Sudden pain and a pulsatile swelling of the right upper medial thigh concerned an 80-year-old woman. Coronary angioplasty had been performed through this site 5 weeks earlier.

A 45-year-old woman who had had several melanomas removed was concerned because of hyperpigmentation beneath her toenail. Some distal onycholysis was also noted. Because of the patient's history and the fact that she could not definitely recall injuring the toe, a partial nail evulsion was performed. Fortunately, the only finding was dried blood.

Congenital adrenal hyperplasia is an autosomal recessive disorder. Deficiency of 21-hydroxylase accounts for 95% of all cases.

Having been treated for pulmonary tuberculosis (TB) 25 years earlier, a 60-year-old man (a nonsmoker) now complained of a chronic cough. The cough was occasionally accompanied by yellowish sputum but no hemoptysis. Examination revealed persistent coarse crackles in the right posterior hemithorax, and the x-ray study seen here established the diagnosis of cystic bronchiectasis.

An 85-year-old man was admitted to the hospital with a cough and shortness of breath of 1 week's duration and a fever and increased sputum production for 2 days. His history included renal cell carcinoma and metastatic renal cancer for 2 years. The patient had smoked cigarettes for 30 years. He had lost 30 lb during the last few months.

An 80-year-old man, who could not walk because of a large mass on his right leg, was brought to the emergency department. The mass had been increasing in size on the anterior region of his right thigh for approximately 6 months. The patient also complained of “lumps” that had developed on his extremities during the past 2 months.

Recurring blisters on the sides of the fingers brought a 72-year-old man to his physician. He was asked to change into a gown for a full-skin examination. Physical examination demonstrated minute papulovesicles affecting the medial and lateral aspects of the fingers, consistent with dyshidrosis. The patient's skin was severely sun-damaged, and there was an irregularly pigmented, asymmetric patch affecting the posterolateral neck.

A 35-year-old man was hospitalized with severe dehydration secondary to necrosis of the throat. He found oral intake impossible because of severe discomfort when swallowing. The patient took no prescription medications; he had not been hospitalized or seen by a medical practitioner recently.

Abrupt onset of symmetric inflammatory arthritis and edema, as seen on the dorsum of this 72-year-old man's hand, is characteristic of remitting seronegative symmetric synovitis with pitting edema-or RS3PE. The work-up of this patient was essentially negative for other types of inflammatory arthritides.

A recent outbreak of small-plaque and guttate psoriasis was confined primarily to the arms of this 32-year-old woman. The slightly scaly, brick-red, linear plaques and clusters consisted of 3- to 10-mm papules, some of which were surrounded by a faint whitish ring. It was quickly ascertained that many of these lesions corresponded to areas where the patient had been scratched by her cat.

Four months after coronary artery bypass surgery, a 77-year-old man began to suffer severe pain in his feet. Multiple necrotic areas developed on the toes.

This 1-year-old boy has a mild, flexible metatarsus adductus deformity of the right foot.

Pain and swelling of the left lower leg and a low-grade fever of 1 week's duration sent a 24-year-old African American man for medical evaluation. The patient had a history of vitiligo since childhood.

A painful, swollen penis was the presenting complaint of an 11-year-old boy. The swelling erupted 1 to 2 hours before the photograph was taken, when the child had attempted to retract the foreskin.

An obese 17-year-old boy sought treatment of an apparent abscess of the umbilicus. Hot soaks, black salve, and oral cephalexin were prescribed. Although there was some drainage, the lesion persisted and the patient returned for further evaluation.

For 2 years, a 60-year-old woman with long-standing hypertension had experienced worsening dizzy spells, fatigue, and chest discomfort. She also had cold extremities, significant dyspnea on exertion, and orthopnea. The patient was taking amlodipine and furosemide.

Referral for biopsy was made because a 6-mm, red and black, dome-shaped papule on a 43-year-old woman's left groin resembled a melanoma. The patient had numerous cherry hemangiomas on her trunk-bright red, 2- to 5-mm papules that are among the most common vascular anomalies.

An obese 52-year-old woman with a 5-year history of type II diabetes mellitus had odynophagia and dysphagia for several days. She described the sensation as food “sticking” in her chest. She also complained of vaginal itching, polyuria, and polydipsia. The only remarkable finding on physical examination was candidal vaginitis. The patient did not smoke cigarettes or drink alcoholic beverages, and there was no history of recent weight loss.

A 1-day-old neonate was brought for evaluation of a mass on the floor of her mouth. The swelling was fluctuant and had a bluish tint. No bruit was detected. There was mild tongue elevation but no airway obstruction. Other than this swelling, physical examination findings were normal. The infant was born at term and was breast-feeding.

While working in her garden in Virginia, a 40-year-old woman felt a sudden, sharp pain between the fingers of her right h and saw blood coming from an open wound. Immediately, she experienced a burning sensation at the site and noticed numbness and swelling in the hand. The patient was rushed to the emergency department.