Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit for primary membranous glomerulopathy. Diagnosis was made by kidney biopsy 4 months ago, and she was found to be positive for anti–phospholipase A2 receptor (PLA2R) antibodies. Medications are furosemide, losartan, and simvastatin. Recent age- and sex-appropriate cancer screening tests were ...

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She placed the stack neatly aside with all forms diligently signed and dated. The inbox was cleared. Being finally rested, her tasks of staying on top of duties and focusing on executions became briefly easier. A few patient callbacks, an eight-page disability form to fill out, a doctor to connect with, seven notes to complete and two test results to review and relay would round off the already pregnant day. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 69-year-old woman is evaluated in the emergency department for new-onset dependent edema that began 3 weeks ago. She says it is difficult to walk, and she has gained 4.5 kg (10 lb) of fluid weight. History is significant for obesity and hypertension. Her only medication is lisinopril. On physical ...

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Even during medical school, there was always the running joke about getting kidney stones. With the frenetic pace of many rotations, it was always difficult to squeeze in bathroom time, and I suspect many of us adopted the same solution – drink less water. That is certainly how I survived my month on vascular surgery. After a nine-hour case, I was told by one of the residents that everyone was ...

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These are trying times for health care optimists. Despite all the hype surrounding breakthroughs in clinical practice and technology, American medicine is stuck in in neutral. Though the engine is revving loudly, little progress is being made. This unfortunate truth came into clearer light last week when I was preparing lesson plans for the health care strategy course I teach at the Stanford Graduate School of Business. During the first class of ...

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World Kidney Day reminds us of the 850 million people globally affected by kidney diseases. It draws attention to the 1 in 7 American adults managing Chronic Kidney Disease (CKD) and the 660,000 Americans with end-stage renal disease (ESRD). It also reminds us that kidney disease is the 9th leading cause of death in the United States. But perhaps one of the most important statistics on World Kidney ...

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How did I miss his hypokalemia? Two weeks into my intern year and my patient’s potassium returned at 2.9. Minutes later, he coded. And I felt responsible. As I explained to my partner how my patient had become pulseless after diuresis of his heart failure, she looked at me and said, “Physicians kill patients, it’s inevitable. Has no one told you it’s part of the job?” There is truth to this ...

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Last week I had a patient with mild kidney disease and a high potassium. I thought that it would be easy to take care of. We called around to all the pharmacies from Bangor to Ellsworth to Belfast, and nobody had Kayexalate, the time-tested antidote, in stock. It happened to be on a Tuesday night with my Suboxone group starting at 5 o’clock. The patient had been there since 4; his ...

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Before I could see her, I could hear her. My patient, a young woman with messy braided hair, was grunting with every effort to breathe. The noises quieted slightly when I reached her bedside, but her tears continued to fall between gasps. Her body movements were exaggerated, rooted in the rhythm of her labored breathing — several violent shudders with every expansive inhale, and a wave of quivers with every ...

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As a family physician, I treat patients of all ages – children to those nearing 100 years old. One issue that plagues young and old alike is lack of sleep. In fact, according to the Centers for Disease Control and Prevention’s (CDC) 2016 Morbidity and Mortality Weekly Report, more than one-third of American adults do not get enough sleep on a regular basis. This is a common ...

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