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...

IMAGES IN CLINICAL MEDICINE Venous Thoracic Outlet Syndrome Sang Jun Park, Hyun Jin Cho N Engl J Med 2023; 389:e32DOI: 10.1056/NEJMicm2301198 A 36-year-old woman was referred to the thoracic surgery clinic after she had presented with a 3-week history of swelling and bluish discoloration of the left arm and hand that occurred when she raised her arms (Panel A). The symptoms started after she had spent 10 days typing at a desk. Computed tomography of the ch...

Abdominal Pain and Hypotension in a 70-Year-Old Woman Educational ObjectiveBased on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis. Case A 70-year-old woman with hypertension, atrial fibrillation, congestive heart failure, and gallstones presented to the emergency department with 3 days of nausea, vomiting, and abdominal pain. She reported no hematemesis, hematochezia, or melena and had no history of abdominal s...

Abdominal Pain and Hypotension in a 70-Year-Old Woman Educational ObjectiveBased on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis. Case A 70-year-old woman with hypertension, atrial fibrillation, congestive heart failure, and gallstones presented to the emergency department with 3 days of nausea, vomiting, and abdominal pain. She reported no hematemesis, hematochezia, or melena and had no history of abdominal s...

JAMA Diagnostic Test Interpretation  August 21, 2023 Multistep Testing Algorithms for Clostridioides difficile Infection Maribeth R. Nicholson, Curtis J. Donskey JAMA. Published online August 21, 2023. doi:10.1001/jama.2023.15875 Case A10-year-old female with spina bifida and neurogenic bowel was hospitalized for abdominal pain, dehydration, and more than 20 episodes of watery diarrhea per day. Her symptoms be...

Teachable Moment  August 14, 2023 Mild Transaminase Elevation With Rapid Diagnostic Escalation: A Teachable Moment Priyal Gandhi, Niloofar Latifi JAMA Intern Med. Published online August 14, 2023. doi:10.1001/jamainternmed.2023.3884 Story From the Front Lines A33-year-old woman with well-controlled hypertension and body mass index of 21 (calculated as weight in kilograms divided by height in meters squared) presented to primary care for fo...

JAMA Diagnostic Test Interpretation  August 21, 2023 Multistep Testing Algorithms for Clostridioides difficile Infection Maribeth R. Nicholson, Curtis J. Donskey JAMA. Published online August 21, 2023. doi:10.1001/jama.2023.15875 Case A10-year-old female with spina bifida and neurogenic bowel was hospitalized for abdominal pain, dehydration, and more than 20 episodes of watery diarrhea per day. Her symptoms began 5 days after com...