A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.
J. Paul Miller, MD
For 3 months, a 66-year-old retired man has had increasing
weakness of the lower legs with stiffness,
tingling, and numbness; worsening ataxia; anergia; and
exertional dyspnea of insidious onset. He has lost 8 lb,
and his appetite is poor. He denies fever, cough, chest or
abdominal pain, paroxysmal nocturnal dyspnea, orthopnea,
ankle swelling, bleeding disorders, hematemesis,
melena, headache, vision problems, sciatica, joint pain,
bladder or bowel dysfunction, and GI symptoms. He has
nocturia attributable to benign prostatic hypertrophy.
Intermittent, worsening confusion recently developed in
an 82-year-old man. His daughter brings him to the office
A70-year-old African American man, who is a retired
electrician, presents with increasing fatigue and
dull back pain of 4 months’ duration. Although he usually
walks about 2 miles a day, he now becomes exhausted
after half a block. He reports exertional dyspnea but no
paroxysmal nocturnal dyspnea or orthopnea. Recently, he
noticed ankle edema.
An 18-year-old college student
presents with a 4-day history of
increasing throat pain, low-grade
fever, and extreme exhaustion. Previously,
she had been healthy and participated
actively in sports, including
marathon running. Her appetite
and intake have been poor. No history
of cough, chest pain, shortness of
breath, nausea, vomiting, diarrhea,
or abdominal distention. She has no
allergies, takes no medications, and
does not smoke or drink alcohol.
She is sexually active with a single partner.
A 24-year-old woman presents to
the emergency department with
increasing left lower quadrant pain,
nausea, and persistent retching and
vomiting of 48 hours’ duration. The
pain ranges from dull and aching to
cramping; it has become generalized,
and there is no specific relieving factor.
During the last 12 hours, she has
also had fever and chills. She has no
urinary symptoms, hematemesis,
melena, diarrhea, constipation, or abdominal
A previously healthy 40-year-old man presents with a 2-hour history of excruciating colicky pain of acute onset that emanates from the right flank and radiates to the groin. He rates the severity of the pain at 9 on a scale of 1 to 10. Before arriving at the emergency department, the patient experienced nausea and 2 episodes of nonbilious, nonbloody vomiting.