William Yaakob, MD

A 28-year-old woman complains of intermittentright upper quadrant pain.The patient is thin, and she is not inacute distress.

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 35-year-old woman has been losing weight and has hadworsening abdominal pain and fullness for the past 2 months.She denies nausea, vomiting, and fever. Medical history issignificant only for asthma.

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 56-year-old man comes to see you2 weeks after an emergency departmentvisit for GI bleeding, which resultedin a diagnosis of colon cancer.Endoscopy revealed a lesion in theproximal sigmoid colon that wasfound on biopsy to be a primary adenocarcinoma.A CT scan of the abdomenand pelvis that was performedto stage the lesion showed a liverlesion suggestive of metastatic diseasebut no evidence of extrahepaticdisease.

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.

For the past several weeks, a 54-year-old man has had progressivelyworsening abdominal pain and general achiness.He has no nausea, vomiting, diarrhea, or fever and no historyof trauma.

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.

A 42-year-old woman complains of anxiety, unexplained weight loss, and palpitationsthat started about 3 weeks earlier. She denies fever, trauma, and newstress. She has a history of several urinary tract infections for which imagingfailed to reveal any predisposing factors; all were successfully treated withmedication. The remainder of the history is unremarkable.

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.

About 1 month ago, a 58-year-old man experienced malaiseand fatigue accompanied by mild diffuse swelling in his neck.After 3 days, the malaise and fatigue began to abate. They resolvedafter a week; however, minimal swelling on the left sideof the neck remains. The patient has no other symptoms.