Clinical Challenge

Extreme weight loss in an elderly woman over a 24-month period

Extreme weight loss in an elderly woman over a 24-month period

A 65-year-old widow presented with a mass on her right breast and complaints of generally not feeling well.

Sudden neurologic symptom onset 
in an adolescent

Sudden neurologic symptom onset 
in an adolescent

Dizziness, photophobia, nausea and 
an unsteady gait develop following a 
routine annual check up.

Presyncope coupled with an enlarged spleen suggests infection

Presyncope coupled with an enlarged spleen suggests infection

A 69-year-old woman presents with night sweats, dizziness, fatigue and chronic pain in the upper abdomen.

Painful skin ulcer ­develops in older woman on dialysis

Painful skin ulcer ­develops in older woman on dialysis

Metastatic calcification of the left 
breast in a patient with renal failure 
raises suspicion.

A routine check-up 
reveals a significant 
genetic abnormality

A routine check-up 
reveals a significant 
genetic abnormality

A corrections officer came into the primary care office for a routine physical and left with an unexpected diagnosis.

Severe dizziness, nausea and vomiting prompt an ED visit

Severe dizziness, nausea and vomiting prompt an ED visit

The patient's gait was affected 48 hours after onset and any slight head movement intensified the feeling of imbalance.

Symptoms suggesting urolithiasis mask a 
life-threatening ailment

Symptoms suggesting urolithiasis mask a 
life-threatening ailment

Two days after symptom onset, a patient's skin is still mildly diaphoretic, he complains of fatigue and he cannot tolerate food.

A simple case of cellulitis on the third finger is a lot more

A simple case of cellulitis on the third finger is a lot more

A patient presents to the emergency department complaining of pain that originated over the distal tip of the digit.

When a patient falls, the pain 
indicates dislocation

When a patient falls, the pain 
indicates dislocation

Tenderness over the hypothenar eminence, swelling and limited flexion also suggest fracture.

Respiratory distress and pronounced muscular weakness signal trouble

Respiratory distress and pronounced muscular weakness signal trouble

A father is rushed to the emergency department after ingestion of a foreign, powderlike substance.

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