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.

Uncomplicated Skin Infections

Posted by Carla Rothaus • March 20th, 2015

Uncomplicated skin infections are a common outpatient clinical problem. In a randomized, controlled trial, clindamycin and trimethoprim–sulfamethoxazole (TMP-SMX) were compared as outpatient therapy for uncomplicated cellulitis or abscess. Results of cultures of skin-infection lesions in the United States have shown that most of the infections are caused by methicillin-resistant Staphylococcus aureus (MRSA), but the most… Read More…

A Man with Progressive Neurologic Decline

Posted by Carla Rothaus • March 20th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 31-year-old man was seen in the neurology clinic because of personality changes and neurologic decline of 3 years’ duration. Previous imaging studies showed mild atrophy in the frontal lobes. He could not speak or follow commands. Additional diagnostic testing was performed. Frontotemporal dementia is… Read More…

Viscosupplementation

Posted by Carla Rothaus • March 13th, 2015

In the latest Clinical Therapeutics review, a 67-year-old woman with osteoarthritis of the right knee seeks guidance regarding the possible benefit of hyaluronate injection. Injections of hyaluronate for viscosupplementation have been used in osteoarthritis of the knee, but their efficacy remains uncertain. Recent estimates suggest that knee osteoarthritis affects approximately 250 million people worldwide. Typically,… Read More…

A Man with Multiple Myeloma and Skin Tightness

Posted by Carla Rothaus • March 13th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 68-year-old man was seen in the rheumatology clinic because of increasing skin tightness, joint pain, and edema of the hands and feet. Nine months earlier, he had received a diagnosis of multiple myeloma and had undergone autologous stem-cell transplantation. Fibrosing dermopathies are a group… Read More…

Bioterrorism-Related Conditions

Posted by Carla Rothaus • March 6th, 2015

The agents most likely to be used in bioterrorism attacks are reviewed in a new Review Article, “Clinical Management of Potential Bioterrorism-Related Conditions,” along with the clinical syndromes they produce and their treatment.  This article comes from University of Pittsburgh’s Drs. Amesh Adalja, Eric Toner, and Thomas Inglesby. On the basis of historical incidents coupled… Read More…

Itching for a Diagnosis

Posted by Carla Rothaus • March 6th, 2015

In the latest Clinical Problem-Solving article, a 58-year-old woman presented with a 2-week history of generalized pruritus. She also reported having fatigue, dizziness, and decreased appetite. A week before the onset of symptoms, a mild upper respiratory tract infection had developed. Collapsing glomerulopathy is one of the few causes of the nephrotic syndrome in which… Read More…

Peanut Consumption in Infants

Posted by Carla Rothaus • February 27th, 2015

Children 4 to 11 months of age who were at high risk for development of peanut allergy were assigned to consumption or avoidance of peanuts until 60 months of age. Peanut allergy was more than five times as likely to develop in children assigned to peanut avoidance. (View a 1-minute Video Summary.  And, ask the… Read More…

A Man with Oral Ulcers

Posted by Carla Rothaus • February 27th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 25-year-old man presented with oral ulcers and odynophagia. On examination, there were scattered pink papules and plaques on the trunk, thighs, and buttocks and multiple raised, erythematous nodules on both shins. A diagnostic procedure was performed. Behcet’s disease affects young adults, usually starting during… Read More…

A Boy with Coughing Spells

Posted by Carla Rothaus • February 20th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 16-year-old boy presented with a 3-week history of cough and nasal congestion and a 3-day history of severe coughing spells, post-tussive emesis, and trouble breathing. A chest radiograph was normal. A diagnostic test was performed. Since the mid-1980s, there has been a gradual upward… Read More…

Groin Hernias in Adults

Posted by Carla Rothaus • February 20th, 2015

Watchful waiting is safe for men with asymptomatic inguinal hernias, but data from randomized trials suggest that most men will ultimately undergo surgery, primarily because of pain. Watchful waiting is not recommended in women, given their higher prevalence of femoral hernias. Read the new Clinical Practice review on this topic. The lifetime risk of development… Read More…