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 Boy with Coughing Spells

Posted by Carla Rothaus • February 20th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 16-year-old boy presented with a 3-week history of cough and nasal congestion and a 3-day history of severe coughing spells, post-tussive emesis, and trouble breathing. A chest radiograph was normal. A diagnostic test was performed. Since the mid-1980s, there has been a gradual upward… Read More…

Groin Hernias in Adults

Posted by Carla Rothaus • February 20th, 2015

Watchful waiting is safe for men with asymptomatic inguinal hernias, but data from randomized trials suggest that most men will ultimately undergo surgery, primarily because of pain. Watchful waiting is not recommended in women, given their higher prevalence of femoral hernias. Read the new Clinical Practice review on this topic. The lifetime risk of development… Read More…

Exercise-Induced Bronchoconstriction

Posted by Carla Rothaus • February 13th, 2015

Asthma or asthma-like conditions can limit the ability of athletes to perform. This article reviews the diagnosis and treatment of asthma and exercise-induced bronchoconstriction in athletes. The term exercise-induced bronchoconstriction describes the transient narrowing of the airways after exercise, a phenomenon that occurs frequently among athletes who may not have a diagnosis of asthma or… Read More…

Smoking and Mortality

Posted by Carla Rothaus • February 13th, 2015

Using data from five U.S. cohort studies, the authors of a new report estimate that 17% of excess mortality among smokers is due to diseases not already established as caused by smoking; for example, renal failure, infections, and intestinal ischemia could potentially be linked to smoking. Mortality among current smokers is 2 to 3 times… Read More…

Gastrointestinal Bleeding

Posted by Carla Rothaus • February 6th, 2015

In the latest Clinical Problem-Solving article, a 66-year-old man with ischemic cardiomyopathy presented to the hospital with a 2-day history of fatigue, dizziness on standing, and bright red blood from the rectum that transitioned to black, tarry stools. Angioectasias are increasingly recognized in patients with either pulsatile or nonpulsatile left ventricular assist devices (LVADs). Clinical Pearls… Read More…

Diabetic Ketoacidosis

Posted by Carla Rothaus • February 6th, 2015

The latest review in the Fluids and Electrolytes series focuses on the safe removal of excess hydrogen ions, the administration of sodium bicarbonate, and the possible contribution of intracellular acidosis to the development of cerebral edema in patients with diabetic ketoacidosis. Several of the issues facing clinicians who care for patients with diabetic ketoacidosis are related… Read More…

Control of Hypertension in Pregnancy

Posted by Carla Rothaus • January 30th, 2015

In a trial comparing less-tight control of hypertension (target diastolic blood pressure, 100 mm Hg) with tight control (85 mm Hg) among pregnant women, rates of pregnancy loss, high-level neonatal care, and serious maternal complications were similar between groups. Blood-pressure targets for women with nonsevere hypertension during pregnancy are much debated. Relevant randomized, controlled trials have been… Read More…

Allergic Rhinitis

Posted by Carla Rothaus • January 30th, 2015

Allergic rhinitis is common and is often associated with asthma. Treatment includes intranasal glucocorticoids, oral and nasal antihistamines, leukotriene-receptor antagonists, and, when pharmacotherapy is not effective or produces unacceptable side effects, allergen immunotherapy. Read the latest Clinical Practice review on this topic. The frequency of sensitization to inhalant allergens is increasing and is now more than 40%… Read More…

Abdominal Pain, Dyspnea, and Diplopia

Posted by Carla Rothaus • January 27th, 2015

Peripheral causes of acute generalized weakness include motor neuronopathies, acute acquired polyneuropathies, myopathies, and presynaptic and postsynaptic neuromuscular-transmission disorders. Clinical Pearls – Is botulism a presynaptic or postsynaptic neuromuscular-transmission disorder? Botulism is a toxin-mediated disease that results in the presynaptic blockade of acetylcholine transmission across the neuromuscular junction.  – What is adult intestinal toxemia? Adult intestinal… Read More…

PD-1 Blockade with Nivolumab

Posted by Carla Rothaus • January 23rd, 2015

Preclinical studies suggest that Reed-Sternberg cells exploit the programmed death 1 (PD-1) pathway to evade immune detection. An ongoing phase 1 study tests the hypothesis that nivolumab, a PD-1-blocking antibody, can inhibit tumor immune evasion in patients with relapsed or refractory Hodgkin’s lymphoma. Clinical Pearls – How do tumors exploit the PD-1 [programmed death 1] pathway?… Read More…