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 Newborn Girl with Hyperbilirubinemia

Posted by Carla Rothaus • June 26th, 2015

In the latest Case Record of the Massachusetts General Hospital, a newborn girl was transferred to this hospital because of hypotension, coagulopathy, anemia, and hyperbilirubinemia. Generalized edema, anuria, and respiratory distress developed, and the trachea was intubated. Diagnostic procedures were performed. Neonatal hemochromatosis is the most common cause of neonatal liver failure and the leading indication… Read More…

Ischemic Optic Neuropathies

Posted by Carla Rothaus • June 19th, 2015

A new review article covers the diagnosis, pathophysiological features, and prognosis of ischemic optic neuropathy, a relatively common cause of visual loss in older patients, including visual loss after cardiac surgery. It must be distinguished from inflammatory optic neuritis. ION refers to all ischemic causes of optic neuropathy. ION is classified as anterior ION or posterior… Read More…

A Man with Chest Pain and Shortness of Breath

Posted by Carla Rothaus • June 19th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 71-year-old man presented with sudden chest pain, diaphoresis, shortness of breath, and hypotension. An electrocardiogram showed new ST-segment elevations. Ten days earlier, an implantable cardioverter–defibrillator had been placed. Diagnostic procedures were performed. Complications of ICD placement are well described, and ICD lead migration or dislodgment… Read More…

Breast-Cancer Screening

Posted by Carla Rothaus • June 12th, 2015

The International Agency for Research on Cancer (IARC) has updated its 2002 guidelines on screening for breast cancer, drawing on data from studies completed in the past 15 years. In November 2014, experts from 16 countries met at the International Agency for Research on Cancer (IARC) to assess the cancer-preventive and adverse effects of different methods… Read More…

A Woman with Decreased Vision and Diplopia

Posted by Carla Rothaus • June 12th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 41-year-old woman presented with decreased visual acuity in the left eye and diplopia. MRI of the head and orbits revealed abnormal soft tissue in the left sphenoid sinus and orbital apex, extending to the left cavernous sinus. A diagnostic procedure was performed. Lymphoma of the… Read More…

Vasopressin Antagonists

Posted by Carla Rothaus • June 5th, 2015

A new review in the Disorders of Fluids and Electrolytes series summarizes the salient discoveries that culminated in the development of vasopressin antagonists, focusing on their actions, side effects, emerging safety concerns, and important gaps in data. The review also considers how and when to use these agents. Ample evidence is available to implicate vasopressin, a… Read More…

In Sight and Out of Mind

Posted by Carla Rothaus • June 5th, 2015

In the latest Clinical Problem-Solving article, a 21-year-old man presented to the emergency department with fever and rash. His fever had started about 1 week before presentation and was associated with chills, myalgia, nausea, and vomiting. He also had a headache without photophobia. In the United States, recent declines in the rate of vaccination against measles… Read More…

Latent Tuberculosis Infection

Posted by Carla Rothaus • May 29th, 2015

About one third of the world population has latent M. tuberculosis infection. A new review explains the approach to patients with latent infection, including an update on the risks and benefits of treatment and assessment of the likelihood of progression to active disease. Studies suggest that active tuberculosis will develop in 5 to 15% of persons… Read More…

Intractable Pain Due to Cancer

Posted by Carla Rothaus • May 29th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 44-year-old woman with metastatic non–small-cell lung carcinoma with an EGFR mutation presented with severe pain, which was worsened by opioids other than hydrocodone and was unresponsive to most other analgesics. Management decisions were made. The discomfort of most dying patients can be controlled with state-of-the-art… Read More…

Pelvic Inflammatory Disease

Posted by Carla Rothaus • May 22nd, 2015

Pelvic inflammatory disease can produce acute symptoms and result in infertility, ectopic pregnancy, and chronic pelvic pain. A new review summarizes current approaches to diagnosis and treatment and the future prospects for better prevention strategies. Pelvic inflammatory disease is an infection-induced inflammation of the female upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum)…. Read More…