Navin M. Amin, MD

A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.

A 3-year-old girl is brought to the office because of a1-week history of hematuria and dysuria. Her motherhad noticed bright red blood in the child’s urine anddiaper. The child did not have dysuria initially but latercomplained of a burning sensation.

A 40-year-old Hispanic homemaker is admitted with a 3-week history of high fever, chest pain, and a dry, irritating cough. Her illness began insidiously with increasing right upper chest pain that is sharp, pleuritic, and rates a 6 on a pain scale of 1 to 10. The pain is associated with temperatures of up to 38.8°C (102°F) and chills, rigors, and profuse sweating that increase in the evening. Worsening dyspnea has been accompanied by a drop in effort tolerance.

A4-year-old boy has a 4-day historyof fever; a persistent dry,irritating cough; coryza; and anonpruritic rash. The rash startedaround the ears and then spread overthe trunk and limbs.

A 59-year-old woman presents with generalized facialswelling and dyspnea that has progressed graduallyover the past month. The patient also reports a sensationof pressure in her neck and ears and swelling of the lowereyelids, neck, upper chest, and upper limbs. The bloodvessels on her upper chest are prominent. A dry, irritatingcough has worsened.

A 12-year-old black girl is hospitalized because of increasinglysevere dyspnea and sore throat. The sorethroat started about a week earlier and was accompaniedby fever and chills. The patient was evaluated at an urgentcare center when her symptoms worsened, where she wasgiven ampicillin for a presumptive “strep throat.” A generalizedmaculopapular erythematous rash developed within24 hours of the start of therapy, and the ampicillin waspromptly withdrawn. The rash cleared gradually thereafter.Now the patient’s sore throat has worsened to the pointthat she has difficulty with drinking and eating. She hasbecome increasingly dyspneic during the past 24 hours.

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman who is employed as a secretary. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

Hepatomegaly is detected during the routine physical examination of a healthy 40-year-old woman. She has noticed some fullness in the right upper abdomen for many years, but it has not been accompanied by pain or GI symptoms.

Man With Worsening Cough and Dyspnea

Young Man With Painless Penile Ulcer

A 44-year-old homeless man complains of a “sore” onhis penis. The ulcer developed from a macular lesionon the glans penis about 5 days earlier. The painless ulcerhas not responded to a topical antibiotic ointment he receivedat another clinic.

22-year-old man is hospitalized because of severe hypertension. In addition, he reports exertional retrosternal pressurelike pain, with a severity of 5/10, that lasts for 2 to 3 minutes.

16-month-old previously healthy child is hospitalized after 36 hours of worsening painful edema and erythema of the right lower leg and high fever with chills.

A 2 1/2-year-old child is hospitalized with a 1-month history of worsening persistent cough. She was initially treated with a 5-day course of oral amoxicillin, and her symptoms abated somewhat. However, for the past week, she has experienced high fever and chills associated with right-sided pleuritic chest pain.

A previously healthy 40-year-old man presents with a 2-hour history of excruciating colicky pain of acute onset that emanates from the right flank and radiates to the groin. He rates the severity of the pain at 9 on a scale of 1 to 10. Before arriving at the emergency department, the patient experienced nausea and 2 episodes of nonbilious, nonbloody vomiting.

A 4-year-old boy is admitted with a 2-week history of high fever with rigors; profuse night sweats; progressive dull, aching, nonradiating right upper quadrant pain; and watery, foul-smelling diarrhea that contains no blood or mucus.

A 56-year-old man was admitted to the hospital with right lower lobe pneumonia, which was exacerbated by smoking-induced chronic obstructive pulmonary disease (COPD).

A 42-year-old woman was hospitalized with an increasingly painful, ulcerated swelling of the right lateral thigh. The patient reported that while cleaning out her attic, she suddenly experienced an excruciating burning sensation in her thigh. Immediately, she rubbed the area with ice, which provided partial relief. An ulcer developed 24 hours later and began to enlarge.

A 68-year-old woman was admitted to the hospital with rapidly increasing, painful swelling of the left eye. She had moderately severe, corticosteroid-dependent chronic obstructive pulmonary disease.

A painful swelling over the right lower eyelid with conjunctival injection was evaluated in a 28-year-old injection drug user. Cephalexin and corticosteroid ophthalmic drops failed to resolve the condition.

57-year-old woman is hospitalized because of a 3-week history of persistent left-sided dull flank pain that worsens with movement and is associated with intermittent high fever.

32-year-old man presents with a 4-day history of fever (temperature as high as 38.8 C to 39.4 C with severe rigors, chills, and profuse night sweats; generalized myalgias, including dull, aching headache; and dry cough.