Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old woman is evaluated for a 1-year history of tremor. The tremor is more prominent on the right side. She also reports increasing problems with balance and numerous falls, especially when arising from a chair or turning. The patient does not have any significant cognitive symptoms. She has ...

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The day begins at 6 a.m. I am rounding on my nine patients, quickly examining them and providing a brief update about the plan. Like the other harried residents, I am speeding from one room to the next, trying to get everything done on time. And then, inevitably my beeper goes off — “Patient in emergency room being admitted, please call for signout.” I stop in my tracks. I can ...

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Since intensive care units (ICU) were created in hospitals more than a half a century ago, there has been a steady decline in death rates for individuals who are critically ill and require life support. That’s significant and meaningful progress, and it’s thanks to the pioneering work of many doctors, nurses and researchers who have discovered better ways to liberate patients from life support so that they can ...

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How do we balance freedom and safety for those with dementia, particularly in the risky domains of sex, driving and money? In 2014, Henry Rayhons, a 78-year-old Iowan, was arrested because he allegedly had sex with his wife. Wait. What? The Rayhonses, both previously widowed, met while singing in a church choir. Over time, Mrs. Rayhons developed dementia and went into a nursing home. At one point, a roommate reported hearing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications ...

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He spoke with an aura of superiority, in a slightly nasal voice, and his topic was migraines. It was in the late 70s, a time when there were few options to treat migraines. “Most people who claim to have migraines just have simple tension headaches,” he scoffed. And in a move that seemed unorthodox at the time, he disclosed that he suffered from “real migraines,” so he knew all about this ...

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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 during a routine follow-up examination of multiple sclerosis, which was diagnosed 3 years ago. The patient says she wishes to discontinue her oral contraceptive and attempt to become pregnant. She has no other personal or family medical history of note. Medications are fingolimod, vitamin ...

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Dementia patients want effective drugs. Five years ago, the Food and Drug Administration (FDA) proposed changes to speed drug approvals for Alzheimer’s disease (AD). No new drugs have been approved. This year, a new FDA draft guidance discusses considering biomarker data and changing cognitive evaluations for accelerated approvals. Would that help make effective drugs available, or are we lowering our expectations? Numerous dementia agents have failed current ...

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The ICU nurse positioned the mirror in front of my face. “You look more like yourself now, Dr. Berk,” she said. She was right! The nurse, whose name was Meghan, had just shampooed, dried and brushed my hair. Clean and coiffed for the first time in over a week, I appeared normal — except, that is, for the tubes sticking out of my left nostril and my mouth. It was 2009, and my ...

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