produces a small amount of sputum; he reports no hemoptysis or shortness of breath. He has felt feverish with mild ...

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I recently read a book by Dr. Barbara Natterson-Horowitz a UCLA cardiologist who also happens to be a consultant for the Los Angeles Zoo. In her book Zoobiquity, Dr. Natterson-Horowitz demystified the story of HIV (Human Immunodeficiency Virus) transmission from monkeys in West and Central Africa to humans. Most physicians today, including me, have a limited knowledge of zoonosis (the science surrounding bugs that can be from animals to humans) ...

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