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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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated during a routine follow-up visit. Medical history is significant for hypertension and chronic active hepatitis B infection. Her hepatitis B infection has been treated with tenofovir for the past 5 years with suppression of her serum hepatitis B DNA levels. She currently notes mild ...

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A number of media outlets recently featured a story about a Florida general surgeon who removed a normal kidney from a woman who was undergoing spine surgery. How could this have occurred? The 51-year-old patient who had been injured in a car crash was scheduled for an anterior lumbar interbody fusion (ALIF) of the fifth lumbar to the first sacral vertebra. The general surgeon’s role was to provide ...

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About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have ...

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Late one Friday night while walking the long and lonely hallways of my hospital, my mind wandered back several years. I recalled my first weekend call as an eager, newly minted nephrology attending. I had met one of my colleagues earlier that morning in the doctors’ lounge, whereupon I had been handed a clunky, black weekend pager. “Welcome to being on call every fourth weekend for the rest of your ...

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I saw two patients with a chief complaint of bubbles in their urine this month. One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK. Even though she was feeling quite well, they were not, and she ended up going straight to Cityside hospital for IV ...

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If you search for “how to pass a urine drug test” on the internet, you will get several million results. As physicians, we see and manage the national opioid crisis every day. We see the impacts of this in our practices and our lives. The crisis frankly shows no signs of abating or becoming a less critical issue. Unfortunately, one major reason for our inability to control this issue might ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical ...

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Six months ago, I had severe right flank pain. In the ER, I had an ultrasound showing a possible kidney stone. I deferred a CT scan and went home with medication. I fit the textbook picture: I had abnormal imaging, and I was given a treatment and discharged. I was advised to return if the pain worsened or failed to resolve. I briefly improved, but then the pain returned much ...

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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 a 2-month history of progressive lower-extremity edema, weight loss, and fatigue. Medical history is significant for recreational use of inhaled cocaine; he denies injection drug use. He has no other known medical issues and takes no medications. On physical examination, temperature is 37.2 °C ...

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In recent years, there has been a push across medical schools to change the grading scale towards that of a pass-fail system. The appeals of a pass-fail system to me were obvious. Instead of worrying about my grades as I had in college to maintain an adequate enough GPA to get into medical school, I believed that merely passing would lessen much of the pressures I faced as an undergrad. Those ...

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