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.

A Man with Olfactory Hallucinations

Posted by Carla Rothaus • May 20th, 2016

Involvement of the nervous system is reported in 5 to 15% of patients with sarcoidosis, although autopsy series indicate that the frequency of lesions in the nervous system may be higher. A 32-year-old man presented with a 1-year history of olfactory hallucinations and a 6-week history of intermittent numbness and paresthesias on the left side. MRI revealed… Read More…

Coronary-Artery Bypass Grafting

Posted by Carla Rothaus • May 20th, 2016

Appropriate selection of patients for coronary-artery bypass grafting (CABG) is critical to ensure good outcomes. The evaluation of patients for CABG relies on a systematic assessment of the characteristics and coronary anatomy known to be associated with a survival benefit from CABG as compared with medical therapy or percutaneous coronary intervention (PCI). There is increasing… Read More…

A Woman with Psychosis

Posted by Carla Rothaus • May 13th, 2016

The combination of malabsorption and autoimmunity strongly suggests the possibility of celiac disease, which is not always associated with gastrointestinal symptoms. Although neurologic and psychiatric symptoms of celiac disease are not widely recognized, they have been reported. Examination of a 37-year-old woman with adult-onset psychosis revealed weight loss, a thyroid nodule, anemia, and micronutrient deficiencies. Diagnostic tests… Read More…

Caregivers of Critically Ill Patients

Posted by Carla Rothaus • May 13th, 2016

Unpaid caregivers (typically family or close friends) are essential to the sustainability of North American health care systems, because their unpaid labor annually accounts for $27 billion in Canada and $642 billion in the United States. Although caregiver assistance can be beneficial for patients, such care may have negative consequences for caregivers, including poor health-related… Read More…

Eye of the Beholder

Posted by Carla Rothaus • May 6th, 2016

Dermatomyositis, polymyositis, and necrotizing autoimmune myopathy all cause proximal muscle weakness. Proximal weakness is often progressive, with patients reporting difficulty in raising their arms above their head, climbing stairs, or standing from a seated position. Clinically, dermatomyositis is distinguished from polymyositis and necrotizing autoimmune myopathy by its distinctive dermal findings. A 47-year-old man presented to an… Read More…

Herniated Lumbar Intervertebral Disk

Posted by Carla Rothaus • May 6th, 2016

“Sciatica” refers to pain in a sciatic-nerve distribution, but this term is sometimes used indiscriminately to describe back and leg pain. Lumbar “radiculopathy” more specifically refers to pain with possible motor and sensory disturbance in a nerve-root distribution. After lumbar stenosis, spondylolisthesis, and fracture have been ruled out, approximately 85% of patients with sciatica are… Read More…

Violence against Health Care Workers

Posted by Carla Rothaus • April 28th, 2016

Health care workplace violence is an underreported, ubiquitous, and persistent problem that has been tolerated and largely ignored. According to the Joint Commission, a major accrediting body for health care organizations, institutions that were once considered to be safe havens are now confronting “steadily increasing rates of crime, including violent crimes such as assault, rape,… Read More…

Aphasia during a Transatlantic Flight

Posted by Carla Rothaus • April 28th, 2016

In more than 60% of patients with ischemic stroke, the cause is readily established and is most often atherosclerosis or heart disease. However, in a young patient with no traditional vascular risk factors and a large clot burden, the search can be broadened to include, at minimum, thrombophilia, arterial dissection, paradoxical embolism, and unusual arteriopathies. A… Read More…

Surgery in Patients with Ischemic Cardiomyopathy

Posted by Carla Rothaus • April 22nd, 2016

The original Surgical Treatment for Ischemic Heart Failure (STICH) trial by Velazquez et al. was designed to test the hypothesis that coronary-artery bypass grafting (CABG) plus guideline-directed medical therapy for coronary artery disease, heart failure, and left ventricular dysfunction would improve survival over that with medical therapy alone. The authors now report the results of… Read More…

A Boy with a Breast Mass

Posted by Carla Rothaus • April 22nd, 2016

When evaluating a boy with breast enlargement, diagnostic considerations include gynecomastia, benign breast lesions, and cancer. An 8-year-old boy presented with a mass in the right breast that had been present for 18 months and had enlarged during the previous 6 months. On examination, a firm, mobile mass (2 cm by 2 cm) was present under the… Read More…