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.

60-Year-Old Man with Bone Pain

Posted by Sara Fazio • October 24th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 60-year-old man was seen in the outpatient cancer center because of bone pain that had lasted for 2 months and the presence of lytic bone lesions on imaging studies. Biopsy specimens of bone marrow and bone lesions showed increased mast cells. A diagnostic procedure… Read More…

Community-Acquired Pneumonia

Posted by Sara Fazio • October 24th, 2014

Community-acquired pneumonia is a commonly diagnosed illness in which no causative organism is identified in half the cases. Application of molecular diagnostic techniques has the potential to lead to more targeted therapy in the face of increasing antibiotic resistance. A new review article looks at this topic. Community-acquired pneumonia (CAP) is a syndrome in which… Read More…

Postherpetic Neuralgia

Posted by Sara Fazio • October 17th, 2014

Postherpetic neuralgia is more common with older age. Recommended treatments include topical agents (lidocaine or capsaicin) and systemic agents (in particular, gabapentin, pregabalin, or tricyclic antidepressants), but their efficacy tends to be suboptimal.  The latest Clinical Practice article is on this topic, and comes from University of Bristol’s Dr. Robert Johnson and Imperial College London’s… Read More…

Chronic Sore Throat and a Tonsillar Mass

Posted by Sara Fazio • October 17th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 78-year-old woman with rheumatoid arthritis was admitted to the Massachusetts Eye and Ear Infirmary because of a chronic sore throat, odynophagia, and a tonsillar mass. A diagnostic procedure was performed. Histoplasma capsulatum is commonly found in soil in certain regions of the United States… Read More…

Acid-Base Disturbances

Posted by Sara Fazio • October 10th, 2014

Acid–base homeostasis is fundamental for maintaining life. The first article in the new Disorders of Fluids and Electrolytes series reviews a stepwise method for the physiological approach to evaluation of acid–base status. Internal acid-base homeostasis is fundamental for maintaining life. Accurate and timely interpretation of an acid-base disorder can be lifesaving, but establishment of a… Read More…

Blood-Pressure Lowering and Glucose Control in Type 2 Diabetes

Posted by Sara Fazio • October 10th, 2014

In a follow-up study of patients with type 2 diabetes, mortality benefits in those originally assigned to antihypertensive therapy were evident at the end of follow-up, but in-trial glucose differences did not result in long-term benefits in mortality or macrovascular events. Post-trial follow-up studies of patients with diabetes have previously reported long-term beneficial effects of… Read More…

Against the Grain

Posted by Sara Fazio • October 3rd, 2014

In the latest Clinical Problem-Solving article, a 42-year-old man with a history of coronary artery disease presented to the emergency department with left-upper-quadrant abdominal pain that radiated to his back and along the subcostal margin. He also reported substernal chest pressure similar to his usual angina. Elevated lipase and amylase levels can be indicative of… Read More…

Microcytic Anemia

Posted by Sara Fazio • October 3rd, 2014

A new review discusses diagnosis and treatment of thalassemia, anemia of inflammation, and iron-deficiency anemia, highlighting recent findings.  The article includes an interactive graphic that shows various types of red cells that are observed in microcytic anemias and other conditions. The microcytic anemias are those characterized by the production of red cells that are smaller… Read More…

29-Year-Old Man with Diarrhea, Nausea, and Weight Loss

Posted by Sara Fazio • September 26th, 2014

A 29-year-old man was seen in the walk-in clinic because of diarrhea of 1 year’s duration and weight loss. Initial laboratory values included elevated hepatic aminotransferase levels and a ferritin level of 1716 ng per milliliter. A diagnostic procedure was performed. Common causes of cirrhosis include chronic alcohol use, viral hepatitis (either HBV or HCV),… Read More…

Depression in the Elderly

Posted by Sara Fazio • September 26th, 2014

Late-life depression (major depressive disorder in adults 60 years of age or older) is often associated with coexisting medical illness or cognitive impairment. Either pharmacotherapy (with SSRIs as the initial choice) or psychotherapy may be used as first-line therapy. Late-life depression is the occurrence of major depressive disorder in adults 60 years of age or… Read More…