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.

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…

Syndromes of Thrombotic Microangiopathy

Posted by Sara Fazio • August 15th, 2014

A new review article covers the diverse pathophysiological pathways that can lead to microangiopathic hemolytic anemia and a procoagulant state with or without damage to the kidneys and other organs. An interactive graphic shows the nine primary syndromes of thrombotic microangiopathy (TMA), and narrated animations describe the causes, clinical features, initial management, and underlying mechanisms… Read More…

37-Year-Old Man with Ulcerative Colitis and Bloody Diarrhea

Posted by Sara Fazio • August 15th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 37-year-old man with ulcerative colitis was admitted to the hospital because of abdominal cramping, diarrhea, hematochezia, fever to a peak temperature of 38.8°C, and drenching night sweats. Several weeks earlier, he had performed home fecal transplantation. Bloody diarrhea is characteristic of infections caused by… Read More…