26 y/o M presents with severe right temporal headaches associated with ipsilateral rhinorrhea, eye tearing, and redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes
65 y/o F presnts with severe, intermittent right temporal headache, fever, blurred vision in her right eye, and pain in her jaw when chewing
Temporal arteritis (giant cell arteritis)
30 y/o F pw frontal headache, fever and nasal discharge. There is pain oni palpationof the frontal and maxillary sinuses.
50 y/o F presents with recurrent episodes of bilateral squeezing headaches that occur 3-4 times per week, typically toward end of work day.
35 y/o M pw sudden severe headache, vomiting, confusion, left hemiplegia and nuchal rigidity
18 y/o obese female pw pulsatile headache, vomiting, and blurred vision for the past 3 weeks. She is taking OCPs
57 y/o M pw daily pain in the right cheek over the past month. The pain is electric and stabbing in character and occurs while he is shaving. Each episode lasts 2-4 minutes
72 y/o M pw memory loss, gait disturbance and urinary incontinence for the past 6 months
Normal pressure hydrocephalus (NPH)
35 y/o F pw intermittent episodes of vertigo, tinnitus, nausea and hearing loss over the past week
44 y/o F pw dizziness on moving her head to left. She feels that the room is spinning around her head. Tilt test results in nystagmus and nausea
Benign positional vertigo
55 y/o F pw dizziness that started this morning. She is nauseated and has vomited once in the past day. She had a URI two days ago and has experienced no hearing loss.
55 y/o pw dizziness that started this morning and of "not hearing well." She feels nauseated and has vomited once in the past day. She had a URI two days ago.
34 y/o pw with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago
34 y/o pw stabbing chest pain that worsens with deep inspiration and is relieved by aspirin. She had a URI one week ago. Chest wall tenderness is noted.
48 y/o F presents with dysphagia for both solid and liquid foods that has slowly progressed in severity over the past year. It is associated with regurgitation of undigested food, especially at night.
45 yo M pw sudden onset of colicky right-sided flank pain that radiates to the testicles, accompanied by nausea, vomiting, hematuria, and CVA tenderness
41 yo obese F presents with RUQ abdominal pain that radiates to the right scapula and is associated with nausea, vomiting and a fever of 101.5. The pain started after she had eaten fatty food. She has had similar but less intense episodes that lasted a few hours. Exam reveals positive Murphy's sign.
43 yo obese F pw RUQ abdominal pain, fever and jaundice. She was diagnosed with asymptomatic gallstones one year ago.
37 yo M pw severe epigastric pain, nausea, vomiting and mild fever. He appears toxic. He has a history of intermittent epigastric pain that is relieved by food and antacids. He also smokes heavily and takes aspirin on a regular basis
Peptic ulcer perforation
70 yo F pw acute onset of severe, crampy abdominal pain. She recently worried and had a massive dark bowel movement. She has a history of CHF and atrial fibrillation, for which she has received digitalis. Her pain is out of proportion to the exam
60 y/o M pw nocturia, urgency, weak stream and terminal dribbling. He denies any weight loss, fatigue or bone pain. He has had two episodes of urinary retention that required catheterization
Benign prostatic hyperplasia (BPH)
35 yo F presents with amenorrhea, galactorrhea, visual field deficits, and headaches for the past six months
Amenorrhea due to prolactinoma
61 yo obese F pw profuse vaginal bleeding over the past month. Her LMP was 10 years ago. She has a history of HTN and DM. She is nulliparous.
28 yo F presents with a thin, grayish white, foul-smelling vaginal discharge
30 yo F presents with thick, white cottage cheese-like, odorless vaginal discharge and vaginal itching.
Vaginitis - candidal
35 yo F presents with malodorous, profuse, frothy, greenish vaginal discharge with intense vaginal itching and discomfort
Vaginitis - trichomonal
65 yo M pw pain in heel of right foot that is most notable with his first few steps and then improves as he continues walking. He has no known trauma
45 yo F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. The patient is unable to tiptoe
45 yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, and there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm are also noted.
Lumbar muscle strain
45 yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g. pushing a grocery cart)
Lumbar spinal stenosis
3 yo M pw two day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center.
Acute otitis media
55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes