dreamrct The most valuable assignment I received in fellowship was to write a few textbook chapters. I wrote on sodium, calcium, potassium, phosphorus, and magnesium for three different chapters. I had already developed deep knowledge of electrolytes writing "The Fluid and Electrolyte Companion," but writing these chapters forced me to look beyond how things work and dive into how we know how things ...

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Yesterday my friend Sophie asked me to accompany her to a Miami hospital intensive care unit to see her older brother, Guillermo. He'd been admitted the previous night with seizures and cardiac arrhythmia. Joined by my husband, we made our way to the ICU. When she saw Guillermo lying immobile, swollen and unresponsive, with a breathing tube in his mouth and other tubes snaking into his chest from IV poles, Sophie ...

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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 for a 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms. On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration ...

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medpagetodayFrom MedPage Today:

  1. Time to Retire Lithotripsy for Kidney Stones? More than 30 years ago, extracorporeal shock wave lithotripsy (ESWL) had a highly anticipated, much-ballyhooed introduction as a nonsurgical therapy for kidney stones. Obviating the need to cut the skin or insert a device into the body, ESWL would use acoustic shock waves to ...

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medpagetodayFrom MedPage Today:

  1. Nephrologists Iffy About Dialysis in Expectant Moms. A third of nephrologists reported being somewhat to very uncomfortable caring for a pregnant patient on hemodialysis despite a growing number having to do so.
  2. What Makes an Opioid Stronger or Weaker Than Morphine? A February 2015 report from the Centers for ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable. On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. ...

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medpagetodayFrom MedPage Today:

  1. Flu Vaccine: A Matter of Time. The flu vaccine was about 23% effective this season.
  2. Supreme Court Spars With Both Sides in Subsidies Case. The Supreme Court pummeled both sides with questions during Wednesday's oral arguments over the fate of the subsidies granted to people enrolling in health insurance ...

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medpagetodayFrom MedPage Today:

  1. Statins and RA: No Joint Benefit. The use of statins does not reduce onset of new joint pain or stiffness in middle-age or older women but their use is associated with poor physical functioning and poor self-rated health.
  2. Expert Groups Clarify HPV Testing Recommendations. Primary cervical cancer screening with ...

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medpagetodayFrom MedPage Today:

  1. Should FDA Change Metformin's Black Box Warning? Diabetes experts are building a case to lift restrictions on using metformin in patients with moderate chronic kidney disease.
  2. Tacrolimus for Induction in Lupus Nephritis? Tacrolimus was found to be noninferior to mycophenolate mofetil (Cellcept) for lupus nephritis induction therapy when given ...

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One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients. I began to understand this paradox clearly when I listened to my friend’s anguish. She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town ...

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medpagetodayFrom MedPage Today:

  1. Clinical Focus in MS: Novel Approaches to Progressive Disease. Although the drug development pipeline still contains numerous products intended for patients with relapsing-remitting multiple sclerosis (RRMS), the consensus among clinicians is that relapses can be effectively squelched in nearly all RRMS patients with the dozen or so currently approved therapies.
  2. Clinical Focus ...

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medpagetodayFrom MedPage Today:

  1. IMPROVE-IT Results Turn Up Volume on Guideline Debate. The long-awaited results of the IMPROVE-IT study comparing Vytorin (ezetimibe/simvastatin) to simvastatin in high-risk patients revealed a small but significant benefit, and a large -- and possibly equally significant -- rift regarding the cardiovascular prevention guidelines.
  2. State Exchange Situations Vary at ...

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medpagetodayFrom MedPage Today:

  1. Ebola: Signs of Progress, CDC says. The response to the Ebola outbreak in Liberia is showing encouraging signs of progress, with downward trends in new cases especially in two regions of the country that had been hot spots.
  2. Millions Of Medicaid Kids Missing Regular Checkups. Millions of low-income children ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He ...

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Internal medicine requires knowledge, deduction, and many skills: history taking, physical examination, analyzing diagnosis tests. When confronting a new patient problem, we use our brains to work on finding a diagnosis. Much like police detectives, we would like to have brilliant diagnostic epiphanies, but often we make our diagnoses by painstakingly collecting all the clues and doing the necessary boots on the ground work. We had a woman admitted to our ...

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We tell ourselves many things about our health each day, every day, all day long. The vast majority are unintentional, uninspired and blunt. A particularly sinful dessert brings admonishment, “You should not have eaten that.” Panting after two flights of stairs call for an exasperated, “I am out of shape!” Receiving a diagnosis prompts mental overdrive of “What if I don’t survive this?” thoughts. Learning my diagnosis of chronic kidney disease ...

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I wish I could share the photo of my 4mm boomerang shaped kidney stone.  I labored for 2 months, back in early 2009 to pass it, the second stone in 5 years. During my ordeal with these stones, I had the following health care encounters, tests, medicines, lab and imaging tests.

  1. at least 5 sets of blood work, with CBC and chemical profiles, parathyroid studies
  2. several urine tests, including urinalysis and urine culture, ...

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Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online. A patient came to see me last week for a check up and requested a prescription for birth control pills.  She’d used them in the past without problems. I wrote the script and sent her on her ...

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nephrology-madness-2014The field of nephrology is in a workforce crisis. We as a subspecialty have witnessed a steady decline in the number of applicants perusing nephrology fellowship over the last several years. In fact, fewer than 100 US medical school applicants participated in the 2014 nephrology fellowship match. This is a sobering statistic as 403 nephrology slots were available in this year’s ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin. Physical examination findings and vital signs are normal. BMI is 27. Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an ...

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