Category: Conditions

MKSAP: 42-year-old man with thrombophilia

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 42-year-old man arrives for follow-up consultation. Three months ago he developed a proximal right leg deep venous thrombosis following a s…

MKSAP: 64-year-old man seen after an intraoperative liver biopsy

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated in follow-up after recent abnormal findings on intraoperative liver biopsy. Two days ago he underwent right co…

The carefully crafted way of how health misinformation spreads

Effective clickbait doesn’t just happen. It’s carefully crafted. Take this wildly misleading article from CNN: Not exercising worse for your health than smoking, diabetes, and heart disease, study reveals. It’s one example — among many generated daily …

PSA-based screening for prostate cancer: Interpreting the changing guidelines

Comparing the 2018 U.S. Preventive Services Task Force (USPSTF) recommendation statement on prostate cancer screening in the October 15th issue of American Family Physician with its previous recommendation, the first question family physicians ought to…

A CT scan for kidney cancer? It may depend on where you live.

About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kid…

We need more behavioral health treatment in primary care

I don’t know how many times a patient has told me, “I was in therapy once, and it didn’t help.” My response is always: “That’s like saying ‘I saw a movie once and I didn’t like it’.” That usually breaks the ice just a little. In primary car…

Why it’s important to determine who’s truly penicillin-allergic

A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection. But one of the most commonly …

Explain hemoglobin A1c in 2 minutes

It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection checkup. She was a 73-year-old female with a history of diabetes. She was elegant and soft-spoken. Prior to examini…

Prescribing unnecessary antibiotics is the path of least resistance

During my urgent care shifts, I see 20 to 30 people with viral upper respiratory infections. They are all feeling miserable, and they just want to feel better. They want an impressive-sounding diagnosis to justify their suffering to themselves, their s…

MKSAP: 79-year-old man with a sacral ulcer

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 79-year-old man is evaluated for pain in the buttocks region. He was diagnosed with non-Hodgkin large B-cell lymphoma 6 months ago. Althoug…