A 41-year-old man fell 3 ft into a bilge; he landed on his left leg and experienced immediate generalized pain in that knee. Three days later, he consulted his physician, who found minimal effusion in the knee and tenderness of the medial collateral ligament (MCL). No abnormalities were seen on plain x-ray films.
The mother of a 1-year-old girl observed that for 1 week her child seemed to be uncomfortable during the night and when she urinated.
An enlarging mass was noted on the dorsum of the right fifth toe of a 2-month-old boy during a well-child examination. The firm, immobile mass measured approximately 1 cm in diameter. A congenital abnormality was suspected; the patient was referred to a plastic surgeon for consultation.
Progressive, uncontrolled blinking and eyelid spasms had begun 3 years ago and now rendered a 77-year-old man functionally blind. Various treatments, including oral and topical medications and acupuncture, had been unsuccessful.
An 83-year-old man with a history of hypertension and coronary artery disease presented with a 4-day history of mental status changes, slurred speech, and difficulty ambulating. He reported a lack of appetite and weakness of several days.
This obstruction is caused by a failure of intestinal peristalsis; there is no evidence of mechanical obstruction. Paralytic ileus is common after abdominal surgery, especially if anticholinergic drugs are given preoperatively and/or narcotics are used postoperatively. It usually lasts 2 to 3 days. Paralytic ileus may also be caused by peritonitis; ischemia or surgical manipulation of the bowel; retroperitoneal hemorrhage; spinal fracture; systemic sepsis; shock; hypokalemia; uremia; pharmacologic agents (eg, vincristine, loperamide, and calcium channel blockers); diabetic ketoacidosis; and myxedema.
A 56-year-old woman was referred for management of severe hyperlipidemia. Her family history included hypercholesterolemia and premature coronary artery disease.
A 32-year-old man sustained a humeral neck fracture from a fall. A proximal humerus fracture often results from a fall on an outstretched hand is called a “FOOSH” injury.
Extremely itchy, crusting nodules appeared on the arms and legs of a 42-year-old woman who was undergoing renal dialysis.
A 72-year-old man presented after several months of dyspepsia and 1 day of hematemesis. He was not taking NSAIDs.
A 15-year-old experienced pain in her toe, particularly when pressure was applied to the foot. An ingrown toenail was the cause of her discomfort.
A 74-year-old man, who had been aware of a gradual increase in hat size over the past 3 years, complained of a mild headache and backache. His serum phosphatase level was 1,475 U/L (upper normal limit, 120 U/L). Skull films showed calvarial enlargement caused by thickening of the cortical tables, radiolucency in the frontal and occipital regions, and patchy osteosclerosis that produced a cotton-wool appearance.
A 50-year-old woman had visited 4 health care providers seeking relief from low back pain. The patient likened the pain to an electric shock that started at the left side of the lower back and radiated to the front of the left leg. The area was also numb.
Progressive weakness and fatigue for the past 6 months prompted a 43-year-old woman to consult her physician. She denied diarrhea, melena, hematochezia, cough, fever, and night sweats. Her skin and conjunctivae were pale.
Consider this diagnosis when a patient presents with a history of rapid, diffuse hair loss. Telogen effluvium affects the entire scalp, but the crown and bitemporal areas may appear to be mainly involved if there is associated androgenetic alopecia.
This rare condition affects both men and women. The average age at onset is 53 years. The lesions are deep brownish red to purple papules, nodules, and plaques. Blisters and ulcers also can occur.
A 72-year-old morbidly obese man who had diabetes mellitus was admitted to the hospital from a nursing home with a fever of 4 days' duration. A tracheostomy had been performed 3 months earlier for respiratory failure. The patient was being treated with corticosteroids for chronic obstructive pulmonary disease.
A 44-year-old man sought relief from severe pain, swelling, and restricted radiocarpal and digital motion of his left hand. Four months before, he had suffered a fracture of the distal radius metaphysis (Colles' fracture), which was treated by closed reduction with long-arm cast immobilization for 6 weeks.
A 38-year-old woman had become increasingly depressed by worsening psoriasis in conjunction with a flare of arthritis in her hands and fingers. The patient complained that she could not function optimally and that her quality of life had diminished.
A 45-year-old man presented with a 2-month history of progressive fatigue, weight loss of 10 lb, abdominal pain, and pruritus. The patient had been taking a maintenance dose of oral mesalamine since he received a diagnosis of ulcerative colitis 14 years before.
