A 6-year-old girl presented with a huge ulcer on her right heel, seen here, that began as a minor laceration when she stepped on a rock several months earlier. On the left heel, there was a similar lesion in the process of healing that had also followed a minor injury. Her feet and hands were dry and hyperkeratotic.
The parents of a 6-year-old boy with a generalized rash sought medical care for the child. The outbreak began 2 years earlier on the boy's abdomen and spread over the entire body; oral antihistamines had been prescribed for the itching. The patient had no history of allergy, insect bite, fever, or GI symptoms. His vital signs were normal.
For the past 2 hours, a 19-year-old man had lower abdominal pain accompanied by nausea and vomiting. He had no fever and no diarrhea. Direct tenderness was mainly in the right lower quadrant, radiating slightly to the left lower quadrant. There was no significant rebound tenderness. The patient refused rectal examination.
Pingueculae-yellow lipid deposits-may develop on the bulbar conjunctiva after several years of exposure to drying, dust, and the UV rays of sunlight. They represent elastotic degeneration of the substantia propria and are not seen in infants or children. These lesions usually are evident on the nasal aspect of the conjunctiva; they are innocuous and require no treatment.
Many disorders that scar the skin also affect the scalp. Systemic lupus erythematosus, when associated with high fever and extensive systemic involvement, can cause a diffuse anagen effluvium. Hair loss caused by localized discoid lupus erythematosus (DLE) is more common. DLE may affect the scalp, where it is seen as circumscribed areas of often irreversible hair loss.
A 72-year-old woman with acute abdominal pain and vomiting was brought to the hospital. The patient had no significant medical history and was taking no medications.
Numerous plaques, some with yellow crusting and central scarring, had erupted primarily on the face and neck of a 46-year-old man. A single lesion had developed on his left elbow as well. The lesions were initially diagnosed as impetigo, but they failed to resolve after 2 courses of oral cephalexin.
For several weeks, a 30-year-old woman had a 1 × 2-cm, oval lesion with a rolled border in the inner upper quadrant of the right breast that had progressed in size and ulcerated. Six weeks earlier, she had been bitten by her infant son in the same area. The medical history and physical examination were otherwise normal.
Concerned about the yellow plaque on his upper eyelid, a 45-year-old man sought medical evaluation. The slow-growing, asymptomatic lesion had developed several months earlier.
Three weeks after undergoing gastric bypass surgery for obesity, a 64-year-old woman presented with fatigue, chills, and abdominal pain of 2 days' duration. She denied shortness of breath, nausea, vomiting, changes in bowel habits, melena, and hematochezia. The patient had no significant past medical history.
A 16-year-old boy was evaluated for elephantiasis in a remote village in the mountains of Kenya. He complained of drainage from his left leg and reported that for the past several months, after the limb swelled, fluid began to weep from the bottom of the foot. He denied pain in his leg or foot and reported no fever, chills, or sweats.
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.
