Image of the Week: Can you identify these cutaneous findings?

Image of the Week: Can you identify these cutaneous findings?

An otherwise healthy 50-year-old man presents with a rash that he has had for several years. The skin eruption becomes ...

Derm Dx: Pink plaques and crusting ulcerations

Derm Dx: Pink plaques and crusting ulcerations

A 53-year-old woman with a history of hypertension, alcohol abuse, and amphetamine dependence presents with painful wounds on the bilateral ...

Ortho Dx: Severe pelvic pain after childbirth

Ortho Dx: Severe pelvic pain after childbirth

A 19-year-old woman complains of severe pain in her pelvis after vaginal delivery of her first child. One day after ...

Image of the Week: What is causing this patient's resistant hypertension?

Image of the Week: What is causing this patient's resistant hypertension?

A 54-year-old man presents with fatigue, lethargy, and frequent headaches. He has a 1-year history of hypertension that has been ...

Ortho Dx: What is the best treatment for this knee injury?

Ortho Dx: What is the best treatment for this knee injury?

A 22-year-old woman presents to the emergency department with left knee pain after a motor vehicle accident. Her left knee ...

Ortho Dx: Treatment for lower back and buttock pain

Ortho Dx: Treatment for lower back and buttock pain

A 27-year-old woman presents to the emergency department with increasing lower back and buttock pain for 3 weeks. She admits ...

Image of the Week: Injuries after a physical altercation

Image of the Week: Injuries after a physical altercation

Three days following a physical altercation, a 21-year-old man presents with nausea and ecchymoses behind the mastoid processes, also called ...

Ortho Dx: A 67-year-old woman with activity-related thigh pain

Ortho Dx: A 67-year-old woman with activity-related thigh pain

A 67-year-old woman presents with activity-related right thigh pain. The pain increases as she gets farther into her walks, and ...

Image of the Week: Wrinkling of the palms after water exposure

Image of the Week: Wrinkling of the palms after water exposure

A 16-year-old female presents with a 1-year history of skin changes to both palms. They are transient in nature, appearing ...

Derm Dx: A blue-black nodule on the hand

Derm Dx: A blue-black nodule on the hand

A 33-year-old Malaysian woman requests removal of a blue–black growth on her right hand. The lesion has been present for ...

Ortho Dx: Foot pain that is worse in the morning

Ortho Dx: Foot pain that is worse in the morning

A 64-year-old man presents with right foot pain that he has had for several months. The pain is worse in ...

Image of the Week: What is causing this patient's headaches?

Image of the Week: What is causing this patient's headaches?

A 50-year-old woman presents to the emergency department with a 2-week history of headaches. The pain is widespread and throbbing ...

Ortho Dx: What is the best treatment for this shoulder pain?

Ortho Dx: What is the best treatment for this shoulder pain?

A 62-year-old woman presents with 3 months of left shoulder pain. X-rays show osteonecrosis of the humeral head with advanced ...

Image of the Week: Why is this newborn hypotonic?

Image of the Week: Why is this newborn hypotonic?

A full-term infant male is born to a healthy 32-year-old woman. The newborn examination reveals generalized hypotonia and a distended ...

Derm Dx: Sudden onset of itchy, reddened macules

Derm Dx: Sudden onset of itchy, reddened macules

A 42-year-old woman presents with a sudden onset of itchy, reddened macules on her trunk. Stroking her skin induces localized ...

Ortho Dx: Neck pain after a motor vehicle accident

Ortho Dx: Neck pain after a motor vehicle accident

A 46-year-old man presents to the emergency department with severe neck pain after a motor vehicle accident. Imaging shows a ...

Image of the Week: Painful lesions in the armpits

Image of the Week: Painful lesions in the armpits

A 27-year-old man presents with painful lesions in both armpits. He has experienced several worsening episodes similar to this one ...

Derm Dx: Flesh-colored lesions on an infant

Derm Dx: Flesh-colored lesions on an infant

A mother brings in her 13-day-old baby for evaluation of facial lesions. Noted on examination are flesh-colored lesions located in ...

Ortho Dx: A woman with a hip that is popping out of place

Ortho Dx: A woman with a hip that is popping out of place

A 35-year-old woman presents with right hip pain, which she has had for several months. She stopped running recently due ...

Image of the Week: Do you recognize this chest abnormality?

Image of the Week: Do you recognize this chest abnormality?

A 30-year-old man presents for a routine physical. He reports being in good health, but he has some cosmetic concerns ...

Derm Dx: Hair loss in a 15-year-old female

Derm Dx: Hair loss in a 15-year-old female

A Hispanic woman brings her 15-year-old daughter for evaluation of hair loss at the front of her scalp. Diffuse thinning ...

Ortho Dx: What is the best treatment for this foot injury?

Ortho Dx: What is the best treatment for this foot injury?

A woman presents with left foot pain from a fall 2 days prior to her visit. She complains of pain ...

Image of the Week: What disorder is a risk factor for this presentation?

Image of the Week: What disorder is a risk factor for this presentation?

A 71-year-old man presents to the emergency department with severe abdominal pain. A palpable tender mass can be felt in ...

Derm Dx: An asymptomatic eruption on the legs and trunk

Derm Dx: An asymptomatic eruption on the legs and trunk

A 76-year-old man is referred for evaluation of an asymptomatic eruption that began on his legs about 2 weeks ago ...

Ortho Dx: A shoulder injury after a mixed martial arts competition

Ortho Dx: A shoulder injury after a mixed martial arts competition

A 23-year-old woman presents to the emergency department with a left shoulder injury that occurred when she was competing in ...

Image of the Week: What is the threshold for surgical intervention?

Image of the Week: What is the threshold for surgical intervention?

A 55-year-old woman with a history of hypertension presents for a routine pre-employment checkup. She is a smoker with a ...

Derm Dx: A rash after a streptococcal throat infection

Derm Dx: A rash after a streptococcal throat infection

A 16-year-old female presents with dermatitis that appeared suddenly after a streptococcal throat infection 10 days earlier. She is otherwise ...

Image of the Week: What audible finding is consistent with this presentation?

Image of the Week: What audible finding is consistent with this presentation?

A 40-year-old man presents to the emergency department with sharp chest pain and palpitations. He says the pain is worse ...

Derm Dx: Scaling dermatitis on the scalp and face

Derm Dx: Scaling dermatitis on the scalp and face

A 7-month-old Hispanic female child presents for evaluation of a scaling dermatitis of several weeks in duration affecting her scalp ...

Ortho Dx: Preventing postoperative infection after an open femur fracture

Ortho Dx: Preventing postoperative infection after an open femur fracture

A 48-year-old man presents to the emergency department by way of ambulance after a motorcycle accident. He was thrown off ...

Derm Dx: A growing lesion first observed in early childhood

Derm Dx: A growing lesion first observed in early childhood

An 18-year-old Caucasian male presents for evaluation of a growth on his leg that he first noted in early childhood. ...

Image of the Week: What is causing this patient's aphthous ulcers and abdominal tenderness?

Image of the Week: What is causing this patient's aphthous ulcers and abdominal tenderness?

A 23-year-old woman presents with a recurrence of severe, crampy abdominal pain and a prolonged history of diarrhea. Her chart ...

Ortho Dx: Complications after total knee arthroplasty

Ortho Dx: Complications after total knee arthroplasty

An 80-year-old woman presents with 3 months of right shin pain. She had a revision total knee replacement 5 years ...

Image of the Week: Do you recognize this neurodegenerative disorder?

Image of the Week: Do you recognize this neurodegenerative disorder?

A 71-year-old male returns for his annual health exam with concerns over progressive memory deterioration. He is pleasant and cooperative ...

Derm Dx: A hard, fixed nodule with a bluish tint on the leg

Derm Dx: A hard, fixed nodule with a bluish tint on the leg

A 33-year-old woman presents with a hard, fixed nodule of the left lower leg. She states that it developed approximately ...

Ortho Dx: Elbow pain in the throwing athlete

Ortho Dx: Elbow pain in the throwing athlete

A 17-year-old male presents with right elbow pain for several months. He plays baseball 7 months of the year and ...

Derm Dx: A red and itchy rash after a vacation

Derm Dx: A red and itchy rash after a vacation

A 37-year-old Caucasian man presents to the emergency department with a red and itchy rash for the past 7 days. ...

Image of the Week: How would you manage this slow-growing neck mass?

Image of the Week: How would you manage this slow-growing neck mass?

A 4-year-old boy presents with an 8-month history of a slow-growing submandibular mass. Further history reveals that he has felt ...

Ortho Dx: Treatment for a comminuted scaphoid fracture

Ortho Dx: Treatment for a comminuted scaphoid fracture

A 58-year-old woman presents with left wrist pain after slipping on ice and falling 3 months ago. X-rays show a ...

Image of the Week: What is causing this child's lethargy and foul-smelling vomiting?

Image of the Week: What is causing this child's lethargy and foul-smelling vomiting?

A 7-year-old girl presents with subacute lethargy, abdominal pain and distension, and foul-smelling vomiting in the context of a lifelong ...

Derm Dx: A flesh-colored lesion above the lip

Derm Dx: A flesh-colored lesion above the lip

A 73-year-old man presents with a lesion above his lip, of approximately 1 year in duration. The site is traumatized ...

Ortho Dx: A case of compartment syndrome

Ortho Dx: A case of compartment syndrome

A 38-year-old man presents to the emergency department in an ambulance after sustaining a right leg injury. X-rays show a ...

Image of the Week: A suspected overdose of acetaminophen

Image of the Week: A suspected overdose of acetaminophen

A 75-year-old woman is brought to the emergency department after ingesting an unknown amount of acetaminophen. After an initial assessment, ...

Derm Dx: Discoloration on the buttocks and lower back

Derm Dx: Discoloration on the buttocks and lower back

A 52-year-old woman with a history of chronic vertebral disk problems and lumbar surgery is referred for evaluation of a ...

Ortho Dx: Which grade of arthritis does this patient have?

Ortho Dx: Which grade of arthritis does this patient have?

A 63-year-old woman presents with left knee pain that she has had for several months. X-rays show mild joint space ...

Image of the Week: Abdominal pain, a rash, and knee pain

Image of the Week: Abdominal pain, a rash, and knee pain

A 3-year-old female presents to her pediatrician with a 1-week history of abdominal pain and a rash following recovery from ...

Derm Dx: Pink to flesh-colored papules on a young child

Derm Dx: Pink to flesh-colored papules on a young child

A 17-month-old Hispanic female presents with a 6-week history of a rash most prominent on her arms and legs. A ...

Ortho Dx: Wrist pain after a motorcycle accident

Ortho Dx: Wrist pain after a motorcycle accident

A 24-year-old male presents with right wrist pain following a motorcycle accident 2 days ago. An X-ray taken on the ...

Image of the Week: Abnormal gynecologic findings

Image of the Week: Abnormal gynecologic findings

A 22-year-old G0P0 female presents for follow-up after a first-time cervical screening test. On her cervical cytology slide, a cluster ...

Derm Dx: A rash on the nasolabial folds, eyelashes, and scalp

Derm Dx: A rash on the nasolabial folds, eyelashes, and scalp

A 68-year-old male presents for treatment of a rash affecting his nasolabial folds, eyelashes, forehead, and scalp. He complains that ...

Ortho Dx: A chainsaw injury to the forearm

Ortho Dx: A chainsaw injury to the forearm

A 58-year-old male presents with a chainsaw injury to the left forearm. He was trimming some trees when he lost ...

Image of the Week: Why does this patient's back pain remit with exercise?

Image of the Week: Why does this patient's back pain remit with exercise?

The patient’s symptoms are typically worse first thing in the morning, but they seem to remit later in the day ...

Derm Dx: Multiple moles and extensive sun exposure

Derm Dx: Multiple moles and extensive sun exposure

The patient is a 47-year-old female requesting full body examination, as she has multiple moles and a family history of ...

Ortho Dx: Can you identify this structure?

Ortho Dx: Can you identify this structure?

Can you identify the structure in Figure 1 that the yellow arrow points to?

Image of the Week: How would you manage this sheep rancher's lesion?

Image of the Week: How would you manage this sheep rancher's lesion?

A 22-year-old male presents with a 1-week history of a lesion on his index finger after working at his uncle’s ...

Derm Dx: Bumps on the leg 10 years after cancer surgery

Derm Dx: Bumps on the leg 10 years after cancer surgery

The patient had salivary gland cancer diagnosed and surgically excised 10 years ago. Examination of the affected ankle reveals scattered ...

Ortho Dx: Pain over the lateral midfoot

Ortho Dx: Pain over the lateral midfoot

The pain is located over the lateral midfoot, and the patient has tenderness to palpation over an apparent ossicle adjacent ...

Image of the Week: What is the cause of this pustular rash?

Image of the Week: What is the cause of this pustular rash?

An 80-year-old female with a history of arthritis and high blood pressure presents with lesions and erythema on her palms ...

Derm Dx: A pruritic eruption on the arms and trunk

Derm Dx: A pruritic eruption on the arms and trunk

A patient’s rash began more than 2 weeks ago and has not responded to 1% hydrocortisone cream. He denies fever ...

Ortho Dx: Ankle stabilization

Ortho Dx: Ankle stabilization

On examination, the patient has an increased anterior drawer test and slight talar tilt of the left ankle. Radiographs of ...

Image of the Week: What's causing this elderly woman's weight loss?

Image of the Week: What's causing this elderly woman's weight loss?

A 65-year-old woman presents to a clinician for the first time in 25 years with a history of weight loss ...

Derm Dx: Simultaneous appearance of multiple indurated plaques

Derm Dx: Simultaneous appearance of multiple indurated plaques

Several of these dusky red indurated plaques appeared simultaneously on the back, thigh, and scalp of a 70-year-old nonsmoker in ...

Ortho Dx: A nondisplaced fracture through a radiolucent lesion

Ortho Dx: A nondisplaced fracture through a radiolucent lesion

Examination of a patient presenting with finger pain finds tenderness to the distal phalanx without deformity. Radiographs show a nondisplaced ...

Image of the Week: What's causing this greasy underarm rash?

Image of the Week: What's causing this greasy underarm rash?

A 17-year-old male presents with a recurrent pruritic rash on his back, shoulders, hands, and axillae. He says the rash ...

Derm Dx: A factory worker with an itchy rash on the wrists and ankles

Derm Dx: A factory worker with an itchy rash on the wrists and ankles

A 42-year-old manufacturing plant worker presents with an itchy rash that was previously diagnosed as contact dermatitis. Mometasone cream has ...

Ortho Dx: Thigh pain 2 years after hip replacement surgery

Ortho Dx: Thigh pain 2 years after hip replacement surgery

A 65-year-old postal worker who had total hip replacement surgery 2 years ago notices pain in his thigh over the ...

Derm Dx: A reddish rash on the scrotum

Derm Dx: A reddish rash on the scrotum

A 38-year-old man presents with diffuse erythema of his scrotum. Oral fluconazole and topical econazole have been ineffective. He is ...

Image of the Week: Free-floating mass found in stab victim

Image of the Week: Free-floating mass found in stab victim

This firm unattached mass was found on exploratory laparotomy of a 57-year-old man who had been stabbed multiple times.

Ortho Dx: A humerus fracture after a bike accident

Ortho Dx: A humerus fracture after a bike accident

A 19-year-old woman is thrown over the handlebars of her bicycle during an accident and lands on her elbow. Radiographs ...

Derm Dx: Discolored patches on the torso of a woman with vulvar lichen sclerosus

Derm Dx: Discolored patches on the torso of a woman with vulvar lichen sclerosus

Examination of a 62-year-old woman with biopsy-confirmed lichen sclerosus of the vulvar region finds discolored patches with central telangiectasias on ...

Image of the Week: A rare reaction to a popular Asian food

Image of the Week: A rare reaction to a popular Asian food

After going to an Asian food festival a few days earlier, a 50-year-old man presents with this pruritic, whiplash-striped, erythematous ...

Ortho Dx: Would you remove this fingernail?

Ortho Dx: Would you remove this fingernail?

After getting her finger caught between a board and a cement block, a 50-year-old woman presents with a subungual hematoma ...

Derm Dx: A growing knot in the palm

Derm Dx: A growing knot in the palm

A nonsmoker who admits to binge drinking presents with a firm, fixed cord in her palm and loss of mobility ...

Image of the Week: Do you recognize the clinical triad in this emergency case?

Image of the Week: Do you recognize the clinical triad in this emergency case?

A 35-year-old woman presents to the emergency department with lower abdominal pain and vaginal spotting. Her last menstrual period was ...

Ortho Dx: Increased forefoot pain when metatarsal heads squeezed

Ortho Dx: Increased forefoot pain when metatarsal heads squeezed

A 56-year-old woman presents with a several-month history of forefoot pain. Examination finds that the pain increases when squeezing the ...

Derm Dx: Whitening and crumbling of fingernails

Derm Dx: Whitening and crumbling of fingernails

An 11-year-old boy presents with hand and foot blisters, a slight fever, mouth irritation, and most recently, distal whitening and ...

Image of the Week: Could a pacemaker be causing this patient's hiccups?

Image of the Week: Could a pacemaker be causing this patient's hiccups?

Hiccups result in a patient whose pacemaker leads are found to be retracted and coiled around the device.

Ortho Dx: A calcified mass in the back of the knee

Ortho Dx: A calcified mass in the back of the knee

Lateral radiograph of an 82-year-old man with knee pain reveals a calcified mass in the back of the knee. Magnetic ...

Derm Dx: Purplish scrotal lesions in a man with hypertension

Derm Dx: Purplish scrotal lesions in a man with hypertension

A 70-year-old man who takes hydrochlorothiazide for hypertension presents with violaceous papules on his scrotum, which also has a reddish ...

Image of the Week: The classic findings of a rare condition

Image of the Week: The classic findings of a rare condition

A 36-year-old woman presents with severe headache, palpitations, diaphoresis, and pruritic, pigmented lesions on her back. An abdominal CT scan ...

Ortho Dx: Pediatric plastic deformation

Ortho Dx: Pediatric plastic deformation

A child riding on a scooter falls forward and lands on his outstretched hand. Radiographs show a distal one-third radius ...

Image of the Week: Why would this man's urine turn red after a house fire?

Image of the Week: Why would this man's urine turn red after a house fire?

A man is rescued from a house fire, resuscitated on scene, and brought to the emergency department, where his urine ...

Derm Dx: Extensive sun exposure and red lesions on the arms and legs

Derm Dx: Extensive sun exposure and red lesions on the arms and legs

A 65-year-old man presents with red lesions on his arms and legs. He has no history of skin cancer but ...

Ortho Dx: A fibula fracture with ankle swelling

Ortho Dx: A fibula fracture with ankle swelling

A 29-year-old man has ankle and leg pain after slipping on ice. Radiographs of the tibia and fibula show an ...

Image of the Week: A dead cat, a sick child, and an unusual rash

Image of the Week: A dead cat, a sick child, and an unusual rash

An 11-year-old boy and his family develop these annular scaling plaques after their cat eats a mouse and dies the ...

Derm Dx: A firm nodule with a positive skin crease sign

Derm Dx: A firm nodule with a positive skin crease sign

A 10-year-old boy presents with an asymptomatic firm nodule on his cheek. When the lesion is squeezed, a longitudinal crease ...

Ortho Dx: Which graft would you choose to reconstruct this ACL?

Ortho Dx: Which graft would you choose to reconstruct this ACL?

A 17-year-old male injures his knee during a lacrosse game. Magnetic resonance imaging shows a complete anterior cruciate ligament (ACL) ...

Derm Dx: An enlarging erythematous nodule on the forehead

Derm Dx: An enlarging erythematous nodule on the forehead

A 43-year-old woman presents with a growing nodule on her forehead. When it was smaller, it was "easily covered by ...

Image of the Week: What condition is contributing to this rare disorder?

Image of the Week: What condition is contributing to this rare disorder?

A 56-year-old man with a history of cirrhosis presents with new pigmented papules on his fingers and toes and progressive ...

Ortho Dx: Does this patient's pain originate at the neck?

Ortho Dx: Does this patient's pain originate at the neck?

A 48-year-old woman with severe shoulder and neck pain demonstrates mildly positive shoulder impingement signs and a negative Spurling test ...

Image of the Week: What's causing this distinctive mucosal pattern?

Image of the Week: What's causing this distinctive mucosal pattern?

White lace-like striations of the buccal mucosa are noted on a woman with a three-month history of mouth pain, sensitivity ...

Derm Dx: A baby with a rash on the hands and feet

Derm Dx: A baby with a rash on the hands and feet

A 3-month-old Hispanic male presents with scattered flesh-colored papules and pustules on his palms and soles.

Ortho Dx: Choose the best surgical option for these two patients

Ortho Dx: Choose the best surgical option for these two patients

A 70-year-old man and a 74-year-old man with shoulder pain have failed conservative treatment with intra-articular steroid injections, rest, and ...

Derm Dx: Itchy bumps on a man who uses a hot tub regularly

Derm Dx: Itchy bumps on a man who uses a hot tub regularly

A man presents with itchy bumps on his arms and legs. He lives alone, does not have pets, and uses ...

Image of the Week: Can you recognize the infrequent signs of this deadly disease?

Image of the Week: Can you recognize the infrequent signs of this deadly disease?

A 14-year-old male with a genetic disorder presents with worsening drowsiness, palpitations, shortness of breath, and difficulty swallowing. An X-ray ...

Ortho Dx: Which finding indicates cervical myelopathy?

Ortho Dx: Which finding indicates cervical myelopathy?

Anteroposterior and lateral cervical spine radiographs of an 85-year-old man with severe upper extremity pain show multilevel degenerative changes.

Derm Dx: Hyperpigmented, hyperkeratotic papules covered by waxy scale

Derm Dx: Hyperpigmented, hyperkeratotic papules covered by waxy scale

A moderately obese 40-year-old white woman presents with an intermittently pruritic rash on her chest and flexural and anogenital regions. ...

Image of the Week: What comorbidity would cause this discolored bone?

Image of the Week: What comorbidity would cause this discolored bone?

A surgeon notices discolored bone during foot surgery on a man with progressive foot pain. What condition could have led ...

Ortho Dx: The treatment dilemma with partial rotator cuff tears

Ortho Dx: The treatment dilemma with partial rotator cuff tears

Shoulder arthroscopy of a 49-year-old woman with a 4-month history of shoulder pain reveals a partial tear through 60% of ...

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