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 Boy with Respiratory Distress

Posted by Carla Rothaus • April 17th, 2015

In the latest Case Record of the Massachusetts General Hospital, a newborn boy was admitted to the hospital because of respiratory distress and hypotension. At delivery, meconium was suctioned from the airway. Respiration and blood pressure improved after intervention, but lethargy and myoclonus developed. Neonatal brain tumors are often not apparent in utero; only 18%… Read More…

Clostridium difficile Infection

Posted by Carla Rothaus • April 17th, 2015

A new review article on Clostridium difficile Infection covers the pathogenesis, epidemiology, diagnosis, and treatment of this nosocomial and potentially fatal infectious diarrhea, as well as the associated risk factors. New treatments include fecal microbiota transplantation for disease that is resistant to vancomycin. Clostridium difficile is an anaerobic gram-positive, spore-forming, toxin-producing bacillus that is transmitted… Read More…

Inflammatory Bowel Disease

Posted by Carla Rothaus • April 9th, 2015

A new review article covers the wide range of cancers associated with inflammatory bowel disease and the drugs used to manage them. Surveillance recommendations are presented. Cancers complicating inflammatory bowel disease can be attributed to chronic intestinal inflammation or to the carcinogenic effects of the immunosuppressive drugs used to treat inflammatory bowel disease. Clinical Pearls -… Read More…

A Woman with Headache and Fever

Posted by Carla Rothaus • April 9th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 28-year-old woman was seen in the emergency department of this hospital because of the acute onset of headache, fever, rash, and myalgias. On examination, she had petechiae on the chest, abdomen, and thighs and a purpuric lesion on the right shoulder. Neisseria meningitidis is… Read More…

Emergency Contraception

Posted by Carla Rothaus • April 3rd, 2015

Ulipristal and levonorgestrel pills are the most commonly used form of emergency contraception; ulipristal is slightly more effective, but levonorgestrel is available over the counter in the United States. The most effective approach is insertion of a copper IUD.  Read the new Clinical Practice review article on Emergency Contraception. Unintended pregnancy is common; in 2008,… Read More…

Community-Acquired Pneumonia in Adults

Posted by Carla Rothaus • April 3rd, 2015

Antimicrobial choices for community-acquired pneumonia in hospitalized patients who do not require ICU-level care continue to be debated. In a new trial, empirical beta-lactam–based therapy with or without a macrolide was compared with fluoroquinolones as initial treatment. The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to… Read More…

Sciatica

Posted by Carla Rothaus • March 27th, 2015

Pain that extends from the buttock down the course of the sciatic nerve is common. Nearly 85% of cases are associated with a disk disorder. The causes, assessment, and management of sciatica are discussed in a new review article. The mundane malady sciatica has been known to physicians since antiquity. It is defined as pain… Read More…

A Girl with Graves’ Disease

Posted by Carla Rothaus • March 27th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 15-year-old girl with Graves’ disease was admitted to the hospital because of psychotic symptoms — including depression, hallucination, and suicidal thoughts — that began approximately 2 months after treatment with methimazole had been initiated. Before a diagnosis of primary mood disorder can be made,… Read More…

Uncomplicated Skin Infections

Posted by Carla Rothaus • March 20th, 2015

Uncomplicated skin infections are a common outpatient clinical problem. In a randomized, controlled trial, clindamycin and trimethoprim–sulfamethoxazole (TMP-SMX) were compared as outpatient therapy for uncomplicated cellulitis or abscess. Results of cultures of skin-infection lesions in the United States have shown that most of the infections are caused by methicillin-resistant Staphylococcus aureus (MRSA), but the most… Read More…

A Man with Progressive Neurologic Decline

Posted by Carla Rothaus • March 20th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 31-year-old man was seen in the neurology clinic because of personality changes and neurologic decline of 3 years’ duration. Previous imaging studies showed mild atrophy in the frontal lobes. He could not speak or follow commands. Additional diagnostic testing was performed. Frontotemporal dementia is… Read More…