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.

Hypersensitivity to Hymenoptera Stings

Posted by Sara Fazio • April 12th, 2014

Anaphylactic reactions after a hymenoptera sting should be treated promptly with intramuscular epinephrine. Patients who have had such a reaction should carry injectable epinephrine and be referred to an allergist for insect-specific testing and subcutaneous immunotherapy if indicated.  The latest Clinical Practice review on this topic comes from the University of South Florida Morsani College… Read More…

Traumatic Injuries after a Bomb Explosion

Posted by Sara Fazio • April 12th, 2014

In this week’s Case Record of the Massachusetts General Hospital, a 34-year-old man was brought to the emergency department because of injuries sustained when a bomb exploded at the Boston Marathon. His right leg had been amputated below the knee and his left leg was burned. Imaging showed metallic foreign bodies in the legs, pelvis,… Read More…

Unfolding the Diagnosis

Posted by Sara Fazio • April 4th, 2014

In our latest Clinical Problem-Solving article, a previously healthy, 25-year-old man was admitted to the hospital because of abdominal pain, nausea, vomiting, and weight loss. Fever, chills, and weakness developed 2 weeks before his admission. In protein loss localizable to the gastrointestinal tract, in most cases, the syndrome of protein-losing enteropathy is associated with diseases… Read More…

Thrombosis Risk after 6-Weeks Postpartum

Posted by Sara Fazio • April 4th, 2014

Using administrative claims data, the authors of a new study published in NEJM found significantly increased risks for primary thrombotic events beyond the 6-week postpartum period, when the risk is well recognized to be high. However, absolute increases in risk from 7 to 12 weeks after delivery were small. Pregnancy significantly increases the risk of… Read More…

Nutrition in Critical Illness

Posted by Sara Fazio • March 28th, 2014

The latest review in the Critical Care series covers current knowledge related to the initiation of enteral or parenteral feeding among critically ill patients in the ICU. Critically ill patients who require vital organ support in the intensive care unit (ICU) commonly have anorexia and may be unable to feed volitionally by mouth for periods… Read More…

45-Year-Old Man with a Rash

Posted by Sara Fazio • March 28th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 45-year-old man was admitted to the hospital because of diffuse, purple, blanching livedo over his arms and legs and signs of severe sepsis. Three days before presentation, the patient was bitten on his hands and forearms while bathing his dog. A diagnostic test result… Read More…

Benign Paroxysmal Positional Vertigo

Posted by Sara Fazio • March 21st, 2014

Benign paroxysmal positional vertigo is characterized by brief spinning sensations, which are generally induced by a change in head position with respect to gravity. Treatment involves canalith-repositioning maneuvers, which are reviewed in detail in this new Clinical Practice article. Benign paroxysmal positional vertigo (BPPV) is by far the most common type of vertigo, with a… Read More…

A 34-Year-Old Woman with Increasing Dyspnea

Posted by Sara Fazio • March 21st, 2014

In the latest Case Record of the Massachusetts General Hospital, a 34-year-old woman with a history of Raynaud’s phenomenon and symmetric joint pain was admitted to the hospital because of increasing dyspnea. An echocardiogram showed severe pulmonary hypertension. Diagnostic test results were received. A diagnosis of pulmonary hypertension can be confirmed in a straightforward manner… Read More…

Management of Skin Abscesses

Posted by Sara Fazio • March 14th, 2014

The incidence of abscesses is increasing, and community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has become common. A new review article explains the role of ultrasonography and provides guidance on the management of skin abscesses and the use of antibiotics. Abscesses are one of the most common skin conditions managed by general practitioners and emergency physicians. The… Read More…

29-Year-Old Man with Headache and Diplopia

Posted by Sara Fazio • March 14th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 29-year-old man was admitted to the hospital because of headache, vomiting, photophobia, diplopia, and stiff neck. He was born in Southeast Asia. Brain imaging showed diffuse leptomeningeal enhancement. Cultures were sterile. A diagnostic procedure was performed. Chronic meningitis differs in important ways from acute… Read More…