The incidence of infective endocarditis during pregnancy has been reported to be 0.006%. The maternal mortality rate can reach 33%, with most deaths related to heart failure or an embolic event. The rate of fetal mortality can reach 29%. Heart diseases are the most important nonobstetric causes of maternal death during pregnancy, accounting for 10% of maternal deaths. As many as 3% of women have a form of cardiac disease diagnosed during or in the period preceding pregnancy, with 70 to 80% of the cardiac conditions having congenital causes.

Smoking is a risk factor for the four leading causes of death in the United States, yet 48 million Americans--24% of the U.S. adult population--continue to smoke. Approximately 70% of people who smoke visit a physician each year, yet only half report ever being advised to quit smoking by their physician. Smoking cessation is difficult due to nicotine addiction and withdrawal symptoms. Expert groups such as the National Cancer Institute and the Agency for Health Care Policy and Research offer protocols for smoking cessation that primary care physicians can use in their office practice. Recent developments in the pharmacotherapy of smoking cessation has led the U.S. Public Health Service to update the practice guidelines for treating tobacco use and dependence. Pharmacotherapy, which includes nicotine replacement therapy, offers assistance to patients who want to stop smoking. However, the cost of pharmacotherapy may be a barrier for some. Other nonpharmacologic therapies, such as counseling, are also effective.

This cardiopulmonary instructional module was well received by the second-year medical students. In the skills OSCE, 80% of the students accurately measured systolic and diastolic blood pressure to within 5 mm Hg. Cardiopulmonary auscultation proficiency results showed average recognition of 60% for cardiac abnormalities and 88% for pulmonary sounds. Developing auscultation transducers with pulse simulation capability ensured that students could identify systole. Therefore, heart murmurs and sounds could be timed with the cardiac cycle. We found the results from the skills OSCE encouraging. Most students demonstrated reasonable competency in the skills taught, and the new transportable simulators performed well. The six-hour instructional module was meant to prepare students for their bedside teaching during the third year of medical school. The significant cost of the "Harvey" simulator may be a barrier to its widespread use for teaching. Therefore, continued development of smaller transportable simulators for teaching and testing purposes is important.

Kikuchi Fujimoto's disease (KFD) is a rare, immune-mediated, self-limiting disorder with unique histopathological features. KFD is usually seen in young Asian females; however, cases have been reported throughout the world and in all ethnicities. It has been recognized that there is a rare association between Systemic Lupus Erythematosus (SLE) and KFD via sporadic case reports. The exact pathophysiological relationship between these two diseases is still unclear. We report a case of a young Asian female who presented with persistent fever and lymphadenopathy and was diagnosed with Kikuchi Fujimoto's disease based on lymph node biopsy; although an SLE workup was done, she did not meet the American Rheumatology Association (ARA) diagnostic criteria for lupus, and the lymph node biopsy did not show features of SLE. She improved clinically with a short course of steroid therapy. Two months later, the patient presented with central facial rash and arthralgia. SLE workup was repeated, a skin biopsy was done, and the results at this time supported a diagnosis of SLE.

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