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.

Chronic Stable Angina

Posted by Carla Rothaus • March 25th, 2016

Angina is the initial manifestation in approximately half of all patients who present with coronary artery disease. The presence of chronic angina approximately doubles the risk of major cardiovascular events. Management of angina includes lifestyle changes and pharmacologic treatment to reduce cardiovascular risks, antianginal therapies (beta-blockers, long-acting nitrates, calcium-channel blockers, and — recently in the United States —… Read More…

A Man with Lung Infiltrates

Posted by Carla Rothaus • March 18th, 2016

Chronic eosinophilic pneumonia causes a relatively specific pattern of histologic reaction, but a specific cause of this pattern is not usually identified. A 71-year-old man presented with recurrent fevers, dyspnea, and hypoxemia. Chest imaging showed consolidation predominantly in the lower lobes and diffuse bilateral ground-glass opacities that had waxed and waned over a 6-month period. A diagnostic… Read More…

Asymptomatic Carotid Stenosis

Posted by Carla Rothaus • March 18th, 2016

Carotid-artery stenting has emerged as a therapeutic alternative to endarterectomy for the treatment of severe cervical carotid-artery stenosis. Rosenfield et al. conducted the Asymptomatic Carotid Trial (ACT) I trial, whose primary aim was to compare the outcomes of carotid endarterectomy versus stenting with embolic protection in patients with asymptomatic severe carotid-artery stenosis who were at… Read More…

A Man with an Ileocecal Mass

Posted by Carla Rothaus • March 11th, 2016

Misdiagnosis of Crohn’s disease in a patient with intestinal tuberculosis would generally result in treatment with glucocorticoids and biologic agents, which then has the potential to cause disease progression that leads to increased morbidity and mortality. A new Case Record summarizes. An 80-year-old man presented with anorexia, weight loss, abdominal pain, diarrhea, and an ileocecal mass. 18F-fluorodeoxyglucose… Read More…

Mesenteric Ischemia

Posted by Carla Rothaus • March 11th, 2016

Although mesenteric ischemia is an uncommon cause of abdominal pain, accounting for less than 1 of every 1000 hospital admissions, an inaccurate or delayed diagnosis can result in catastrophic complications; mortality among patients in whom this condition is acute is 60 to 80%. Although mesenteric ischemia is uncommon, it can be life-threatening, and its recognition is… Read More…

Portal Hypertension

Posted by Carla Rothaus • March 4th, 2016

Portal hypertension, which is most often caused by cirrhosis, is seen frequently in medical practice. Noncirrhotic portal hypertension is much rarer, particularly in the developed world. A 54-year-old man presented to the emergency department with a 1-month history of edema in the lower legs and a 1-week history of upper abdominal pain. He also reported intermittent nausea,… Read More…

Uncomplicated Skin Abscess

Posted by Carla Rothaus • March 4th, 2016

Between 1993 and 2005, annual emergency department visits for skin and soft-tissue infections in the United States increased from 1.2 million to 3.4 million, primarily because of an increased incidence of abscesses. The primary treatment of a cutaneous abscess is drainage. Whether adjunctive antibiotics lead to improved outcomes in patients with uncomplicated abscesses or just… Read More…

Aspirin before Coronary Artery Surgery

Posted by Carla Rothaus • February 26th, 2016

Most patients with coronary artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing surgery, but it is unclear whether aspirin should be stopped before coronary artery surgery. Myles et al. used a 2-by-2 factorial trial design to randomly assign patients… Read More…

A Boy with Abdominal Cramping

Posted by Carla Rothaus • February 26th, 2016

Colorectal carcinoma is extremely uncommon in children. Hereditary cancer syndromes may confer a predisposition to colorectal carcinoma in children. A 10-year-old boy was seen in the gastroenterology clinic because of abdominal cramping and fevers. Abdominal imaging studies revealed circumferential thickening of a segment of the colonic wall and mesenteric lymphadenopathy. A diagnostic procedure was performed. A new Case… Read More…

Testosterone Treatment in Older Men

Posted by Carla Rothaus • February 19th, 2016

Testosterone concentrations in men decrease with increasing age. Many symptoms and conditions similar to those that are caused by low testosterone levels in men with pituitary or testicular disease become more common with increasing age. Such symptoms include decreases in mobility, sexual function, and energy. These parallels suggest that the lower testosterone levels in older… Read More…