IMAGES IN CLINICAL MEDICINE Spontaneous Oral Purpura in Immune Thrombocytopenia Jakob L. Drivenes, Anette Bygum N Engl J Med 2024; 390:1029DOI: 10.1056/NEJMicm2312260 A 76-year-old man presented to the dermatology clinic with a 2-day history of blood-filled blisters on the tongue. The lesions had appeared suddenly without antecedent trauma. He reported no other bleeding symptoms. The physical examination was notable for multiple hemorrhagic bullae on the t...

IMAGES IN CLINICAL MEDICINE Green Dialysis Effluent and Plasma Bao-ping Xu, Xiao-tao Wang N Engl J Med 2024; 390:e27DOI: 10.1056/NEJMicm2311085 A 72-year-old man with end-stage kidney disease who began receiving continuous renal-replacement therapy in the intensive care unit (ICU) was noted to have green-colored dialysis effluent and plasma. Seven hours earlier, the patient had presented to the emergency department with a gastrointestinal perforation. An e...

JAMA Clinical Challenge  October 30, 2023 Coin-Shaped Opacities in the Stomach Neil Shadbeh Evans, Paul Aronowitz, Timothy E. Albertson JAMA. 2023;330(20):2016-2017. doi:10.1001/jama.2023.19032 Case A50-year-old man with end-stage kidney disease receiving hemodialysis was admitted to the hospital for treatment of calciphylaxis and foot cellulitis. His home medications included sevelamer and hydrocodone-acetaminophen (10...

JAMA Clinical Challenge  October 30, 2023 Coin-Shaped Opacities in the Stomach Neil Shadbeh Evans, Paul Aronowitz, Timothy E. Albertson JAMA. 2023;330(20):2016-2017. doi:10.1001/jama.2023.19032 Case A50-year-old man with end-stage kidney disease receiving hemodialysis was admitted to the hospital for treatment of calciphylaxis and foot cellulitis. His home medications included sevelamer and hydrocodone-acetaminophen (10...

Basics of Volumetric Capnography ‑ Part 2: Single Beath CO2 Analysis Anatomical dead space, alveolar dead space, and CO2 elimination: Learn how they can give you an insight into the patient's lung condition. Single breath CO2 analysis: insight into the patient‘s lung condition The volumetric capnogram can also be divided into three areas: Area X ‑ CO2 elimination Area Y ‑ Alveolar dead space Area Z ‑ Anatomical dead space The size of the areas, ...

JAMA Clinical Challenge  October 6, 2023 Peripheral Blasts in a Patient Receiving Chemotherapy Sabin Kshattry, Terri L. Parker, Scott F. Huntington JAMA. 2023;330(16):1581-1582. doi:10.1001/jama.2023.17117 Case An 80-year-old man with stage II bladder carcinoma (T2NXM0) and atrial fibrillation treated with apixaban presented to the emergency department with 1 week of fatigue and 2 days of dyspnea on exertion. One week p...

JAMA Clinical Challenge  October 6, 2023 Peripheral Blasts in a Patient Receiving Chemotherapy Sabin Kshattry, Terri L. Parker, Scott F. Huntington JAMA. 2023;330(16):1581-1582. doi:10.1001/jama.2023.17117 Case An 80-year-old man with stage II bladder carcinoma (T2NXM0) and atrial fibrillation treated with apixaban presented to the emergency department with 1 week of fatigue and 2 days of dyspnea on exertion. One week prior to presentation, he recei...

Guide to Statistics and Methods  Surgical Education Research January 3, 2024 Practical Guide to Common Flaws With Surgical Education Research Dimitrios Stefanidis, Laura Torbeck, Amy H. Kaji JAMA Surg. Published online January 3, 2024. doi:10.1001/jamasurg.2023.6675 Introduction Over the past 2 decades, surgical education literature has seen tremendous growth driven by changes in graduate medical education,...

IMAGES IN CLINICAL MEDICINE Constrictive Pericarditis Meghan Nahass, John Kassotis N Engl J Med 2023; 389:2087DOI: 10.1056/NEJMicm2301671 A 69-year-old woman presented to the emergency department with a 3-year history of dyspnea on exertion. She had a history of focal pleural plaques that had been attributed to asbestos exposure that occurred during her work at an insulation-manufacturing company. Physical examination was notable for signs of volume overlo...

IMAGES IN CLINICAL MEDICINE Transverse Leukonychia (Mees’ Lines) Annabel M. Follows, George A. Follows N Engl J Med 2023; 389:e48DOI: 10.1056/NEJMicm2304533 A 30-year-old man presented to the hematology clinic with a 4-month history of white lines across his fingernails. Five months before presentation, he had received a diagnosis of primary mediastinal large B-cell lymphoma and began to receive systemic chemotherapy. The nail changes had first appeared mi...