Continuing Medical Education

In a randomized trial of fractional flow reserve versus IVUS to guide PCI, the use of FFR resulted in fewer coronary interventions and was noninferior to IVUS with respect to clinical outcomes at 2 years.

A 3-year-old boy presented with abdominal pain and vomiting. He had associated chills without fever, nonbloody and nonbilious emesis, constipation, reduced urinary output, and a decreased activity level.

Chronic urticaria differs from acute urticaria in characteristics and treatments. The chronic form is spontaneous or inducible, with the latter elicited by cold, heat, pressure, or other precipitants.

In patients with rheumatoid arthritis, the monoclonal antibody against interleukin-6, olokizumab, was superior to placebo and noninferior to adalimumab at 12 weeks.

Lesions of the ovary and fallopian tube are common and may be acute or chronic. Diagnostic assessment is designed to distinguish benign from malignant causes. Referral to a gynecologic oncologist is often necessary.

A 48-year-old woman was evaluated for abdominal pain. CT showed numerous liver lesions and lung cysts and nodules; liver biopsy revealed an eosinophilic inflammatory infiltrate. A diagnosis was made.

A 25-year-old woman was evaluated for worsening headaches, photophobia, nausea, vomiting, and blurred vision. MRI revealed hydrocephalus and leptomeningeal enhancement. CSF analysis revealed neutrophilic pleocytosis.

Formerly known as Devic’s disease, this relapsing, demyelinating disorder of the central nervous system encompasses six syndromes and is associated with aquaporin-4 autoantibodies. Effective treatment prevents relapses.

Pregnant women were assigned to be evaluated with lower or higher glycemic criteria for the diagnosis of gestational diabetes. Lower criteria did not reduce the risk of a large-for-gestational-age infant.

Removal of small, asymptomatic kidney stones during surgery to remove ureteral or contralateral stones resulted in less relapse than nonremoval and in similar numbers of subsequent emergency department visits.

This article reviews the presentation, diagnosis, and treatment of bronchiectasis, a syndrome of abnormal airways that results in chronic cough, sputum production, and respiratory impairment.

A 31-year-old man was admitted with perianal and penile ulcers, rectal pain, and vesiculopustular rash. He had first noticed itchy white “bumps” around the anus 9 days earlier. A diagnostic test was performed.

Spina bifida, a congenital disorder of the spinal cord, leads to medical and neurologic complications. Modern surgical techniques and comprehensive medical care have greatly improved outcomes.

A 63-year-old woman presented with dyspnea and cough. She had been in her usual state of health until 2 days earlier, when myalgias and dyspnea with ambulation developed, followed by a cough productive of green sputum.

This trial compared once-weekly dulaglutide, a GLP-1 receptor agonist, with placebo for glycemic control in youths with type 2 diabetes who may have been receiving metformin or basal insulin. Dulaglutide was superior at 26 weeks.

This interactive feature describes a 50-year-old woman who presents to the ED with progressive neurologic symptoms and is admitted to the neurology service. Test your diagnostic and therapeutic skills at NEJM.org.

A study ancillary to a large trial showed that supplemental vitamin D₃ did not lower the risk of fractures among generally healthy midlife and older adults not selected for vitamin D deficiency, low bone mass, or osteoporosis.

Smoking addiction causes substantial illness and death; morbidity and mortality are markedly reduced with cessation. Effective treatments for smoking addiction include medications and counseling.

A 49-year-old man with a family history of diabetes was evaluated because of hypoglycemia. Two hours earlier, he had been found on the floor, obtunded and making nonpurposeful movements. A diagnostic test was performed.

The authors review the many adverse effects of obesity on pregnancy, including hypertension, diabetes, insulin resistance, subfertility, miscarriage, and congenital abnormalities.