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.
During a comprehensive ophthalmic examination 3 or 4 years earlier, a 62-year-old man had been told there were suspicious changes in his eye that suggested glaucoma. His mother had glaucoma and began using timolol maleate eye drops when she was almost 80 years old. Glaucoma is 4 to 8 times more likely to develop in first-degree relatives of persons with primary open-angle glaucoma than in the general population.
Dyspnea, orthopnea, and weight loss sent a 40-year-old woman for medical consultation. Fifteen years earlier, the patient had been nephrectomized because of left kidney lithiasis. There was no history of other symptoms or diseases.
Turner syndrome is a genetic disorder in females in which one of the X chromosomes is missing or incomplete.
A mildly painful, nonpruritic rash on the forearms and legs prompted a 42-year-old man to go to the emergency department (ED). The patient noted the rash when he awoke that morning. He had had joint pain and fever for the past 7 days and generalized malaise with chills that began about 3 days earlier. He had no significant medical history.
A male infant was delivered at term to a 24-year-old woman. The pregnancy had been uncomplicated; the vaginal delivery was normal. Apgar scores were 7 at 1 minute and 9 at 5 minutes. Birth weight was 3020 g (6 lb 11 oz); length, 51 cm (20 in); and head circumference, 36 cm (14 in).
During a routine examination, macular dermatitis with irregular borders was noted on the genitalia of an otherwise healthy 41-year-old woman. The right labia minora featured a 7-cm dark pigmented macular area; a similar area measuring 10 cm was observed on the left upper labia minora.
This condition, which accounts for about 30% of cases of intestinal obstruction among neonates, is characterized by the inspissation of thick, tenacious meconium in the bowel. The most common cause is cystic fibrosis; approximately 6% to 20% of infants with cystic fibrosis have meconium ileus. Hyperviscous mucus secreted by abnormal intestinal glands, an abnormal concentrating process in the proximal small intestine, and a deficiency of pancreatic enzymes have been implicated in the pathogenesis. The histologic hallmark is distention of the goblet cells in the intestinal mucosa.
For 2 months, a 31-year-old woman had had dyspnea and dull, continuous retrosternal pain. She was admitted to the hospital, and a helical CT scan of the thorax identified a saddle pulmonary embolism. An ultrasonogram revealed deep venous thrombosis (DVT) in the left leg. Intravenous heparin was given; the patient was discharged, and warfarin was prescribed.
A 40-year-old man was hospitalized with the superficial, reddening, and painful facial lesion seen here. Its borders were sharp, and it had developed rapidly. The patient had a temperature of 40°C (104°F) and chills. His erythrocyte sedimentation rate was elevated, and he had neutrophilic leukocytosis.
Headache and vomiting suddenly developed in a 41-year-old woman who was 16 weeks pregnant. The next day, she suffered an episode of tonic-clonic seizures associated with a 15-minute loss of consciousness.
A 35-year-old man, a sea and white-water kayaking instructor, complained of pain and congestion in the right ear. Otoscopy revealed bilateral external auditory canal stenosis with impacted cerumen and otitis externa on the right.
A 68-year-old man presented with a sudden-onset, 2.5 × 2-cm, rock-hard, erythematous, nontender nodule on the right side of the chest. A dense mat of telangiectases surrounded the solitary lesion. The remainder of the cutaneous examination was unremarkable.
While on the job, a 24-year-old construction worker accidentally shot a nail through his right index finger with a nail gun. Roentgenographic studies revealed no damage to the bone. No neurovascular deficit was noted on examination.
Tortuous, dilated varicosities; multiple smaller caliber abnormal perforating vessels; and chronic brawny edema of chronic venous insufficiency (CVI) were seen on a 70-year-old man's left leg. He reported that the edema and discoloration had worsened over the last 15 years. The brawny edema stopped just above the ankle, indicating that compression by the patient's sock controlled the signs and symptoms of CVI.
After suffering with a severe, disabling headache for 2 weeks, a 20-year-old soldier sought medical treatment. He had no significant medical history other than his 6-year history of smoking.
A 22-year-old man complained of progressive shortness of breath and abdominal distention. Three years before, he had completed chemotherapy for Hodgkin's disease and had since been in remission. Recently, he had been treated for tonsillitis with oral antibiotics.
For 2 years, a 40-year-old oil-field worker wore heavy, steel-toed work boots all day. He experienced weeping and white discoloration at the center of both distal soles. At night, with his boots off, the feet would dry and hurt. There was no pruritus.
An 82-year-old man complained of dry, gritty eyes with chronic, bilateral tearing. He stated that friends tell him his eyes are always red.
A 42-year-old woman complained of facial puffiness, fullness, and redness for 2 weeks, which were gradually becoming more severe. She also noticed a sensation of “heaviness” in her head. The patient had no significant past medical history. She denied having a cough, shortness of breath, hoarseness, allergies of any kind, and neurologic deficits. Her weight and appetite were unchanged. She had smoked a pack of cigarettes every day for the past 20 years.
