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 Woman with Syncope

Posted by Sara Fazio • September 19th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 60-year-old woman was seen in the emergency department after a syncopal episode. Oxygen saturation was 71% while she was breathing ambient air. A focused cardiac ultrasound revealed right-sided heart strain and McConnell’s sign. Additional diagnostic procedures were performed. A FOCUS examination, also referred to… Read More…

Ultrasonography versus CT for Suspected Nephrolithiasis

Posted by Sara Fazio • September 19th, 2014

Patients with suspected nephrolithiasis were randomly assigned either to ultrasonography performed by an emergency physician or a radiologist or to CT for initial study. Ultrasonography was associated with lower cumulative radiation, with no significant difference in complications. Pain from nephrolithiasis is a common reason for emergency department visits in the United States. Abdominal computed tomography… Read More…

Pancreatic Adenocarcinoma

Posted by Sara Fazio • September 12th, 2014

Cancer of the pancreas is predominantly adenocarcinoma and involves activating KRAS mutations in the large majority of cases. Surgical resection can be effective in localized disease; combination chemotherapy offers some palliation in advanced disease. A new review article on this topic comes from Massachusetts General Hospital’s David Ryan, Theodore Hong, and Nabeel Bardeesy. Pancreatic ductal… Read More…

Rash, Headache, Fever, Nausea, and Photophobia

Posted by Sara Fazio • September 12th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 39-year-old man was admitted to the hospital, 10 days after receiving prednisone for severe contact dermatitis, because of headache, nausea, and photophobia. Examination of the cerebrospinal fluid revealed white cells and gram-positive cocci. Diagnostic tests were performed.  The most common cause of bacterial meningitis… Read More…

Hemorrhoids

Posted by Sara Fazio • September 5th, 2014

Initial management for internal hemorrhoids includes adequate fiber and water intake and avoidance of straining. Office procedures (e.g., rubber-band ligation) are helpful when medical therapy fails; excisional therapies such as hemorrhoidectomy are used for severe disease.  Read the new Clinical Practice review article on this topic. Symptoms related to hemorrhoids are very common in Western… Read More…

Influenza Vaccination in Pregnant Women

Posted by Sara Fazio • September 5th, 2014

In two trials of a trivalent inactivated influenza vaccine in pregnant women in South Africa, HIV-infected and HIV-uninfected vaccine recipients had increased influenza antibody titers and decreased influenza attack rates. Pregnant women are designated as a priority group for seasonal influenza vaccination by the World Health Organization (WHO) because of their heightened susceptibility to severe… Read More…

Barrett’s Esophagus

Posted by Sara Fazio • August 29th, 2014

A new review article covers the epidemiology, pathogenesis, and natural history of Barrett’s esophagus and management options for the disorder. It has been estimated that 5.6% of adults in the United States have Barrett’s esophagus, the condition in which a metaplastic columnar mucosa that confers a predisposition to cancer replaces an esophageal squamous mucosa damaged… Read More…

10-Month-Old Boy with Microcephaly and Episodic Cyanosis

Posted by Sara Fazio • August 29th, 2014

A 10-month-old boy with microcephaly and developmental delay was admitted to the hospital because of episodes of respiratory distress and cyanosis. Microcephaly was present at birth, and hypotonia was noted at 5 months. On admission, brain MRI revealed decreased myelination. Microcephaly literally means “small head.” It is diagnosed when the head circumference is more than… Read More…

A 21-Month-Old Boy with Lethargy, Respiratory Distress, and Abdominal Distention

Posted by Sara Fazio • August 22nd, 2014

In the latest Case Record of the Massachusetts General Hospital, a 21-month-old boy presented to the emergency department because of lethargy, respiratory distress, and abdominal distention. Initial laboratory evaluation was notable for anion-gap metabolic acidosis. A diagnostic test result was received. The differential diagnosis of acutely altered mental status in a toddler includes trauma (accidental… Read More…

Aortic-Valve Stenosis — From Patients at Risk to Severe Valve Obstruction

Posted by Sara Fazio • August 22nd, 2014

A new review article on aortic-valve stenosis comes from Dr. Catherine Otto at the University of Washington School of Medicine in Seattle and Dr. Bernard Prendergast at John Radcliffe Hospital in Oxford, UK. Valvular aortic stenosis is a progressive disease in which the end stage is characterized by obstruction of left ventricular outflow, resulting in… Read More…