Psychiatry

A 24-year-old African American man presents for a routine eye examination. Theocular findings are unremarkable; however, well-circumscribed areas of whitenedskin are noted on his forehead and hands (A and B). The patient reportsthat the patchy loss of pigment has been progressing over a number of years.

A 56-year-old man presented tothe emergency department with ahistory of constipation, abdominalpain, and blood-stained mucusdrainage from the rectum. The patienthad no fever; vital signs werestable. A vague fullness was felt in thelower abdomen. Rectal examinationrevealed anal warts; a patulous analsphincter; and a smooth, mobile, firmmass above the dentate line.

A 42-year-old woman sought medical advice for a facial rash of 4 weeks' duration. She denied any drug allergies, changes in her routine, or use of new laundry products.

A 72-year-old man slipped and fell backward in the bathroom, hitting hishead on the toilet seat; he suffered only minimal discomfort. The followingday, he presented with mild back pain and extensive bruising.