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Ars longa, vita brevis
Medical Challenge | Altered Mental Status Pt. 2
This medical challenge is adapted from a real clinical scenario, and though complex, is an excellent example of the broad differential required for an elderly person with a change in mental status – one of the most common presentations to the emergency department. An 80 year old white male is brought to the emergency department […]
Posted in: Medicine
Eating Healthy While on Vacation
July 3, 2013
This guest post was contributed by Cole Millen. Cole is an avid traveler and foodie who never forgets that life’s best memories are made through real life apprehension of legitimate “experiences.” Follow his blog at Cole’s Mill. How to Maintain a Healthy Diet on a Family Vacation Whether it is the call of the glorious sunshine […]
On Floss Picks and Empathy
June 26, 2013
Humanism and empathy are all the rage in today’s medical literature and are increasingly emphasized in the education process. We select applicants who display these virtues or in whom we think we can cultivate them. They’re even recognized by national societies like the Arnold P. Gold Foundation, of which I am I a member. All […]
The Importance of the USMLE Step 2 Clinical Skills Examination
March 29, 2013
This guest post was written by Dr. Mark Swartz, M.D. Please see the author bio below for more information. The Importance of the USMLE Step 2 Clinical Skills Examination “Do you smoke, drink coffee or consume alcohol? If you answered yes—how often?” As a patient, you may feel overwhelmed having to answer each question as […]
Posted in: Medicine
March Madness
March 27, 2013
If you know me personally, you know I don’t really care for sports – but whether or not you’re into college hoops, if you’re a 4th year medical student in the U.S., March means only one thing: Match Day. Before completing their final year of training, senior medical students participate in the competitive application process […]
Medical Challenge | Sudden Pain
March 23, 2013
Case: A 43 year old female presents to the emergency department complaining of sudden-onset, sharp, left-sided abdominal pain that radiates to the groin, followed by nausea, vomiting, and diarrhea. Based on the images and history provided above, what is the most likely diagnosis? A) Appendicitis B) Diverticulitis C) Hernia D) Nephrolithiasis (kidney stone) E) Ruptured […]
Posted in: Medicine
Talking About Obesity
December 27, 2012
During my family medicine rotation, I noticed the physicians I worked with focused more time on weight management than in any other outpatient clinic I had worked in. Recently, while on a less demanding elective, I decided to conduct my own observational study. How often, and with what prompting, do physicians address their patients’ weight? […]
Time Out – Does Milk Ruin Tea Time?
September 22, 2012
For centuries, certain cultures have customarily added milk to fresh-brewed tea – but in recent years, scientists in laboratories around the world have been “hotly” debating whether this seemingly-benign practice may actually inhibit some of the already well-established health benefits of tea drinking. The topic arose recently in the oncology clinic (of all places), when […]
Medical Challenge | A Young Man with Bloody Stool
August 19, 2012
You are the GI fellow consulted to see a 17 year old white male with a chief complaint of diarrhea & bright red blood per rectum (BRBPR). The patient was in his usual state of health until he experienced sudden-onset diffuse, crampy abdominal pain and diarrhea roughly 36 hours ago. He experienced 3-5 episodes of […]
Posted in: Medicine
2011-2012: The Year in Clinicals
August 8, 2012
It’s easy to get caught up in the tests and scutwork that dominate the third and fourth years of medical school. Students are eager to get out of the classroom and into the hospital full-time, but that enthusiasm often fades with each fax, copy, or phone call that must be placed, and can turn to […]
Time to Ditch the BMI?
June 22, 2012
I’ve been interested in health and nutrition since I started playing high school sports. During my 3 year stint as a personal trainer, I developed a distinct opinion of the Body Mass Index (or BMI – the most widely used anthropomorphic measurement in medicine): it’s not a very good tool. My issue with BMI began […]
At Odds: Quantity vs. Quality
April 27, 2012
As a medical student who just completed this third year of training, I took special interest in Dr. Pauline Chen’s recent article about Harvard Medical School’s “Integrated Clerkship” – a program that eliminates traditional block-style clerkships and asks students to follow a panel of “up to 100 patients” longitudinally over the course of a year […]
Posted in: Medicine
Pediatrics in the Hood
April 18, 2012
I thought my last clerkship as a third year medical student deserved something more memorable than the typical medical haiku I write. In its stead I submit to you a David Letterman style Top Ten, drawn 100% from actual events. So, without further ado: The Top Ten Signs You are a Medical Student Practicing Pediatrics […]
Posted in: Humor, Shit my _____ says
Childhood Obesity: The Elephant in the Room
March 30, 2012
Since March is National Nutrition Month, and because I’m still on my pediatrics clerkship, I thought “What better time to write about childhood obesity?” In recent years, childhood overweight and obesity statistics have received a good deal of media attention, but this has done little to slow their rise. Data from the National Health and […]
Rise of the Machines
March 8, 2012
I recently observed my first robot-assisted operation with the da Vinci surgical system (left). It’s designed to allow for surgery that’s less invasive and more precise, resulting in shorter hospital stays. As you can see on the manufacturer’s website, the da Vinci surgical system is the best thing ever invented, and is somehow related to […]
Running Subcuticular Suture Technique
February 20, 2012
Suturing is an important part of several clerkships, and whether or not you’re going to be a surgeon, I believe it’s just proper form for a physician to be able to suture half-decently. Unfortunately, for some of us the opportunity to practice doesn’t present itself often, and we may be rusty when we’re called upon […]
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Hold That Thought: Walking Through Doorways Makes Us Forget
January 15, 2012
Are you sitting down as you’re reading this? If not, you may want to – chances are, if you’re browsing this on your iPhone while walking to the fridge, you’ll forget what you were reading about by the time you get back (and you may even forget what brought you to the kitchen in the […]
Posted in: Medicine
Medical Challenge | Difficulty Swallowing
January 9, 2012
A 45 year old African American male presents to the emergency department with a chief complaint of dizziness. He states that 4 days ago, he began to have difficulty swallowing food – he was eating a breakfast consisting of eggs, bacon & grits. He noticed some difficulty swallowing his last bite, and reports “spitting up” […]
Posted in: Medicine
The Steel City
December 18, 2011
I apologize for the lack of content recently – I was pressed for time, between finishing up my psych rotation and relocating to Pittsburgh for a family medicine clerkship. The drive wasn’t bad – in fact, I made it here from Philly in only 4 hours. But when I decided to check out my accommodations, […]
Clerkship Advice | Internal Medicine
November 28, 2011
For most third year medical students, the internal medicine clerkship is make-or-break — it’s where we get to flex our diagnostic muscles and probably where we get our first real taste of autonomy in patient care. Our performance here will be scrutinized by residency directors as they evaluate our fitness for their program. The clerkship […]
Posted in: Medicine
Why Doctors Don’t Know Nutrition
November 20, 2011
As I’ve alluded to in the past, the study of medicine can be overwhelming. We’ve simply discovered too much for one person to master completely. This is the challenge medical educators are tasked with – what’s so important that it must be allotted time in the brief 2 years of dedicated book learning doctors-to-be receive? […]
Medical Challenge | Abdominal Pain
November 6, 2011
This is the interesting case I promised you last week – I think it allows for several great teaching points. Take your time, and share this one with your friends. -Jim A 33 year old woman presents to the emergency department complaining of severe abdominal pain. When you go to examine the patient, you notice […]
Posted in: Medicine
The Dangers of Science Illiteracy
October 30, 2011
October is health literacy month, and I would be remiss not to take a moment to give this issue the attention it deserves. In his book The Demon-Haunted World: Science as a Candle in the Dark, astronomer Carl Sagan wrote: “We live in a society exquisitely dependent on science and technology, in which hardly anyone […]
Medical Challenge | Altered Mental Status
October 23, 2011
This week’s Medical Challenge is from guest blogger Vincenzo Happach – medical student at DMU & good personal friend of mine. If you would like to submit a guest post or a medical case of your own, please use the contact page. An 86 year old Caucasian female presents to the medicine floor after, while […]
Posted in: Medicine
Steps to Prevent Diabetes
October 8, 2011
I recently took care of a patient who, very unfortunately, had undiagnosed type II diabetes and presented in a state known as Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) – his blood sugar on presentation was ~1,000 mg/dL. HHNS is a very serious complication of untreated diabetes, but can happen to any type II diabetic with poor […]
How Important is the Physical Exam?
September 17, 2011
As a primer for this article, please enjoy the first half of this short video by the physician-blogger ZDoggMD (warning: seriously great Yoda impression): I’ll be the first to admit it – I don’t always complete (or repeat) an entire physical exam on my patients. But that’s okay — sometimes only a “focused” physical is […]
Posted in: Medicine
Medical Challenge | Muscle Weakness
August 27, 2011
A 60 year old white male presents with a primary complaint of muscle weakness. He is a mechanic and has been having a progressively difficult time carrying some of the heavier parts around his shop. His past medical history is significant for hypertension and osteoarthritis, and his family history is non-contributory. He smokes 2 packs […]
Posted in: Medicine
Doctors Should Be Prescribing A Third Wheel
August 19, 2011
When a patient shows up for a doctor’s appointment with a companion, I often find myself studying (and later, interacting with) them as much as I do the patient. Most times, a quick review of body language is all I need to make an assessment – is this person looking out for the interests of […]
Iron Man
August 12, 2011
Bombs, concealed weapons, spare change at the beach – metal detectors were designed to help us find all sorts of things, but what if I told you they could also pick up on genetic diseases? While not practical (or medicolegally acceptable), they may provide a clue to the diagnosis of a rare inherited disorder. The […]
Medical Challenge | Make the Diagnosis
August 6, 2011
More image challenges to come, but I still have some friends who haven’t taken their USMLE Step 1 exam, and a question like this may be good practice. Case: A slender 23 year old white male presents to your office reporting general malaise and fever. He has been feeling crummy for […]
Posted in: Medicine
Helmet Laws & Organ Donations: Should Those Who Ride Decide?
August 2, 2011
This is a guest post by Patricia Walling. Patricia is a web content designer for several healthcare-related sites. She self-identifies as a perpetual student of medicine, and can be found most of the time researching anything related to the field. Motorcycles and organ donors Motorcycle helmet laws historically have been similar to a toggle-switch. In […]
Medical Challenge | CT Interpretation
July 25, 2011
This time, a more detailed history is provided, and you are the inexperienced medical intern, not the seasoned radiologist. If you missed last week’s challenge, you can still give it a shot. You are asked to examine an 84 year old Hispanic female who was admitted to the hospital with shortness of breath. Her past […]
Posted in: Medicine
5 Super Foods for Super Heart Health
July 22, 2011
This guest post was written by Ashley from Long Island Heart Associates. For questions about heart health and aging, contact a local cardiologist today. It is an unfortunate misconception that foods must either taste good or be good for you. While some kids may turn their noses up at anything green on the dinner table, […]
Harvard Researchers Challenge Conventional Weight Loss Wisdom
July 19, 2011
As we are reminded that obesity is still a problem in America, and the USDA tries again to revise its image, it becomes more important by the day to help people learn how to stop the process of packing on those extra pounds each year. A long-term study recently published in the New England Journal […]
Medical Challenge | X-Ray Interpretation
July 14, 2011
I really enjoy when some of the blogs I read post medical challenges for their readers, and I think I’m ready to start doing it from time to time here on my own. Because I’m currently rotating through radiology, I think it’s appropriate to begin with the interpretation of a radiograph. You are the radiologist […]
Posted in: Medicine
Clerkship Advice | Third Year Surgery
July 12, 2011
The third year of medical school can be just as scary as it is exciting. It’s great when you have someone who can tell you what to expect on your rotations, but that’s not always the case. Because of that, I’m planning on summarizing most of my clerkships so other medical students may benefit. I […]
Posted in: Medicine
What I’m Eating | Grilled Plums with Spiced Greek Yogurt
July 4, 2011
After returning from my Costco run this weekend, I realized I had to start thinking of creative ways to get rid of the 4 lbs. of plums I purchased (seemed like a good idea at the time). I could have made some type of plum sauce, but since it’s July 4th weekend, something just had […]
Problems With Clinical Mentorship
June 22, 2011
As I finished my 24-hour call this morning, I was reminded of a 2009 study revealing a decline in empathy as medical students transition from their mostly-didactic second year to third year, which is essentially an apprenticeship in the hospital with lecture as an afterthought. I began my third year with what most would argue […]
Posted in: Medicine
USDA Dumps Food Pyramid for Younger, More Curvaceous Figure
June 7, 2011
The USDA has recently released it’s new concept, the food plate, to replace the iconic food pyramid it introduced in 1992 (and modified in 2005). At its release, Agriculture Secretary Tom Vilsack criticized the food pyramid for being “too complex to serve as a quick and easy guide for American families” – I completely agree, […]
How to Crush the USMLE Step 1
May 14, 2011
The sympathetic nervous system mediates the classic “fight or flight” response – pupils dilate, the heart races, sphincters contract, and hair stands on end. “If you have a cat at home, put his favorite food in a dish. Then just before he starts to eat, snatch the dish away. Before he scratches you, look at […]
Posted in: Medicine
May: The Month for Bone Health
May 12, 2011
April was National Organ and Tissue Donor Awareness Month (or National Donate Life Month), and though I campaigned as best I could while studying, I didn’t have time to draft a decent post. Fortunately, it’s not too late for me to dedicate a post to National Osteoporosis Awareness Month. Osteoporosis is a poorly understood concept […]
How Colonoscopies Save Lives
April 7, 2011
Recently, I was speaking with my father and the topic of his next colonoscopy came up. After I gave him due praise for scheduling his appointment, he asked if it’s really worth it to have one done as often as is recommended. I’d like to share with you some of the things I told […]
Does Size Matter?
March 31, 2011
Fortunately, at least when it comes to dementia and certain brain injuries, the answer is no. That’s thanks to something referred to as one’s “cognitive reserve.” When comparing the two images, you might assume that the owner of the brain on the left has severely reduced mental capacity – but you’d be wrong. That decimated […]
Knowledge is Power, Knowledge is Pain
March 26, 2011
Why do I say knowledge is pain? Well, for one, you can’t unlearn what you come to know (though, put an exam in front of me and I’ll prove myself wrong, if you’d like). More importantly, however, you become a resource to your loved ones – this is empowering for all parties involved, but is […]
Ann Coulter Extols Radiation Exposure “Benefits”
March 22, 2011
Professional conservative troll Ann Coulter attempted to discredit fears regarding Japan’s nuclear disaster during a segment aired this week on The O’Reilly Factor by telling viewers “radiation is good for you.” Coulter claimed that a “stunning number” of physicists believe radiation is good for you, and went on to cite several studies that revealed a […]
Celebrity Advice is Bad for Your Health
March 19, 2011
Common cold? Give me those antibiotics, I don’t care if you say they won’t work for a viral infection! Breast cancer? Chemotherapy is poison, I’ll take my chances! Got any of those bioidentical hormones? I can’t help but notice a funny mentality many Americans seem to hold (no, not funny like a clown, Joe). People […]
Answer to Medical Challenge | Bloody Nose
February 5, 2014
**If you would like another chance to read the challenge before seeing the answer, click here. Scroll down for the answer. ** ———————————————————————————————————————————————————————————– The correct answer is C) Acute promyelocytic leukemia. This was a challenging case and differential, but the presentation and smear were classic and are exactly what you would be […]
Posted in: Medicine
Answer to Image Challenge | Difficulty Breathing
October 5, 2013
**If you would like another chance to read the challenge before seeing the answer, click here. Scroll down for the answer. ** ———————————————————————————————————————————————————————————– The correct answer is Aspiration Pneumonitis (D). Explanations of the choices follow, and management of the patient is discussed at the bottom of the page. Don’t feel bad if you chose Pneumoperitoneum (A) – […]
Posted in: Medicine
Answer to Medical Challenge | Altered Mental Status Pt. 2
August 1, 2013
**If you would like another chance to read the challenge before seeing the answer, click here. Scroll down for the answer. ** ———————————————————————————————————————————————————————————– The correct answer is Medication induced delirium (G). This was a difficult case, but with the information provided the most likely answer should be clear. It’s an important topic, as this is a commonly-encountered clinical […]
Posted in: Medicine
Abnormal Facies 
July 12, 2013
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