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.

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… 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… 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… Read More…

A Girl with Seizures

Posted by Carla Rothaus • May 22nd, 2015

In the latest Case Record of the Massachusetts General Hospital, a 9-year-old girl presented to the emergency department with loss of consciousness and a seizure. She had returned from a trip to Puerto Rico 3 weeks earlier. Unilateral inguinal lymphadenopathy was present, and rapidly progressive encephalopathy developed. The diagnosis of cat scratch disease is based… Read More…

Refractory Metastatic Colon Cancer

Posted by Carla Rothaus • May 15th, 2015

TAS-102, a combination of trifluridine and tipiracil in which tipiracil interferes with the deactivation of trifluridine, improved overall and progression-free survival in patients whose disease had progressed after treatment with fluorouracil-containing drug combinations. A new Original Article assesses the efficacy and safety of TAS-102 in a global population of such patients. Early clinical trials conducted… Read More…

Appendectomy or “Antibiotics First”

Posted by Carla Rothaus • May 15th, 2015

Prompt appendectomy is generally recommended for uncomplicated appendicitis. Randomized trials comparing appendectomy with an antibiotics-first strategy have shown similar complication rates but substantial crossover to or later need for appendectomy with the latter strategy.  A new Clinical Practice review article covers this topic. A major uncertainty in the management of appendicitis is whether an appendectomy… Read More…

Iron-Deficiency Anemia

Posted by Carla Rothaus • May 8th, 2015

Iron-deficiency anemia is the most common form of anemia in the world. A new review article covers the global nature of the disease, iron homeostasis in normal and iron-deficient states, clinical findings, treatment, and causes of iron-resistant iron deficiency. Iron is crucial to biologic functions, including respiration, energy production, DNA synthesis, and cell proliferation. Although… Read More…

Sick as a Dog

Posted by Carla Rothaus • May 8th, 2015

In the latest Clinical Problem-Solving article, a 42-year-old man presented to an emergency department in rural Colorado with a 2-day history of fever, cough with scant hemoptysis, chest pain, and myalgias. He reported no sick contacts and no oropharyngeal or gastrointestinal symptoms, rashes, or lymphadenopathy. Yersinia pestis is a gram-negative, facultatively anaerobic bacillus or coccobacillus… Read More…

Inflammatory Muscle Diseases

Posted by Carla Rothaus • May 1st, 2015

The four main types of inflammatory muscle disease — dermatomyositis, polymyositis, necrotizing autoimmune myositis, and inclusion-body myositis — are summarized in a new review article. Pathogenesis, differential diagnosis, and treatment approaches are discussed. The inflammatory myopathies constitute a heterogeneous group of disorders that are best classified, on the basis of distinct clinicopathologic features, as four… Read More…

A Woman with Shortness of Breath

Posted by Carla Rothaus • May 1st, 2015

In the latest Case Record of the Massachusetts General Hospital, a 58-year-old woman presented with an 8-month history of shortness of breath on exertion. Previous chest imaging had shown pleural thickening and peripheral nodules in the upper lung zones, without lymphadenopathy. A diagnostic procedure was performed. When a pulmonologist is presented with a case of… Read More…