Posts Tagged ‘NEJM’

A New Combination Therapy to Help Prevent COPD Exacerbations?

Posted by • June 8th, 2016

You walk into your office to see, once again, Mr. Jones, at 64-year-old male who suffers from chronic obstructive pulmonary disorder (COPD). Mr. Jones is recovering from a recent visit to the ED due to his third COPD exacerbation event this year. He’s frustrated with his recurrent COPD exacerbations, and wants to know if his… Read More…

Knife and Gun Club: The Rez Edition

Posted by • June 7th, 2016

In 1989, Eugene Richards published the visual chronicle of scenes from the Denver Country Hospital Emergency Department.  Anyone who has worked in an emergency department (ED) would recognize the grainy photos that put on display the gruesome injuries that people incur as a result of senseless violence. Let’s face it — in addition to unscheduled primary… Read More…

Catheter-Associated Urinary Tract Infections

Posted by • June 2nd, 2016

In your role as Unit Medical Director, you regularly meet with nursing leadership for 6-West.  Today, they bring to your attention several cases from the last month: a 67-year old female admitted for severe pneumonia who initially rapidly improved on antibiotics, but then developed a new fever and was found to have a urinary tract… 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…

Primary Prevention of Cardiovascular Events — A Pragmatic Approach

Posted by • May 25th, 2016

Ms. Barnstable is a 66 year-old woman who is seeing you for an annual physical check-up today.  She does not take any medications and is a smoker.  She asks if there are drugs that she should be taking to lower her risks for heart attacks and strokes. Besides smoking cessation counseling, what do you tell… 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…

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Posted by • May 18th, 2016

Whether you are a resident on the cardiology, surgery, or general medicine service, encountering patients with atrial fibrillation is common. Many patients, particularly after cardiac surgery, go in and out of atrial fibrillation so often that residents caring for them often ignore the blinking lights and loud alarms from telemetry machines after a while. However,… Read More…

A Woman with Psychosis

Posted by • May 13th, 2016

The combination of malabsorption and autoimmunity strongly suggests the possibility of celiac disease, which is not always associated with gastrointestinal symptoms. Although neurologic and psychiatric symptoms of celiac disease are not widely recognized, they have been reported. Examination of a 37-year-old woman with adult-onset psychosis revealed weight loss, a thyroid nodule, anemia, and micronutrient deficiencies. Diagnostic tests… Read More…