A 23-year-old man who been a passenger in a minivan was brought to the ER after a high-speed road accident. He had transient hypotension and tachycardia, which improved after the administration of intravenous fluids.

A healthy 14-year-old boy presented with a 1-week history of a well-circumscribed, fleshy, nonpulsating growth at the proximal nail fold of his left third finger. The nail plate was absent under the growth.

An 18-year-old man with no notable medical history had sudden transient tetraplegia after heading a soccer ball. Ten minutes later, he had recovered normal strength. On examination, he had intense cervical pain, paresthesias on his shoulders and arms, and no other neurologic deficits.

A 55-year-old man with a 31-year history of type 1 diabetes mellitus presented for a routine clinical evaluation, his first in two decades. His insulin regimen consisted of a combination of neutral protamine Hagedorn (NPH) and rapid-acting insulin. In the ...

A 42-year-old man presented with severe nausea and vertigo, which were precipitated by the application of pressure just anterior to the left external auditory canal. Otoscopic examination revealed a cholesteatoma arising from the pars flaccida of the left tympanic membrane.

A 56-year-old female smoker presented with cough, a weight loss of 27 kg, and diffuse bone pain. There was digital clubbing, and the palms had a raised, velvety texture. There was a fixed, tender lump (4 cm in diameter) on the right lower leg and one over the lower lumbar spine.

A 61-year-old man with spinal cord compression underwent therapeutic laminectomy of the fifth vertebra and laminectomy and vertebroplasty of the fourth vertebra. During the vertebroplasty, polymethylmethacrylate cement leaked into the paravertebral vascular system.

A 74-year-old woman with chronic renal failure was admitted for diarrhea and functional impairment. She was noted to have a tender, soft swelling of the medial and distal phalanx of the right index finger (Panel A). She had no history of joint ...

An 18-year-old man presented with a 1-year history of episodic hemoptysis. He otherwise felt well, with no dyspnea, fever, night sweats, weight loss, pedal edema, rash, or evidence of bleeding elsewhere. He took no medications. Laboratory examination ...

An 18-year-old man presented with a history of progressive anasarca and exertional dyspnea. His jugular venous pressure was elevated and showed prominent systolic pulsations that were eliminated when gentle pressure was applied at the base of the neck.

A 40-year-old woman with asthma presented with pleuritic chest pain of acute onset. She had been coughing markedly for 2 weeks and had been treated with antibiotics for a lower respiratory tract infection. There was no history of trauma.

A woman was referred to the dermatology department for evaluation of swelling and nodules in the right foot, which had been present for 11 years. The nodules were painful, drained material periodically, and made weight-bearing difficult.

Cranial CT imaging revealed a metal foreign body at the edge of the foramen magnum in an 85-year-old man who had been hit by a bullet 82 years earlier. There was no evidence of neural damage.

A 19-year-old woman was brought to the ER after a nearby lightning strike in which her Great Dane dog had been instantly killed. She briefly lost consciousness and found herself on the wet ground, calling for help.

A 63-year-old man with a history of peptic ulcer and recent use of NSAIDs presented to the emergency department with acute shortness of breath and chest pain. He had hypotension and tachycardia.

A 23-year-old man presented with a 1-year history of diabetes mellitus, hypertension, and hypogonadism and a weight gain of 22 kg. Abdominal striae were present on physical examination (Panel A). An endocrine evaluation showed a corticotropin-dependent ...

A 59-year-old woman with a history of breast cancer who had undergone bilateral mastectomy and placement of breast prostheses reported that her “body swallowed one of the implants” during a Pilates stretching exercise. The patient reported no chest pain or dyspnea.

An 8-year-old girl with a history of congenital mitral stenosis and mitral-valve replacement presented with dyspnea on exertion, fatigue, and orthopnea. On examination, she had tachypnea, a heart rate of 130 bpm, and oxygen saturation of 85 to 87% while breathing ambient air.

A 32-year-old man presented with vision loss in the left eye. One week earlier, while under local anesthesia, he had had an autologous fat injection into his forehead to correct frown lines. During the injection, he felt a sudden, severe periocular pain and had complete vision loss in his left eye.

A 45-year-old woman presented to the emergency department 3 days after the acute onset of severe dysphagia, breathy dysphonia, and earache and pulsatile tinnitus in the left ear. Her medical history was unremarkable. Physical examination revealed leftward ...