A 68-year-old woman presented to the otorhinolaryngology clinic with a 5-year history of swelling in the neck and the recent development of discomfort when she swallowed. On physical examination, she had a soft and nontender mass in the midline of the neck that moved with protrusion of the tongue…
A 72-year-old woman presented to the urology clinic with a 2-week history of passing gas in her urine. Three months earlier, she had been treated for acute diverticulitis, and just before the current presentation she had completed treatment for a urinary tract infection. On physical examination,…
A 17-year-old boy presented to the emergency department with pain and swelling in his jaw 2 hours after an e-cigarette exploded during use. The patient was in a hemodynamically stable condition and had no respiratory distress. He had a circular puncture to the chin, extensive lacerations in his…
A previously healthy 48-year-old man presented to the emergency department with acute onset of pain in both flanks. During the preceding 6 months he had had an unintentional weight loss of approximately 5 kg. Numerous splinter hemorrhages were observed on the fingernails of both hands (Panel A). No…
A 64-year-old man presented to the emergency department with a 6-month history of fatigue and dizziness. A physical examination was notable for an enlarged liver and spleen without lymphadenopathy. Laboratory studies showed a white-cell count of 1,279,000 per cubic millimeter (reference range, 4000…
A 66-year-old man presented to the emergency department with a 3-day history of cough, congestion, and pain in his chest and the left side of his abdomen. Several months before presentation, he had immigrated to the United States after living in a refugee camp for 20 years. The results of the…
A 76-year-old man presented to the pulmonary clinic with a 6-month history of progressively worsening dyspnea and productive cough. The patient had never smoked; 40 years earlier, he had worked as a sandblaster for 7 years. Physical examination was notable for diminished breath sounds and diffuse…
A 34-year-old man with a history of human immunodeficiency virus (HIV) infection presented to the emergency department with a 1-week history of headache, fever, and confusion. His temperature was 39.3°C, and on physical examination a large, ulcerative lesion was noted on his tongue (Panel A). The…
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