Clinical

A 27-year-old man presents complaining of a single skin lesion on his hand. He reports that it first appeared as a smooth nodule that ulcerated and spread in a lymphangitic fashion. He grew worried when he started to have a fever. The only unusual activity he’d done in the last few weeks was clean out one of his large saltwater aquariums to prepare for purchasing new fish. View the photo and consider what your diagnosis …

The patient is a 57-year-old man who complains of lightheadedness for the last 3 days. He has a history of a heart stent placed 4 years ago and has been asymptomatic since that time. He denies vomiting, diarrhea, chest pain, shortness of breath, abdominal pain, or paresthesias. No recent travel. He takes metoprolol and clopidogrel. There is a family history of hypertension Upon exam, you find: General: Sitting comfortably in a chair, alert, breathing comfortably …

The patient, age 50, is a farmer who presents with flu-like symptoms—fever, chills, productive cough, myalgia, and pleuritic chest pain that developed over a few weeks. What worried him most, however, was a crusted lesion on his arm that was a large verrucous scaly plaque. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Case The patient is a 9-year-old girl who is brought in by her parents shortly after choking on a chicken nugget. They are concerned because even though she stopped gagging, she complains that it feels “like there’s something stuck in there.” View the images, ordered to rule out a lodged foreign body, and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.