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 Woman with a Pleural Effusion

Posted by • June 16th, 2016

A 52-year-old woman presented with a unilateral pleural effusion. Several weeks later, uterine bleeding, pelvic fullness, and bloating developed. Magnetic resonance imaging revealed a large pelvic mass. Diagnostic procedures were performed. A new Case Record of the Massachusetts General Hospital summarizes. Clinical Pearl • What is the most common benign solid ovarian tumor? Although only 4% of all ovarian masses… Read More…

Upper Gastrointestinal Bleeding

Posted by • June 16th, 2016

Peptic ulcers, which are primarily due to Helicobacter pylori infection or the use of nonsteroidal antiinflammatory drugs (NSAIDs), occur in the stomach or duodenum and are the most frequent cause of upper gastrointestinal bleeding. Most patients who are hospitalized with upper gastrointestinal bleeding should undergo endoscopy within 24 hours, after appropriate resuscitation and transfusion to… Read More…

A Woman with Dyspnea

Posted by • June 10th, 2016

Bronchiolitis is a disease of the small airways, which are defined as airways less than 2 mm in diameter and without cartilage. The bronchioles are especially vulnerable to infectious or inhalational insults because of their narrow diameter. A 60-year-old woman was seen in a pulmonary clinic because of increasing dyspnea. Chest imaging revealed bronchiectasis and mild,… Read More…

Ablation for Paroxysmal Atrial Fibrillation

Posted by • June 10th, 2016

According to a 2012 expert consensus statement, catheter ablation of drug-refractory paroxysmal atrial fibrillation is a class I level A indication, and pulmonary-vein isolation is the standard approach. Kuck et al. conducted a randomized trial to compare the performance of the rather complex yet well-established approach of radiofrequency ablation with that of the apparently simpler… Read More…

The Hidden Lesion

Posted by • June 3rd, 2016

The repeated occurrences of clots involving the veins in the proximal left leg raise suspicion for the May–Thurner syndrome (compression of the left iliac vein by the overlying right iliac artery). A 24-year-old woman presented to the ED with pain in the left leg. She had been training for a 5-km race when, 2 days before presentation,… Read More…

Catheter-Associated Urinary Tract Infection

Posted by • June 3rd, 2016

Catheter-associated urinary tract infection (UTI) is a common device-associated infection in the United States and one of the most common health care–associated infections worldwide. Preventing health care–associated infection in general, and catheter-associated UTI in particular, has emerged as a priority in the United States, with government agencies taking a lead role. The Agency for Healthcare… Read More…

Cryptogenic Stroke

Posted by • May 27th, 2016

Cryptogenic ischemic strokes are symptomatic cerebral infarcts for which no probable cause is identified after adequate diagnostic evaluation. In general, the percentage of ischemic strokes that are classified as cryptogenic has declined over time as diagnostic testing has advanced. However, stroke that is cryptogenic after a standard diagnostic evaluation remains a common clinical challenge, accounting… Read More…

A Pregnant Woman with Fever

Posted by • May 27th, 2016

Listeriosis is a rare but notorious cause of chorioamnionitis. Listeriosis is caused by Listeria monocytogenes, an environmentally ubiquitous, facultative, anaerobic gram-positive bacillus. In humans, listeriosis is almost exclusively a foodborne disease, and unheated processed meats and unpasteurized soft cheeses can be contaminated with listeria; pregnant women should avoid eating such foods. Listeriosis is a nationally… Read More…

A Man with Olfactory Hallucinations

Posted by • 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 • 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…