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 This year, a new FDA draft guidance discusses considering biomarker data and changing cognitive evaluations for accelerated approvals.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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A baby acutely ill with leukemia seems like the polar opposite of a woman with Alzheimer’s disease (AD), with her slow, insidious deterioration. Yet each disease can be progressive and fatal. I’ve cared for both, in different ways.  Can a childhood cancer doctor like me have insights about that other end of medicine, older adults with dementia? As a husband and caregiver, confronting my wife’s Alzheimer’s disease, I am appalled by the ...

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Any debate as to whether chronic traumatic encephalopathy (CTE) is a legitimate neurological malady that affects football players is slowly being put to bed. Repetitive hits to the head resulting in sub-concussive trauma and that concussions are the culprit here. Clinical findings associated with CTE include memory loss, depression, anxiety, violent behavior, mood disorders and heightened suicidality, among other impairments. It tends to progress with time and can lead to ...

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I just read a Clinical Problem Solving case from the New England Journal of Medicine (NEJM). It was entitled "Stream of Consciousness"and it told the story of a 65-year-old man who was a patient at the Brigham and Women's Hospital of Harvard Medical School, arguably one of the finest medical institutions in the world. These cases are presented in single paragraphs to a clinical expert physician who then ...

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A patient comes to you asking, "Doc, my seizures are getting worse, I really hate the side effects of my medications, I want to go a different route. What do you think about medical marijuana?" You start sweating profusely, fidgeting in your seat, thinking of every single reason why not to recommend it and come up with the standard response, "Uh, well, I'm not qualified to recommend it, and it's ...

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As an emergency medicine physician, a sports medicine physician who has spent countless hours on the sideline, and a concussion researcher, I spent a few minutes on Valentine’s Day reading with great interest the FDA release about a concussion biomarker. Currently, the diagnosis of a concussion is a timely, complicated task, taking into account both subjective historical elements and objective findings from the physical exam. The idea that a blood ...

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At my job as a primary care doctor in a federal safety net clinic, I was given a free T-shirt to wear the following day. It reads "Crucial Catch -- Intercept Cancer" in between the logos of the National Football League (NFL) and the American Cancer Society (ACS). This celebrates the 8-year partnership of almost $18 million dollars donated to fund cancer screening and prevention. These philanthropic gestures of large donors ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 22-year-old woman is evaluated for a 2-year-history of abnormal involuntary movements. She describes these movements as a quick elevation of the left shoulder followed by a rolling movement of the neck from side to side. The patient is able to suppress the movements completely for brief periods but then feels ...

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