A 32-year-old man presented with a yellow, papular rash on the buttocks and extensor surfaces. His medical history included diabetes mellitus, alcoholism, obesity, and polysubstance abuse. Laboratory results disclosed a serum triglyceride level of 5,793 mg/dL.
Clad only in shorts, T-shirt, and helmet, a 21-year-old man was involved in a motorcycle accident. He sustained “road rash”-diffuse multiple body abrasions, lacerations, and contusions-particularly on the extremities. Abrasions about the chest wall and abdominal region were also noted. Other injuries included a closed right clavicle shaft fracture and a nondisplaced open fracture of the dorsal aspect of the right olecranon.
A 22-year-old man's chest shows the most common form of congenital pectoralis major muscle anomaly-partial absence of the right pectoralis major muscle with the clavicular origin intact.
A 29-year-old man was born with radial clubhands that required several operations during his early weeks of life. In addition to shortened forearms, the patient was left with severe limitation of wrist motion bilaterally.
A 6-year-old girl with mental retardation was seen for a physical examination. She was being followed by a neurologist for seizures that began in her first year of life. She had no acute health problems.
This 2-month-old infant was brought to her physician with a 2-week history of intermittent swelling in the right distal inguinal and upper labial area. A palpable solid, nonreducible lump was visualized ultrasonographically as an oval, hypoechoic mass and identified as a herniated ovary. The hernia was repaired surgically, and the ovary remained intact.
A 45-year-old man with a history of congestive heart failure presented with cough and dyspnea. A chest roentgenogram showed loculated pleural effusion in the horizontal fissure of the right lung, and a CT scan revealed pleural-based density in that lung.
A minimally responsive 26-year-old man was brought to the emergency department after being found in his home by a friend. A suicide note lay next to his body. The patient had a history of depression.
This asymptomatic pigmented lesion on the left posterior jaw of a 52-year-old man had been present for 6 years, with no evidence of recent change. At the patient's request, the lesion was excised.
A 16-year-old African American boy complained of exertional pain below his left knee that severely limited his ability to participate in sports. The patient had had bilateral bowed legs until his early school years, when the right knee straightened. For the past year, exertional pain had been present below the left knee in the epiphyseal area.
For the past 6 weeks, a 72-year-old woman with a history of ovarian cancer had had intensifying dyspnea. Initially, she thought her breathing problem was caused by progressive congestive heart failure.
A 58-year-old man with a history of a seizure disorder was hospitalized with acute-onset shortness of breath immediately following a tonic-clonic seizure. He was afebrile; in respiratory distress; and hypoxic, with an oxygen saturation of 84% on room air.
A hard, painless lump on a 12-year-old boy's left lower eyelid began to grow rapidly on the inside of the lid. A fleshy, red, sessile conjunctival mass with a palpable rigid, nontender lesion was noted on the eyelid.
A 2-year-old girl presented with a 2-day history of urinary frequency and dysuria. Physical examination revealed complete fusion of the labia minora. Urine culture showed Escherichia coli with a colony count of 108/L. The child was treated with a 10-day course of amoxicillin that resulted in complete clearance of the urinary tract infection.
A 3-mm long, double-tipped, polypoid lesion appeared just anterior to the anus on an 8-month-old girl 2 days earlier. The lesion was excised in the office: a local anesthetic was administered, and the base was lightly electrodesiccated. Antibiotic ointment was applied until the area healed. Pathologic findings identified an infantile perianal pyramidal protrusion.
Two years ago, Dr Alexander K. C. Leung reported on a case of pseudopseudohypoparathyroidism. The patient was a 13-year-old girl with short stature, short fourth metacarpals and metatarsals, mild mental retardation, and no identifiable biochemical abnormalities.
Significant burning and tearing of her eyes and eyelid swelling occurred soon after a 49-year-old woman had a permanent at a hair salon. Her ears also showed signs of a toxic burn. She had never before experienced such a reaction.
Presenting symptoms of this 42-year-old man were left pleuritic pain and severe dyspnea while climbing stairs. He had a 2-year history of exertional dyspnea but had not sought medical advice. The patient's pulse was 123 beats per minute; respiratory rate, 45 breaths per minute; blood pressure, 80/45 mm Hg; and temperature, 37.3°C (99.1°F). Chest examination revealed hyperresonance with absence of breath sounds over the left hemithorax and wheezing over the right lung.
A 79-year-old male nursing home resident with Parkinson's disease was brought to the emergency department after 3 days of severe constipation and inability to pass flatus. Examination showed generalized abdominal distention with tympany. Results of rectal examination were normal.
A 19-year-old man was admitted to the hospital with malaise, fatigue, and intermittent fever (temperature of 38°C [100.4°F]) for the last 2 weeks. Physical examination revealed scarce purpuric lesions over the lower extremities; a pericardial friction rub was audible over the precordium when the patient was supine and seated, and the spleen was remarkably enlarged.