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Clinical Problem-Solving
Whistling in the Dark
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 38-year-old woman living in…
- May 3, 2012
- Solomon D.A., Fanta C.H., Levy B.D., Loscalzo J.
- N Engl J Med 2012; 366:1725-1730
- CME
Shortness of breath, fever, and cough productive of yellow sputum developed in a 38-year-old woman soon after the birth of her third child. Although her symptoms initially resolved with antibiotics, an intermittent nonproductive cough, wheezing, and shortness of breath soon followed.
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Images in Clinical Medicine
Achalasia
Figure 1.
- April 12, 2012
- Jafferbhoy S. and Rustum Q.
- N Engl J Med 2012; 366:e23
- Free Full Text
A 43-year-old woman presented to the surgical clinic with an 8-month history of weight loss and progressive dysphagia to solids and liquids. She also had dyspepsia and depression.
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Interactive Medical Case
Whistling in the Dark
A 38-year-old woman in Florida presented to her primary care physician with shortness of breath, fever, and a cough productive of yellow sputum. She was treated empirically with antibiotics for a presumed respiratory tract infection, and her symptoms resolved. She returned a few weeks later with an…
- April 12, 2012
- Vaidya A., Solomon D.A., Fanta C.H.
- N Engl J Med 2012; 366:e24
- Free Full Text
- CME
A 38-year-old woman had shortness of breath, fever, and cough with yellow sputum soon after childbirth. Her symptoms initially resolved with antibiotics, but she soon had nonproductive cough, wheeze, and shortness of breath. Test your diagnostic and therapeutic skills at NEJM.org.
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Images in Clinical Medicine
Barium Aspiration
Figure 1.
- March 15, 2012
- Albeldawi M. and Makkar R.
- N Engl J Med 2012; 366:1038
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A 79-year-old man was evaluated for unintentional weight loss and dysphagia. He underwent a modified barium swallow.
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Images in Clinical Medicine
Lingual Thyroid
Figure 1.
- March 8, 2012
- Yu T.-Y. and Chang T.-C.
- N Engl J Med 2012; 366:e15
- Free Full Text
A 45-year-old woman presented with long-standing dyspnea, especially when lying down, and dysphagia in association with solid food. She had been diagnosed with hypothyroidism at 43 years of age, at which time levothyroxine replacement therapy was initiated.
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Images in Clinical Medicine
Hemotympanum
Figure 1.
- March 1, 2012
- Watanabe K.
- N Engl J Med 2012; 366:e14
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A 78-year-old man presented because of hearing loss and ear fullness after a head injury that had occurred during a walk 5 days earlier. Otoscopy of the left ear revealed a dark-bluish-purple eardrum, a finding suggestive of hemotympanum.
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Clinical Practice
Lichen Planus
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 53-year-old…
- February 23, 2012
- Le Cleach L. and Chosidow O.
- N Engl J Med 2012; 366:723-732
- CME
- Full Text Audio
Lichen planus, an inflammatory disease, tends to affect the skin and oral mucosa but may involve the nails, scalp, esophagus, and anogenital regions. Its various clinical presentations and treatment options are reviewed, including available data to guide management.
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Images in Clinical Medicine
Lingual Raynaud's Phenomenon
Figure 1.
- February 16, 2012
- Katada Y. and Tanaka T.
- N Engl J Med 2012; 366:e12
- Free Full Text
A 20-year-old woman presented with a report of tongue numbness. The patient had a long-standing history of Raynaud's phenomenon and had received a diagnosis of mixed connective-tissue disease; testing was positive for antinuclear and anti-...
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Images in Clinical Medicine
Perilymph Fistula Test
Figure 1.
- January 26, 2012
- Chu H. and Chung W.-H.
- N Engl J Med 2012; 366:e8
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A 42-year-old man presented with severe nausea and vertigo, which were precipitated by the application of pressure just anterior to the left external auditory canal. Otoscopic examination revealed a cholesteatoma arising from the pars flaccida of the left tympanic membrane.
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Original Article
CPAP for the Metabolic Syndrome in Patients with Obstructive Sleep Apnea
Obstructive sleep apnea is a highly prevalent but underrecognized clinical problem. The Wisconsin Sleep Cohort Study estimated a prevalence of 24% among men and 9% among women in that state. In an urban setting in northern India, the prevalence of obstructive sleep apnea and the obstructive sleep…
- December 15, 2011
- Sharma S.K., Agrawal S., Damodaran D., et al.
- N Engl J Med 2011; 365:2277-2286
Patients in this randomized, double-blind trial in India were treated for the obstructive sleep apnea syndrome with 3 months of continuous positive airway pressure (CPAP) or sham CPAP. CPAP therapy lowered blood pressure and ameliorated metabolic abnormalities.
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Internal-Carotid-Artery Dissection and Cranial-Nerve Palsies
Figure 1.
- December 8, 2011
- Peltz E. and Köhrmann M.
- N Engl J Med 2011; 365:e43
- Free Full Text
- Video
A 45-year-old woman presented to the emergency department 3 days after the acute onset of severe dysphagia, breathy dysphonia, and earache and pulsatile tinnitus in the left ear. Her medical history was unremarkable. Physical examination revealed leftward ...
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Images in Clinical Medicine
Persistent Stapedial Artery Visualized through a Perforated Tympanic Membrane
Figure 1.
- December 1, 2011
- Lollar K.W. and Bien A.G.
- N Engl J Med 2011; 365:e42
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- Video
A 29-year-old woman presented with a perforation of the right tympanic membrane secondary to previously placed tympanostomy tubes. The perforation was 25% of the size of the tympanic membrane. She also reported mild intermittent pulsatile tinnitus and hearing loss.
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Images in Clinical Medicine
Zoster of the Tympanic Membrane
Figure 1.
- November 17, 2011
- Watanabe K. and Funaki M.
- N Engl J Med 2011; 365:e40
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A 44-year-old man presented with severe right otalgia after an outbreak of a rash on the right side of his face. He had been treated for AML with cord-blood stem-cell transplantation 6 months earlier and had received immunosuppressive therapy with glucocorticoids.
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Images in Clinical Medicine
Lingual Zoster
Figure 1.
- November 3, 2011
- Lee C.-K. and Baek B.J.
- N Engl J Med 2011; 365:1726
- Free Full Text
A 72-year-old woman presented to the ER with white patches on the right side of her tongue and slight palsy on the right side of her face, reporting that the symptoms had developed 4 days earlier. She also reported dizziness, otalgia, nausea, and vomiting.
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Case Records of the Massachusetts General Hospital
Case 33-2011 — A 56-Year-Old Man with Hypophosphatemia
Presentation of Case. Dr. Eric Hesse (Harvard School of Dental Medicine): A 56-year-old man was seen in the outpatient endocrinology and oral-surgery clinics of this hospital because of recurrent hypophosphatemia. The patient had been well until 19 years earlier, when rib pain developed and a left…
- October 27, 2011
- Bergwitz C., Collins M.T., Kamath R.S., Rosenberg A.E.
- N Engl J Med 2011; 365:1625-1635
- CME
A 56-year-old man presented with recurrent bone pain, stress fractures, and hypophosphatemia. A tumor of the jaw had been resected in the past, with resolution of symptoms. Studies of the jaw revealed no recurrent tumor. Diagnostic tests were performed.
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Human Papillomavirus Lesions of the Oral Cavity
Figure 1.
- October 27, 2011
- Stoopler E.T. and Balasubramaniam R.
- N Engl J Med 2011; 365:e37
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A 49-year-old man who was HIV-positive and had type 2 diabetes presented with multiple papillary lesions in his mouth and throat. The lesions, which had developed 10 years earlier and had increased in size and number, had been evaluated but not diagnosed or treated.
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Images in Clinical Medicine
Myotonia of the Tongue
Figure 1.
- October 13, 2011
- Wang Z.J. and Huang X.S.
- N Engl J Med 2011; 365:e32
- Free Full Text
- Video
A 27-year-old woman presented with a 1-year history of progressive weakness and grip myotonia in both hands. There was no family history of any similar condition and no personal history of cataracts. Physical examination revealed weakness of the muscles ...
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Ectopic Tooth in the Maxillary Sinus
Figure 1.
- September 29, 2011
- Nisa L. and Giger R.
- N Engl J Med 2011; 365:1232
- Free Full Text
A 15-year-old boy was referred for evaluation of recurrent episodes of maxillary and dental pain accompanied by a purulent oral discharge. Examination revealed purulent material draining from a small opening in the gum next to the upper right maxillary first molar.
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Case Records of the Massachusetts General Hospital
Case 28-2011 — A 74-Year-Old Man with Pemphigus Vulgaris and Lung Nodules
Presentation of Case. Dr. Omobolaji T. Campbell (Infectious Diseases): A 74-year-old man was seen in the surgery clinic at this hospital for evaluation of lung nodules. A diagnosis of pemphigus vulgaris had been made 5 months earlier after a 2-month history of skin lesions that had progressed from…
- September 15, 2011
- Mylonakis E., Muse V.V., Mino-Kenudson M.
- N Engl J Med 2011; 365:1043-1050
- CME
A 74-year-old man with pemphigus vulgaris was referred to this hospital for evaluation of lung nodules. Imaging of the chest revealed multiple ill-defined nodules, some with marked ¹⁸F-fluorodeoxyglucose avidity. A diagnostic procedure was performed.
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Chemotherapy-Induced Hyperpigmentation of the Tongue
Figure 1.
- September 8, 2011
- Blaya M. and Saba N.
- N Engl J Med 2011; 365:e20
- Free Full Text
After undergoing breast lumpectomy and biopsy of the sentinel lymph nodes, a 42-year-old woman with invasive ductal carcinoma began adjuvant chemotherapy. After the second cycle, asymptomatic hyperpigmented macules and patches were noted on the patient's tongue.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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