Anh-vu Nguyen, MD

A 64-year-old woman complainsof neck fullness that has increased inthe last few months. She has occasionaldyspnea but denies fever, cough, andhemoptysis. Hypertension is well-controlledwith propranolol.

A 43-year-old woman presents to the emergency departmentwith fatigue, dyspnea, and intermittent chest painof 3 days’ duration. Her symptoms have worsened sinceshe arose, and 2 hours ago palpitations developed. She describesthe chest pain as a heavy pressure under her sternumthat does not radiate; she denies fever, nausea, vomiting,and diaphoresis.

A 48-year old man presents to the emergency departmentwith constant, dull epigastric pain and right upperquadrant pain. The pain has been present for 2 to 3months; does not radiate; has not changed its pattern; andis not associated with fever, nausea, vomiting, diarrhea, orchanges in urine or stool color. There are no alleviating orprecipitating factors.

An 80-year-old woman complains of left hip painthat started after she fell while feeding her cat. The painis moderately severe and is localized to the left hip; itdoes not radiate. The patient is unable to bear any weighton the injured hip but denies numbness in her left leg.There are no other injuries.

A 54-year-old woman presents with severe, throbbingpain in her right shoulder that began 3 daysearlier. She has no history of trauma or of problems withthis shoulder. She denies shortness of breath, fever,chills, and rash.

A 72-year-old man is brought to the emergency department by his wife. Hecomplains of nausea, vomiting, and severe abdominal pain that makes it difficultfor him to walk. The pain began the previous afternoon and has worsened steadily.The patient denies trauma and recent foreign travel. His history includes an appendectomyperformed many years earlier but is otherwise noncontributory.

A 13-year-old boy presents with swelling of the left eyelidsthat started 12 hours earlier; the eyelashes are mattedwith yellow discharge. He does not wear contact lenses oreyeglasses and denies ocular trauma or foreign bodies. Hehas been nauseated and has vomited once; his motherattributes these symptoms to an antibiotic that was prescribed5 days earlier for a sinus infection. Medical historyis noncontributory; there is no family history of ocularproblems.