Stephen Schabel, MD

A 57-year-old woman presents with swelling of the hands that began several weeks earlier and is now worsening. She denies joint pain, and she has no history of trauma or significant vascular disease. She has had pneumonia several times; each episode was successfully treated with antibiotics. She has smoked 2 packs of cigarettes a day for the past 20 years

A 32-year-old man complains ofknee pain that resulted when he felland twisted his right knee skiing theday before. He suffered other minorcontusions from the fall, but none ofthese required medical attention. Heis otherwise in good health and hasno relevant medical history.

A 32-year-old man complains oflong-standing low back discomfortthat has worsened to frank pain overthe past month. He denies fever, trauma,and excessive physical activity. Hismedical history is noncontributory.

A 67-year-old man complainsof abdominal distention and bouts ofdiarrhea with intermittent constipation.These symptoms have beenpresent for weeks but recently havebecome more severe. The patienthas not seen blood in his stool. Hedenies fever, travel to a foreign country,and recent trauma. He has hypertension,which is well controlledwith calcium channel blockers.

A 59-year-old woman complainsof progressively worsening bloatingand right upper quadrant pain thatbegan 1 day earlier. She denies feverand trauma. Her medical history includescholecystectomy for cholelithiasisand several emergency departmentvisits for treatment of woundssustained in falls. She has a history ofalcohol abuse, for which she now receivescounseling. However, she admitsthat she occasionally has boutsof heavy drinking.

Right hip pain in a high schoolfootball playerA 15-year-old boy complains ofright hip pain that began the day before,when he felt a "pop" during footballpractice. His medical history issignificant only for several ligamentousinjuries in both ankles and fracturesof the right lateral malleolusand the left medial malleolus, whichhealed uneventfully. He denies anabolicsteroid use and alcohol use.

For the past month, a 19-year-old woman has had abdominalpain, diarrhea, intermittent fever, and occasionalvomiting. She now seeks medical attention because earlierin the day she noticed a large amount of blood in herstool. She denies trauma, travel to a foreign country, andillicit drug use. She drinks alcohol occasionally but hasnot done so for the past 3 months.

A 75-year-old man with coronaryartery disease presents to the emergencydepartment with abdominalpain and light-headedness. The painbegan as a dull ache 4 days earlierand recently became considerablyworse. The patient denies recenttrauma, fever, nausea, vomiting, and diarrhea.

A 76-year-old woman complains of gradually worsening back pain thatbegan 6 weeks earlier, after she fell off a ladder rung 3 feet from the ground(she landed on her feet). She is otherwise in good health and denies fever andloss of sensation or control in the lower extremities.

A 75-year-old woman complains of chest pain that radiates to her back betweenher shoulder blades. The pain began the morning of her presentationand has progressed throughout the day. She denies recent trauma, shortnessof breath, and fever. She has hypertension, which is treated with a &#946-blocker.Three years earlier, she fractured her right femur in a motor vehicle accident;the fracture was treated by open reduction and internal fixation.

A 62-year-old man has had nightsweats and worsening fever andcough for the last 4 days; 2 days agohe had an episode of hemoptysis. Hedenies trauma or travel to a foreigncountry but has a 30-pack-year smokinghistory. The medical history isotherwise noncontributory.

A 53-year-old man complains ofdyspnea and a cough that has progressivelyworsened over the pastweek. He denies recent trauma.

A 29-year-old woman is brought to the emergency department after a caraccident. She complains of head pain and has a contusion over the posterioraspect of the right temporal bone and right occipital bone; a small amount ofblood flows from the right external auditory canal. She has only a vague recollectionof the accident. Past medical history-although difficult to ascertain-seems noncontributory.

A 58-year-old man complains ofintermittent headaches that beganabout 2 months earlier and have recentlyincreased in severity. Theheadaches occur at various times ofthe day and improve slightly whenhe sits. He denies trauma, fever, photophobia,and other neurologicsymptoms. He has 1 alcoholic drinka day and has smoked 1 pack of cigarettesa day for the past 20 years.Medical history is noncontributory.

A 64-year-old woman presentsto the emergency department withworsening crampy abdominal painthat began the night before. Afterthe pain started, she had a bowelmovement containing a significantamount of blood; since then she hashad episodes of diarrhea. She hadbeen previously healthy, denies traumaand fever, and knows no one withsimilar symptoms. She reports norecent enema, endoscopy, or otherabdominal procedure.

A 25-year-old man complainsof right hip pain that began earlierin the day when he fell and landedon his hip while playing basketball.He has no other symptoms, and hishistory is noncontributory.

A 56-year-old woman complainsof right hip pain that has been presentfor several weeks but has recentlyworsened. She denies recent trauma,fever, and increased physicalactivity. She has no history of arthritis,but she does have systemiclupus erythematosus, which a dailyregimen of prednisone, 20 mg PO,has kept in remission. Her medicalhistory is otherwise unremarkable.

A 13-year-old boy complains ofpain in his right hip. The pain began3 days earlier after he was tackledseveral times while playing footballwith his friends. He was able to walkhome. The pain has increased sincethat time. Although the patient is stillable to walk, he now has a limp andfavors his left leg. The patient isotherwise healthy and has no significantmedical history.

A 67-year-old woman who is being treated as an inpatient for head traumacomplains of vague tenderness during an abdominal examination. Othercomplaints are difficult to assess. She had been placed on an oxygen ventilator;however, her cognitive function and pulmonary function are improving, andher cerebral edema is diminished.

A 57-year-old woman presents with severe chest pain, and a frontal upright radiograph of the chest is obtained. What does this image reveal, and how will you arrive at a diagnosis?

A 39-year-old African American man complains of mild dyspnea that has worsened steadily over the past 2 weeks and that is unrelated to activities or unusual exposures. He denies trauma, fever, and chest pain. His medical history is unremarkable.

A 23-year-old woman presents with severe right kneepain that resulted from a collision with another playerduring a soccer game. The majority of the force of theblow was to the right knee. The medical history is noncontributory.

A 29-year-old man presents with right ankle paincaused by a basketball injury he sustained 1 day earlier.He fell after he had jumped up and landed on anotherplayer’s foot. The patient’s foot was “turned in” during thefall; this position indicates an inversion injury. He says hehas injured his ankle before but never this severely. Therest of the medical history is noncontributory.

A 53-year-old man has hadmalaise, intermittent cough, and occasionalfever and night sweats for 2weeks. He has also lost some weightduring this time but denies hemoptysisand sputum production; he hasnot traveled abroad recently. His onlysignificant medical condition is hypertension,which is well controlled withmedication.