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…
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 relief. History is …
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,…
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. History is also …
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…
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 …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months…
A 23-year-old woman is evaluated for a 1-year history of morning stiffness and achiness of the hands as well as Raynaud phenomenon. Two months ago, she experienced a sun-induced rash on the chest and back and patches of discoloration on the hands.
On physical examination, temperature is 36.4 °C (97.5 °F), blood pressure …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man comes for a preoperative evaluation before total joint arthroplasty of the left knee. He has a 25-year history of rheumatoid arthritis.…
A 66-year-old man comes for a preoperative evaluation before total joint arthroplasty of the left knee. He has a 25-year history of rheumatoid arthritis. He has had progressive pain in his left knee with activity, which limits his ability to hike. The patient has similar pain in the right knee, but it …
I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three…
I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three or more lanes, and slammed into the dividing median. I remember screaming “NO!” internally right before impact. I couldn’t believe what was happening as it happened.Read more…
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated for a 2-year history of knee osteoarthritis. He has bilateral knee pain that worsens with walking. He has tried…
A 64-year-old man is evaluated for a 2-year history of knee osteoarthritis. He has bilateral knee pain that worsens with walking. He has tried topical therapies, physical therapy, and acetaminophen, none of which has provided relief. The patient also has peripheral vascular disease, hyperlipidemia, and hypertension. Medications are hydrochlorothiazide, pravastatin, and a …
Recently, an international research team led by Xavier Rodó published a fascinating study in PNAS suggesting that Kawasaki disease is caused by an agent transported by wind from farms in Northeast China. This agent, possibly a fungal toxin, is responsible…
Recently, an international research team led by Xavier Rodó published a fascinating study in PNAS suggesting that Kawasaki disease is caused by an agent transported by wind from farms in Northeast China. This agent, possibly a fungal toxin, is responsible for triggering an exuberant immune response in children, causing the typical manifestation of the disease: fevers, rash, conjunctivitis, “strawberry tongue,” enlarged lymph nodes, and swelling of the extremities. Untreated, Kawasaki disease can cause aneurysms of the …
It is noteworthy how certain vital and effective generic drugs for common diseases have become exorbitantly expensive. We are use to new pharmaceutical brands costing a small fortune. But generics, one of which goes back to use in Egyptian times?…
It is noteworthy how certain vital and effective generic drugs for common diseases have become exorbitantly expensive. We are use to new pharmaceutical brands costing a small fortune. But generics, one of which goes back to use in Egyptian times? Really? Allopurinol and asthma inhalers that are cheap but effective medications have become unaffordable to those that need it the most: Simply stated, those that can’t breathe and those that …
During our weekly physician conference, I discussed a patient with a suspected autoinflammatory disease. An elderly male, he had a history of recurrent fevers, hives, and elevated inflammatory markers, which had gone untreated for many years. Eventually, he developed renal…
During our weekly physician conference, I discussed a patient with a suspected autoinflammatory disease. An elderly male, he had a history of recurrent fevers, hives, and elevated inflammatory markers, which had gone untreated for many years. Eventually, he developed renal amyloidosis, and was finally referred to rheumatology clinic for further evaluation. Although he had many of the classic signs and symptoms of an autoinflammatory disease, his physicians had not recognized …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated following a diagnosis of chronic fatigue syndrome. She has a several-year history of chronic disabling fatigue, unrefreshing sleep, muscle…
A 32-year-old woman is evaluated following a diagnosis of chronic fatigue syndrome. She has a several-year history of chronic disabling fatigue, unrefreshing sleep, muscle and joint pain, and headache.
A comprehensive evaluation has not identified any other medical condition, and a screen for depression is normal. Her only medications are multiple vitamins and …
Many years ago, Alfred Korzybski wrote that "the map is not the territory." Gregory Bateson went on to argue that the map, which represents reality, is not the reality. This distinction has implications for the role of patient voice in…
Many years ago, Alfred Korzybski wrote that “the map is not the territory.” Gregory Bateson went on to argue that the map, which represents reality, is not the reality. This distinction has implications for the role of patient voice in health care planning and policy.
Today, many organizations are making serious attempts to include the patient voice in policy and decision-making. Unfortunately, more than a …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain…
A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. …
We’ve all been there. You’re in medical school, sitting in a lecture hall -- maybe the course is pathology -- and for the first time since starting your studies, you’re actually learning about real diseases, not just benzene rings and…
We’ve all been there. You’re in medical school, sitting in a lecture hall — maybe the course is pathology — and for the first time since starting your studies, you’re actually learning about real diseases, not just benzene rings and the Krebs cycle. You’re furiously note-taking, and you reach back to work out a kink in your neck. There it is! A palpable, enlarged lymph node. You have lymphoma. You …
My right eye had a blackout in September 2010 when I stepped onto our deck. I didn’t pay much attention to this episode as my vision zoomed back into focus within seconds. But several months later, my eye was playing…
My right eye had a blackout in September 2010 when I stepped onto our deck. I didn’t pay much attention to this episode as my vision zoomed back into focus within seconds. But several months later, my eye was playing tricks with me when the only way I could read was with my right eye closed.
Back in 1981, I had lupus though I didn’t know it at the time. My …
A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids. On physical examination, temperature is…
A 56-year-old woman is evaluated during a follow-up visit for a 6-year history of Sjögren syndrome treated with low-dose hydroxychloroquine and cyclosporine eyedrops. She has had two episodes of cutaneous vasculitis, which resolved with corticosteroids.
On physical examination, temperature is 36.4 °C (97.6 °F), blood pressure is 116/64 mm Hg, pulse rate is 72/min, and respiration rate is 18/min. Oral mucous membranes are dry. There is a new firm, left parotid …
I am a 47-year-old female. In December of 2010, I had surgery to remove a 2 inch atrial myxoma (a heart tumor) in my left atrium. The costs for that were astronomical. That is not what I am writing about.…
I am a 47-year-old female. In December of 2010, I had surgery to remove a 2 inch atrial myxoma (a heart tumor) in my left atrium. The costs for that were astronomical. That is not what I am writing about. I am writing about what happened in the months after my surgery and a cure that cost $9.19 if you don’t count all of the unnecessary doctor visits and …
I had been laid off a few months when my ulcerative colitis kicked in, and my doctor and I struggled to get it under control. After trying a variety of medicines, my health continued to deteriorate and I agreed to…
I had been laid off a few months when my ulcerative colitis kicked in, and my doctor and I struggled to get it under control. After trying a variety of medicines, my health continued to deteriorate and I agreed to take Remicade.
Remicade is a potent drug, administered through an IV infusion at the oncology center that comes with a whole host of potential side effects. The dosage requires an initial …
When I recently read the phrase, “I’m embarrassed to be sick,” it made my stomach clench and my breath catch. That's exactly what I've been feeling: this vague sense of social unease even with close friends, a reluctance to be…
When I recently read the phrase, “I’m embarrassed to be sick,” it made my stomach clench and my breath catch. That’s exactly what I’ve been feeling: this vague sense of social unease even with close friends, a reluctance to be seen or even talk to people–especially those that knew me before I became chronically ill.
Another disturbed and disturbing night. It doesn't happen often three years later. Now – when it does happen – I generally know why. I am preparing to make a presentation of a sentinel event from my daughter's final illness to…
Another disturbed and disturbing night. It doesn’t happen often three years later. Now – when it does happen – I generally know why.
I am preparing to make a presentation of a sentinel event from my daughter’s final illness to a group of medical professionals and patient advocates. Last night, I was working on key points. What issues seem most important for hospital staffs to address after these years of reflection?
