Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports ...

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When asked to describe my career, I consider myself primarily a clinician educator.  Recently I have reflected on the influences that allowed me to have a successful career doing what I love.  This post is not meant to mention all those influencers, but just some that I recall often.  As I have thought about this post, I quickly realized that all the “heroes” that I recall focused on clinical education. ...

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I enter the corridor of my new workplace. I’m welcomed and introduced all around. For some reason, best known to her, the human resource lady took so much of my time that I am already pissed and looking angry. I don’t feel comfortable in this different setup, and I miss my old workplace. Every single thing about it, which previously used to get on my nerves, I miss. However, I succumb ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old woman is evaluated in the emergency department for an episode of hematemesis that occurred 1 hour ago. She had previously felt well except for a recent knee injury, for which she has been taking ibuprofen. She currently is experiencing lightheadedness and weakness. Medical history is ...

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“Apocalyptic” was the word used by my fellow volunteers at the local church, a temporary shelter for displaced families on post-hurricane-landfall day 3. Although the flooded roads harboring similarly displaced alligators, fire ants, and snakes and the black flecks in the sky representing rescue helicopters were grossly removed from the many-eyed beasts of Revelations, I agreed with their assessment. In fact, the thousands of flooding victims stranded on roofs in ...

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"OK, one more patient to go," I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major ...

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Dear John Oliver, First of all, thank you for your recent segment on dialysis. Kidney disease deserves much more attention and discussion than it currently receives. Thank you also for your full-throated support of transplantation and the need for more kidney donors. As a practicing nephrologist, there is nothing better than hearing that one of my patients has been given a transplant. Finally, thank you for pointing out that end-stage renal ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he ...

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I felt a gust of sharp pain a couple of centimeters to the right of my belly button. It will subside, I thought. All pain subsides. It was an easy dictum to follow as a 39-year-old pediatric eye doc who last spent a night in the hospital as a patient in 1977. I’d undergone bilateral laparoscopic inguinal hernia repair ten days earlier, so I was accustomed to brief squalls of discomfort ...

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Chronic kidney failure is a serious disease. When progression to end-stage renal disease (ESRD) occurs, dialysis is required to sustain life. It is shocking, then, that in the United States, it is estimated that over 1,000 patients annually are involuntarily discharged from their dialysis clinics. Further, they are often "blackballed" from other local clinics. The consequences for such patients, predominately African-American, are dire. A patient may be unable to find a ...

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