Click to enlarge.  Credit:  Ookaboo February 2, 2014
George Morrow / Punch Magazine 1914 January 1, 2014
diaphragm air2 October 3, 2013
Sagittal CT imaging demonstrating abscess formation (green arrow) with collapsed vertebra (red arrow) and obvious involvement of a nearby vertebral body (yellow arrow). August 4, 2013

Medical Challenge | Altered Mental Status Pt. 2

July 12, 2013

1

question mark

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

3

colemillen1

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 […]

Posted in: Health, Nutrition

On Floss Picks and Empathy

June 26, 2013

2

Floss pick

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 […]

Posted in: Humor, Medicine

The Importance of the USMLE Step 2 Clinical Skills Examination

March 29, 2013

1

Physical Exam 2

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

2

Click to enlarge.

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 […]

Posted in: Humor, Medicine

Medical Challenge | Sudden Pain

March 23, 2013

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sudden pain 5

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

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weight-loss-scale-help

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

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milk in tea

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 […]

Posted in: Health, Medicine, Nutrition

Medical Challenge | A Young Man with Bloody Stool

August 19, 2012

2

Click to enlarge.

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

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I'm going to start bringing this to work.

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 […]

Posted in: Humor, Medicine

Time to Ditch the BMI?

June 22, 2012

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bmi-comparison

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 […]

Posted in: Fitness, Health, Medicine

At Odds: Quantity vs. Quality

April 27, 2012

1

Do we dehumanize our patients?  (Image: Hüseyin Tuncer)

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

4

You thought I was kidding?

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 […]

Childhood Obesity: The Elephant in the Room

March 30, 2012

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McDonalds kids

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 […]

Posted in: Health, Medicine, Nutrition

Rise of the Machines

March 8, 2012

2

da_Vinci_robot

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 […]

Posted in: Humor, Medicine

Running Subcuticular Suture Technique

February 20, 2012

6

subq11

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 […]

Posted in: Medicine

Hold That Thought: Walking Through Doorways Makes Us Forget

January 15, 2012

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question door

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

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Click to enlarge.

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

0

Just like prison - all I'm missing is a toilet next to the cot.

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, […]

Posted in: Cooking, Humor, Uncategorized

Clerkship Advice | Internal Medicine

November 28, 2011

2

Unfortunately, you can't give your eyes a rest and use your stethoscope to read.  I've tried.

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

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docs_nutrition

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? […]

Posted in: Health, Medicine, Nutrition

Medical Challenge | Abdominal Pain

November 6, 2011

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Click to enlarge.

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

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If you don't understand something about the plan for your care, ask your doctor.

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 […]

Posted in: Health, Medicine

Medical Challenge | Altered Mental Status

October 23, 2011

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med challenge clock drawing

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

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glucometer

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

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physical exam

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

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Click to enlarge.

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

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elderly patient with meds

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 […]

Posted in: Health, Medicine

Iron Man

August 12, 2011

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Bloodletting as depicted by the ancient Greeks.

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 […]

Posted in: Health, Medicine

Medical Challenge | Make the Diagnosis

August 6, 2011

3

question mark

  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

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Helmet law cartoon

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 […]

Posted in: Health, Medicine

Medical Challenge | CT Interpretation

July 25, 2011

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Click to enlarge

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

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Wrap salmon in foil with olive oil, lemon, herbs & cherry tomatoes for no-mess baking!

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, […]

Posted in: Health, Nutrition

Harvard Researchers Challenge Conventional Weight Loss Wisdom

July 19, 2011

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diet-soda

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

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What's the diagnosis?

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

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(Non-medical friends:  this is an analogy for how much we carry in our pockets).

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

0

This could easily be a dessert if you were to drizzle some more honey over the top and dust with confectioner's sugar.

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 […]

Posted in: Cooking, Nutrition

Problems With Clinical Mentorship

June 22, 2011

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depressed-doc

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

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I would love to know how much money was spent designing this..

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, […]

Posted in: Health, Medicine, Nutrition

How to Crush the USMLE Step 1

May 14, 2011

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This is what my copy of First Aid looked like by the time I was done with it.

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

0

Osteoporosis compromises bone stregnth.

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 […]

Posted in: Fitness, Health, Medicine

How Colonoscopies Save Lives

April 7, 2011

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Progression of colorectal cancer

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 […]

Posted in: Health, Medicine

Does Size Matter?

March 31, 2011

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cognitive reserve

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 […]

Posted in: Health, Medicine

Knowledge is Power, Knowledge is Pain

March 26, 2011

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All rights to this image belong to Dr. Fizzy @ doccartoon.blogspot.com

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 […]

Posted in: Health, Humor, Medicine

Ann Coulter Extols Radiation Exposure “Benefits”

March 22, 2011

4

Bottoms up

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 […]

Posted in: Health, Medicine

Celebrity Advice is Bad for Your Health

March 19, 2011

6

suzanne somers book

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 […]

Posted in: Health, Medicine

Answer to Medical Challenge | Bloody Nose

February 5, 2014

0

**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

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**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

0

**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
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