A 79-year-old nursing home resident was hospitalized for evaluation of hyperkalemia and leukocytosis. Her medical history included hypertension, respiratory failure with subsequent tracheostomy placement and ventilator dependency, and anemia. Both of her legs had been amputated above the knee secondary to complications of type 2 diabetes mellitus.
After 3 months of seeing this painless mass at the angle of the 3-year-old's left jaw, his parents sought medical advice for their son. The youngster had no constitutional symptoms. A Mantoux test was performed, and an erythematous, indurated area measuring 15 mm in diameter was found at the test site 48 hours later.
A 65-year-old woman was admitted to the hospital with abdominal discomfort and constipation. A nontender mass was palpated in the right hypochondrium.
An irritable, lethargic, toxic-looking, and slightly cyanotic 2-month-old boy had a temperature of 40°C (104°F), malaise, and a cough for 2 days. The infant's heart rate was 98 beats per minute, and his respiratory rate was 55 breaths per minute. He had nasal flaring, sternal and subcostal retractions, diminished breath sounds, and scattered rales over the left lung, which was dull to percussion.
During a camping trip, a 7-year-old boy sustained a 1.5-cm laceration down to the bone above the left eyebrow. The laceration was clean and linear; it bled freely. The patient did not lose consciousness.
A mildly itchy, tender “red bump” on his eyelid concerned a 68-year-old man. Two years earlier, a basal cell carcinoma, which started as a “red bump,” had been removed from his cheek. This lesion had been present for 2 weeks; the patient noted a small amount of discharge at the site in the mornings.
A 76-year-old man reported a 3-month history of an asymptomatic, raised, reddened lesion on his penis. The patient had type 2 diabetes mellitus. In 1994, a basal cell carcinoma had been excised from his chest and, 3 years later, a squamous cell carcinoma was excised from his left temple.
A 28-year-old man presented to the emergency department with a 1-week history of multiple, concentric, erythemic, targetlike plaques over the entire body. Severe necrosis and hemorrhagic crusting were evident on the oral mucosa and lesions were present on the upper lip. The remainder of the physical examination was unremarkable. The patient had no known medical problems, was seronegative for HIV, and denied a history of herpes simplex virus (HSV) infection. He used no medications.
A 2-year-old girl presents to the pediatric emergency department (ED) for evaluation of a fleshy mass protruding from her rectum. The mass, which had been present for 1 day, protruded spontaneously and not during defecation. There is no history of cough, constipation, diarrhea, vomiting, weight loss, or parasitic or chronic disease. However, the child has been having episodic, painless bleeding during the past month. There is no family history of GI disease.
A 56-year-old man had an asymmetric, maculopapular, sharply demarcated, pruritic, excoriated dermatitis on his upper thighs. The eruption had been present for 2 to 3 weeks.
Tiny, asymptomatic "bumps" had been present for 4 years on the posterolateral surface of the upper arms of a 34-year-old woman. Similar but less severe eruptions also appeared on her forearms and anterior thighs.
A pruritic, erythematous rash developed in a 6-year-old boy over the previous 5 days. The rash erupted in crops; the lesions appeared initially as rose-colored macules, progressed rapidly to papules and vesicles, and finally crusted. The distribution of the lesions-with the greatest concentration on the trunk-is typical of chickenpox.
The erythematous rash with punctate satellite lesions seen on the axillary and inframammary areas of a 46-year-old woman are typical of the lesions of moniliasis, or candidiasis. The patient reported that the pruritic rash had erupted 2 months earlier and worsened during the summer heat.
A 15-year-old boy noticed that his tongue had become dark shortly after he recovered from an upper respiratory tract infection. The dusky, matted layer seen on its dorsal surface represents hypertrophied filiform papillae and lack of normal desquamation. The papillae mimic long hairs and may be stained black, brown, yellow, or whited from foods, medications, tobacco, or chromogenic bacterial overgrowth. Hence the term: black hairy tongue.
A 30-year-old man, who was homeless, was admitted to the hospital with a several-month history of dyspnea and fever. He complained of producing excessive sputum and having frequent bouts of hemoptysis. Bilateral crackles were heard during examination of the lungs. The patient was in acute respiratory distress and was intubated to provide ventilatory support.
A 70-year-old man first noticed this skin condition when he returned from the South Pacific at the end of World War II. Over the years, the rash has itched only occasionally; however, during a recent spate of hot weather, the eruption became highly pruritic. Applications of an over-the-counter 1% hydrocortisone ointment exacerbated the condition.
When this boy was born, he was covered by a transparent membrane resembling oiled parchment or collodion. The membrane was shed within 2 weeks and, subsequently, the infant was found to have normal skin. Lamellar ichthyosis usually develops in babies with this condition, although in some the skin clears completely.
A 40-year-old farmer had been complaining for 3 weeks of a tender, red, itchy, scaling plaque with papulopustules on one knee. A potassium hydroxide examination of the scale revealed fungal hyphae.
These pruritic but otherwise asymptomatic lesions on the right upper arm of a 77-year-old woman first appeared about 1 year before she sought medical consultation. The patient's history included frequent, generalized pruritus, which was believed to be secondary to long-standing type 1 diabetes mellitus.
A 34-year-old man experienced fever and arthralgia several days after appearance of the rash.
Three months ago, a 50-year-old man who was otherwise in good health noticed a hard, round nodule on his left arm. Within 2 months, similar nodules appeared all over his trunk, head, arms, and legs. The reddish purple lesions, less than 2 cm in diameter, were painless and slightly pruritic.
An 85-year-old white woman was brought to the emergency department (ED) with acute, severe left posterolateral chest wall pain of several hours' duration. The nonradiating pain was accompanied by shortness of breath. She denied palpitations, diaphoresis, syncope, or dizziness.
A 37-year-old man presented with a reddish nodule in the umbilical area that had been present since early infancy. The lesion had been cauterized with silver nitrate several times in the past but had not resolved. No drainage or secondary infection was noted, and the patient was otherwise in good health.
In the web space of his left hand, a 50-year-old barber had a painful cystlike lesion. The lesion had recurred intermittently, despite oral antibiotic treatment and warm compresses. The patient's father, also a barber, had a similar, more severe condition, which eventually required surgical intervention.
Several hours after he had installed ceramic tile, a 33-year-old man experienced muscle spasms and felt pressure in his right shoulder. He denied previous injury to the area.
