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Displaying 331 - 340 of 7513 in ACP Online

From the Trenches

“National Physician Burnout Study: Latest Statistics on Burnout in Healthcare and Doctor Well-Being” Burnout in medicine: When was burnout at its peak for doctors? Why are doctors so burnt out? What causes burnout in health care? Is there a National Burnout Study? From the latest episode of AMA Update, Michael Tutty, PhD, group vice president of Professional Satisfaction and Practice Sustainability at the American Medical Association.

July 18, 2025

ACP Well-being Champions: Cultivating Connections in Uncertain Times

Patients Before Paperwork

Patients Before Paperwork Update:

Noteworthy Resources

New! Group Coaching for ACP Well-being Champions

New ACP Webinars

Resident Well-being During the COVID-19 Pandemic Irene Alluen-Metzner, MD, FACP; Suja Mathew, MD, FACP; Benjamin Mba, MBBS, FACP Wednesday, July 22, 2020, 3:00–4:00 p.m. ET

In the News

“Doctors are Covid's First Historians,” The New York Times By Ron Suskind, Illustrations by Lilli Carré, June 12, 2020 Over 40 physicians from NewYork–Presbyterian and Massachusetts General Hospital recorded 10-minute conversations with colleagues discussing their experiences, fears, and hopes as they battle the COVID-19 pandemic.

From the Trenches

Moving Professionalism and Wellness Into the Formal Residency Curriculum By Arielle Berger, MD, ACP Well-being Champion, Ontario

July 17, 2020

In these times of crisis, a community of well-being is increasingly important.

Patients Before Paperwork

The Centers for Medicare & Medicaid Services (CMS) recently posted additional FAQs for the Interoperability and Patient Access Final Rule. ACP was supportive of these efforts, as the FAQs are based on stakeholder feedback and provide current information about the policies included in the final rule.

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Displaying 331 - 340 of 500 in Annals of Internal Medicine: Clinical Cases

Thinker's Sign | Annals of Internal Medicine: Clinical Cases

Thinker's sign, also called the Dahl sign, is a dermatologic sign of chronic obstructive pulmonary disease (COPD), characterized by hyperpigmented, bilateral, callused patches triggered by continuous tripod posture. It also can be associated with bilateral hyperkeratosis and hyperpigmentation of the forearms and elbows. Although the incidence of thinker's sign in severe COPD has not been well established, its potential diagnostic value is worth noting, as it can unmask the magnitude of the underlying disease. We report the case of a Honduran Garifuna woman with thinker's sign on both thighs and elbows, associated with clinical features of COPD.

Thinking Twice About Benzodiazepines: Treatment of Progressive Dementia in a Hospitalized Patient | Annals of Internal Medicine: Clinical Cases

Catatonia is an illness that overlaps with depression, dementia, and delirium, creating a diagnostic challenge. We present a case of catatonia in an older patient who initially presented with hypoactive delirium and who was later determined to have progressive dementia. Her physical examination showed signs of echopraxia, mitmachen, mutism, staring, a withdrawn affect, and a marked response to lorazepam, leading to the diagnosis of catatonia. An extensive work-up for an underlying cause was unrevealing. Catatonia was thought to be related to underlying Lewy body dementia in this patient. Our case illustrates the importance of early recognition of catatonia, especially in older patients.

Fatal Disseminated Mucormycosis Presenting With Pneumomediastinum in a Patient With Diabetic Ketoacidosis and Methicillin-Resistant Staphylococcus aureus Bacteremia | Annals of Internal Medicine: Clinical Cases

Mucormycosis is a potentially fatal infection that may invade distinct organ systems. We present the case of a 21-year-old man with type I diabetes and recurrent diabetic ketoacidosis who developed disseminated mucormycosis with rhinocerebral and pulmonary involvement. Mucormycosis infection was confirmed through pathology samples obtained from nasal secretion and subsequent surgical debridement. Pneumomediastinum appears to be exceedingly rare in the setting of this infection, with only 2 previous cases presenting with such a finding, to our knowledge. Our patient developed extension of the infection into the brain despite medical and surgical therapy. He died soon after being discharged to hospice on day 31.

Scolex on the Brain: Intraventricular Neurocysticercosis | Annals of Internal Medicine: Clinical Cases

Neurocysticercosis is a parasitic infection caused by the pork tapeworm Taenia solium. Intraventricular neurocysticercosis develops when cysticerci become lodged in the ventricular outflow tract, which occurs in 10% to 20% of cases. Identification of a scolex within a cystic lesion is pathognomonic. Neurosurgical consultation is recommended to determine the appropriate operative course. When possible, removal of cysticerci using an endoscopic approach is recommended. We present a case of a 22-year-old woman from Honduras who was found to have obstructive hydrocephalus secondary to intraventricular neurocysticercosis and was treated successfully with shunt placement followed by medical therapy.

Listeria monocytogenes Spontaneous Bacterial Peritonitis: A Rare Entity | Annals of Internal Medicine: Clinical Cases

Spontaneous bacterial peritonitis (SBP) is a common complication of ascites, with a high mortality rate reported. Listeria is a rare cause of SBP and is diagnosed by positive ascitic culture. Growth of the bacteria may take up to 4 days. Routine SBP treatment using third-generation cephalosporins will not cover Listeria, causing a delay in treatment and increase in mortality. In patients with SBP who are not improving clinically within 48 hours, it is important to rule out secondary causes of peritonitis, such as viscus perforation or intra-abdominal abscess. It is also crucial to expand antibiotic coverage. Treatment involves ampicillin with or without aminoglycosides.

Miliary Tuberculosis Presenting With Meningitis, Tuberculomas, Osteomyelitis, Psoas Abscesses, and Pulmonary Involvement | Annals of Internal Medicine: Clinical Cases

Tuberculosis (TB) is endemic in many areas of the world and is a leading infectious cause of death in adults globally. Miliary TB can affect multiple organs and systems. This case report describes a patient with miliary TB that affected the central nervous system, lumbar spine, psoas muscles, and lungs. We highlight the diagnosis and management of miliary TB with central nervous system involvement.

Systemic Transthyretin Amyloidosis With Concomitant Cardiopulmonary Involvement: A Case Report | Annals of Internal Medicine: Clinical Cases

Systemic amyloidosis is an uncommon disease that includes light chain and transthyretin amyloidosis. In the early years, cardiopulmonary systemic amyloidosis had poor outcomes attributable to delayed diagnosis. Recent advances have enabled early diagnosis and newer treatment options. Our patient presented with chronic dyspnea initially attributed to congestive heart failure, but findings from a repeat echocardiogram raised concerns for cardiac amyloidosis. Further work-up of dyspnea revealed alveolar-septal pulmonary amyloidosis. A diagnosis of transthyretin cardiac amyloidosis was made by Tc-99m pyrophosphate single-photon emission computed tomography/computed tomography. He improved symptomatically on tafamidis. A strong clinical suspicion of amyloidosis can lead to early diagnosis, treatment, and better outcomes.

Ibrutinib and Neurolisteriosis: Simple Coincidence? | Annals of Internal Medicine: Clinical Cases

Listeria monocytogenes is an opportunistic food-borne pathogen that can cross the blood–brain barrier and infect the central nervous system, causing potentially life-threatening neurolisteriosis, including brain abscess. Ibrutinib is a potent and irreversible small-molecule inhibitor of Bruton's tyrosine kinase. It has demonstrated efficacy in the treatment of various lymphoid cancers, and its use has increased exponentially in recent years. We describe here a case of neurolisteriosis in a patient treated with ibrutinib for chronic lymphoid leukemia and discuss the potential pathogenesis.

Spontaneous Pneumomediastinum as the Result of Marijuana Use | Annals of Internal Medicine: Clinical Cases

Spontaneous pneumomediastinum is the pathologic presence of extraluminal gas within the mediastinum with an unclear cause. It typically has a spontaneously resolving course and has been associated increasingly with marijuana use, coinciding with the growing prevalence of marijuana use. Several proposed causative mechanisms include Valsalva and Müller maneuvers, associated vomiting, and induced physiologic changes. We present a case of a 37-year-old man with a medical history of alcohol and marijuana use disorder who presented with intractable vomiting and intermittent hematemesis and was found to have spontaneous pneumomediastinum.

Intracardiac Sarcoma Arising From Metastasis of a Primary Phyllodes Tumor of the Breast | Annals of Internal Medicine: Clinical Cases

A 57-year-old woman with a malignant phyllodes tumor of the breast and recent bilateral pulmonary emboli presented with an incidental intracardiac mass on transthoracic echocardiography. Because of concern for clot burden aspiration, thrombectomy was performed. Pathology findings were consistent with spindle-cell sarcoma and histologically similar to the malignant phyllodes breast tumor. Current treatment strategies for this condition include chemotherapy and surgery. Aspiration thrombectomy typically is performed for retrieval of venous thromboemboli; however, our case suggests the procedure may be another diagnostic and therapeutic option for malignant cardiac tumors.

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