Posts in the ‘Physicians-In-Training’ Category

The posts below are excerpted from the NEJM Resident e-Bulletin, a free weekly email of teaching topics. Including the content here in Now@NEJM enables you to have a conversation or ask questions about clinical points that interest you. To receive the email version, register as a student or resident on NEJM.org.

Inflammatory Muscle Diseases

Posted by Carla Rothaus • May 1st, 2015

The four main types of inflammatory muscle disease — dermatomyositis, polymyositis, necrotizing autoimmune myositis, and inclusion-body myositis — are summarized in a new review article. Pathogenesis, differential diagnosis, and treatment approaches are discussed. The inflammatory myopathies constitute a heterogeneous group of disorders that are best classified, on the basis of distinct clinicopathologic features, as four… Read More…

A Woman with Shortness of Breath

Posted by Carla Rothaus • May 1st, 2015

In the latest Case Record of the Massachusetts General Hospital, a 58-year-old woman presented with an 8-month history of shortness of breath on exertion. Previous chest imaging had shown pleural thickening and peripheral nodules in the upper lung zones, without lymphadenopathy. A diagnostic procedure was performed. When a pulmonologist is presented with a case of… Read More…

A Woman with Arthralgias

Posted by Carla Rothaus • April 24th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 27-year-old woman was seen in the emergency department of this hospital during the summer because of fever, arthralgias, and a rash. Three days before the onset of illness, she had returned from a vacation in the Caribbean. A diagnostic test was performed. When considering… Read More…

Uterine Fibroids

Posted by Carla Rothaus • April 24th, 2015

Fibroids, which are common in women of reproductive age, may cause heavy menstrual bleeding and symptoms related to leiomyoma bulk. Hysterectomy is an effective treatment, but many uterus-sparing options are available and should be discussed with patients. The latest Clinical Practice review is on this topic, and comes from Elizabeth A. Stewart, M.D., at the… Read More…

A Newborn Boy with Respiratory Distress

Posted by Carla Rothaus • April 17th, 2015

In the latest Case Record of the Massachusetts General Hospital, a newborn boy was admitted to the hospital because of respiratory distress and hypotension. At delivery, meconium was suctioned from the airway. Respiration and blood pressure improved after intervention, but lethargy and myoclonus developed. Neonatal brain tumors are often not apparent in utero; only 18%… Read More…

Clostridium difficile Infection

Posted by Carla Rothaus • April 17th, 2015

A new review article on Clostridium difficile Infection covers the pathogenesis, epidemiology, diagnosis, and treatment of this nosocomial and potentially fatal infectious diarrhea, as well as the associated risk factors. New treatments include fecal microbiota transplantation for disease that is resistant to vancomycin. Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that is transmitted… Read More…

Inflammatory Bowel Disease

Posted by Carla Rothaus • April 9th, 2015

A new review article covers the wide range of cancers associated with inflammatory bowel disease and the drugs used to manage them. Surveillance recommendations are presented. Cancers complicating inflammatory bowel disease can be attributed to chronic intestinal inflammation or to the carcinogenic effects of the immunosuppressive drugs used to treat inflammatory bowel disease. Clinical Pearls -… Read More…

A Woman with Headache and Fever

Posted by Carla Rothaus • April 9th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 28-year-old woman was seen in the emergency department of this hospital because of the acute onset of headache, fever, rash, and myalgias. On examination, she had petechiae on the chest, abdomen, and thighs and a purpuric lesion on the right shoulder. Neisseria meningitidis is… Read More…

Emergency Contraception

Posted by Carla Rothaus • April 3rd, 2015

Ulipristal and levonorgestrel pills are the most commonly used form of emergency contraception; ulipristal is slightly more effective, but levonorgestrel is available over the counter in the United States. The most effective approach is insertion of a copper IUD.  Read the new Clinical Practice review article on Emergency Contraception. Unintended pregnancy is common; in 2008,… Read More…

Community-Acquired Pneumonia in Adults

Posted by Carla Rothaus • April 3rd, 2015

Antimicrobial choices for community-acquired pneumonia in hospitalized patients who do not require ICU-level care continue to be debated. In a new trial, empirical beta-lactam–based therapy with or without a macrolide was compared with fluoroquinolones as initial treatment. The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to… Read More…