Thoracic Key

GOUT   43A A 58-year-old man with a long history of treated essential hypertension and mild renal insufficiency presents to the urgent care clinic complaining of pain in the right knee. His…

INFECTIVE ENDOCARDITIS   79A A 55-year-old man who recently emigrated from China presents to the emergency department with a fever. He has had recurring fevers over the past 3 weeks associated with…

RHEUMATOID ARTHRITIS   45A A 47-year-old woman presents to the clinic with a 4-week history of fatigue, bilateral hand pain and stiffness, and hand and wrist joint swelling. About 1 month before…

SYSTEMIC LUPUS ERYTHEMATOSUS   46A A 22-year-old African American woman reports intermittent joint pain in her right knee and the joints of the fingers of her right hand, especially the proximal interphalangeal…

DEPRESSION   57A A 57-year-old woman presents to her primary care clinician complaining of insomnia for 4 months. She reports that she can often fall asleep but awakens very early in the…

SHOCK   22A A young woman is brought to the emergency department by ambulance after a severe motor vehicle accident. She is unconscious. Her blood pressure is 64/40 mm Hg and heart…

GASTROINTESTINAL BLEEDING, LOWER   32A A 53-year-old man comes to the emergency department with a 3-hour history of bright red blood per rectum. The man states that he had been feeling well…

HYPERPARATHYROIDISM, PRIMARY   71A A 56-year-old woman presents to her primary care clinician complaining of progressive fatigue, weakness, and diffuse bony pain. She says that her symptoms have been getting worse over…

HYPOTHYROIDISM   73A A 55-year-old woman complains of fatigue, 30 lb of weight gain despite dieting, constipation, thinning hair, and menorrhagia. On physical examination, the thyroid gland is not palpable; the skin…

STROKE   62A An 82-year-old woman with atrial fibrillation comes to the emergency department with 1 hour of difficulty moving her right arm and leg. Her medical history includes a transient ischemic…