Professor Brian Andrews NEJM Recommendations for Medical Students and
Tutors
Week of the 10th December 2015 (#20)
University of Notre Dame Australia
(Fremantle Campus)
Occasional Editorial
Comments
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MUST READ SECTION
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Articles Recommended for Medical Students
IMAGES
IN CLINICAL MEDICINE
Cullen’s and Grey Turner’s Signs in Acute
Pancreatitis
These signs are talked
about frequently but uncommonly seen by students.
Required learning: Acute pancreatitis (presentation, common causes
and management – but don’t forget the rare autoimmune pancreatitis associated
with the IgG4 syndromes), SIRS, MODS.
Look for Sister Mary Joseph's nodule in previous Images in Clinical Medicine
CLINICAL
PRACTICE
Thyroid
Nodules
A very important area
which is a frequent OSCI topic for the head and neck examination.
This area is covered
in pathology, various lectures in medicine, surgery and ENT and is one of the
case studies covered in MED300 medicine rotation cases.
Recommended learning:
Examination of the
head and neck (don’t forget the examination of oral cavity, pharynx, sinuses,
larynx and scalp), anatomy of lymphatic drainage and approaches to “lumps in
the neck.”
Examination of the
thyroid, thyrotoxicosis and approach to thyroid nodules
CLINICAL
IMPLICATIONS OF BASIC RESEARCH
The Immune Response — Learning to Leave Well
Enough Alone
This article is
written by Dr. Jim Rosenbaum who is a rheumatologist and ophthalmologist at the
University of Oregon, Portland. He is a world authority on systemic and
autoimmune diseases involving the eye and provides a precise overview on
concepts of autoimmunity and autoinflammation which is easy to understand.
CORRESPONDENCE
Ischemic Limb Gangrene with Pulses
Recommended learning: Review the causes of ischaemic limb
gangrene with and without palpable pulses. Good Figure and case with pictures
Important Articles Related to Mechanisms of Disease and
Translational Research
None
Other areas which should be of interest to medical students
CASE
RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL
Case 38-2015 — A 21-Year-Old Man with Fatigue
and Weight Loss
http://www.nejm.org/doi/full/10.1056/NEJMcpc1506821
An interesting case of metastatic
non-seminomatous germ-cell tumour of the testis with extremely high levels of
hCG causing gynaecomastia and thyrotoxicosis with discussion of the mechanisms.
Recommended learning: Review testicular tumours, types and
management and swellings within the scrotum.
EDITORIAL
Scabies and Global Control of Neglected
Tropical Diseases
ORIGINAL ARTICLE
Mass Drug Administration for Scabies Control in
a Population with Endemic Disease
http://www.nejm.org/doi/full/10.1056/NEJMoa1500987
This is a very significant population study (from
Sydney, Melbourne, Darwin and Fiji) on scabies and secondary impetigo on three
Fijian islands, each with a scabies prevalence ranging from 32.1 to 49%!! Participants on the three islands were
treated respectively with permethrin to a) patients and contacts, b) mass
administration of permethrin and c) mass administration of ivermectin.
Prevalence of scabies fell respectively to 18.8%, 15.8% and 1.8% at 12 months with a similar
proportional fall in the prevalence pf impetigo. This is a major study with
significance public health implications for developing countries.
Recommended learning: Identification of scabies infection, the populations
affected and the management.
Perspective
My Life as a (Fake) Patient
http://www.nejm.org/doi/full/10.1056/NEJMp1508706
An interesting perspective
from a professional standardized patient and when she becomes a real patient.
