Long ago primitive sharks had ridges running down their sides from gill to tail. Later, muscles grew into the folds, and eventually, the central portion of each ridge receded while the ends enlarged to form fins both fore and aft. All was well. Then one day several hundred million years ago, a fish was swimming blissfully in a shallow pool. The tide went out ...

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All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived ...

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There are 168 hours in a week and 8,736 hours in a year. There are 10,080 minutes in a week, and 524,160 minutes in a year. Residents and fellows working in an academic environment often work close to, if not in large part, more than 80 hours a week, or 4,160 hours a year. They work 4,800 minutes a week, and a staggering 249,600 minutes a year. In medicine, it’s ...

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Residency training is an opportunity to get a good feeling of the specialty that interested you when thinking about what to pursue in the future. You may think that after applying for premed college, medical school and residency, applying for fellowship would be a piece of cake for you. Let me tell you: applying for fellowship is probably the hardest one among all other applications you went through so far. ...

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Have you ever had a prescription altered? I have, several times — all opioids. Despite making copies of every prescription to prove what I actually wrote for, dealing with everything from patients who threatened to sue me for false accusations to time spent with the DEA was a real pain. The good news is that during the pre "pain as fifth vital sign" era at least — since my prescribing ...

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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 right knee pain that began 2 days ago. He was playing football when he stopped suddenly and pivoted to make a catch. He heard a popping sound and immediately developed severe pain in his right knee. Within 30 minutes, the knee became swollen. ...

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The emergency room staff was immediately suspicious. His father said that Peter, just over six months old, was pulling himself up to a standing position by grasping his pant leg. Peter fell back, screaming. The extreme distress, entirely unusual for Peter, continued until some Tylenol helped him fall asleep. The next morning Peter was screaming again, and his mother took him to the emergency room. X-rays showed a fractured leg. The ...

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Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system. Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate. Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures. Type III fractures occur through the ...

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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 for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or ...

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A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today's standards I would be considered a “good old country orthopedist.” Thirty years ago, I moved to a small community to ...

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