Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation ...

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Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique experience of attending a convention for patients and health care providers to learn about one such rare disease category, vasculitis. Vasculitides (plural of vasculitis) are a family of autoimmune diseases characterized ...

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I had my first outpatient surgical procedure when I was still in high school and needed a plantar wart removed from the sole of my foot. As the doctor injected the area with a local anesthetic, he explained he did these procedures all the time, and I wouldn't feel a thing. After a short wait, he began to dig out the deeply embedded wart with a hooked scalpel. With the first ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including ...

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It was Albert Einstein’s “biggest blunder.” Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the heavenly bodies together. In Einstein’s time, the universe was thought to be stationary. A universe that was anything but stagnant was an inconceivable idea since celestial matter would spin out of control, ...

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On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia. A few jaws literally dropped, and there was an awkward silence, then polite applause. Afterwards several of my colleagues came up to talk with me privately and were offended and/or curious as to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing ...

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Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school. That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring. My first patient of the day was ...

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Jeffrey Lurie is the owner of my beloved Philadelphia Eagles.   He pays the players.  He picks the coaches.  But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays.  The coach should do that. So why is it different in health care? I have a patient who was diagnosed with polymyositis.  Polymyositis is an autoimmune disease that causes inflammation of muscles ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated for a 6-month history of gout. He was doing well on colchicine and allopurinol but developed hypersensitivity to allopurinol, which resolved with cessation of the agent. He then began to have more frequent gout flares; two flares occurred in the past month and were treated with prednisone. ...

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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 examination. She seeks advice in reducing her personal risk of developing rheumatoid arthritis, because her mother was recently diagnosed with the disorder. The patient is asymptomatic. She has a 10-pack-year history of smoking and consumes six alcoholic beverages per week, usually on weekends. She ...

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medpagetodayFrom MedPage Today:

  1. Sudden Infant Death Risk Greater in Mountains. Babies born at a higher altitude faced a greater risk of sudden infant death syndrome (SIDS).
  2. Delayed Dx in Psoriatic Arthritis Worsens Damage, Disability. Patients with psoriatic arthritis (PsA) who delayed seeing a rheumatologist by more than 6 months were more likely ...

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medpagetodayFrom MedPage Today:

  1. Costly Hep C Tx Could Still Save Big Money. Treating genotype 1 (GT1) chronic hepatitis C (CHC) patients with ledipasvir/sofosbuvir (Harvoni) would result in an annual societal productivity gain of approximately $2.7 billion in the U.S.
  2. Workout May Ease Pain in Women With Fibromyalgia. A strong association exists between ...

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medpagetodayFrom MedPage Today:

  1. How to Rein In Out-of-Control Healthcare Costs. We all know the medical bill horror stories, but now we have to act on them.
  2. More ED Visits Since Obamacare. One objective of the Affordable Care Act was to increase access to primary care and curb visits to emergency rooms. Now ...

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medpagetodayFrom MedPage Today:

  1. ACP Prefers Cervical Cytology Over DNA Screens for Young Women. The American College of Physicians (ACP) said Pap smears should be the mainstay of cervical cancer screening in normal-risk women younger than 30, with molecular testing for human papilloma virus (HPV) reserved for older patients only.
  2. FDA Wants Data ...

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medpagetodayFrom MedPage Today:

  1. Peds Serve as Primary Prevention for Child Abuse. Physical abuse of children and infants is often difficult to diagnose, but can lead to lifelong physical and mental health disorders, according to a new clinical report from the American Academy of Pediatrics.
  2. Blood Test to Guide RA Tx Proves Cost ...

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medpagetodayFrom MedPage Today:

  1. Health IT: 'We Were Bound To Be Disappointed'. Robert Wachter, MD, works an hour north of Silicon Valley. Being surrounded by an "incredibly dynamic, vibrant IT ecosystem" contributed to a sense of disconnect for the associate chairman of medicine at the University of California San Francisco.
  2. Americans Miss WHO ...

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medpagetodayFrom MedPage Today:

  1. Methotrexate Helps Save Large Joints in RA. Patients with rheumatoid arthritis (RA) who received concomitant methotrexate with their tumor necrosis factor (TNF) inhibitor were less likely to need a large joint replacement than if they were on anti-TNF treatment alone.
  2. More U.S. Teens Opt for Birth Control With IUDs, ...

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