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Interactive Medical Cases

This interactive feature describes a 36-year-old man with HIV infection who presented to the hospital with fever and a mass on the left side of the neck. Test your diagnostic and therapeutic skills at NEJM.org.

A 36-year-old Man with HIV Infection, Fever, and a Mass on the Left Side of the Neck

This interactive feature describes a 59-year-old man who presented to the hospital with crampy abdominal pain on the left side, irritability, and confusion that had begun 2 days before the current presentation. Test your diagnostic and therapeutic skills at NEJM.org. ...

A 59-year-old Man with Crampy Abdominal Pain, Irritability, and Confusion

A 68-year-old man presented to his primary care doctor with blurry vision in his right eye. Test your diagnostic and therapeutic skills at NEJM.org.

A 68-year-old Man with Blurry Vision in His Right Eye

A 50-year-old woman presented to the ED with pleuritic chest pain and shortness of breath. Test your diagnostic and therapeutic skills at NEJM.org.

Thinking Outside the Heart

This interactive feature describes a 70-year-old Albanian woman with progressive pain in the right upper quadrant. She described it as a dull ache that radiated to her midback and lower abdomen. She also noted fevers, anorexia, and fatigue. Test your skills at...

A 70-Year-Old Albanian Woman With Progressive Pain in the Right Upper Quadrant

This interactive feature describes a 68-year-old woman with a 2-year history of intermittent palpitations who is admitted to the cardiac care unit for management of ventricular tachycardia. She states that the palpitations have been occurring with increasing frequency and that she now also has...

A 68-year-old Woman with a 2-Year History of Intermittent Palpitations

This interactive case describes a 59-year-old man who presented to the ED with worsening fatigue and headache. While describing his symptoms, he became unable to produce fluent speech. Test your diagnostic and therapeutic skills at NEJM.org.

A 59-year-old Man with Worsening Fatigue and Headache

This interactive feature describes the case of a 50-year-old woman who presents to the emergency department with a 4-month history of progressive neurologic symptoms and is admitted to the inpatient neurology service. Test your diagnostic and therapeutic skills at NEJM.org. ...

A 50-year-old Woman with a 4-Month History of Progressive Neurologic Symptoms

This interactive feature describes the case of an 18-year-old man who presents to the emergency department with painful, red bumps on both legs and his left ankle. He reports that the lesions had appeared 2 weeks before presentation and had begun to interfere with walking. Test your diagnostic and therapeutic...

A 18-year-old Man with Painful, Red Bumps on Both Legs and His Left Ankle

This interactive case features a 58-year-old man who reports having crushing, substernal chest pain that starts immediately after a plane’s takeoff. Test your diagnostic and therapeutic skills at NEJM.org.

A 58-year-old Man with Crushing, Substernal Chest Pain that Starts Immediately After a Plane’s Takeoff

This interactive feature describes the case of a 20-year-old woman who presented to the emergency department with pain in her throat and the left side of her neck, fever, and foul-smelling breath. Test your diagnostic and therapeutic skills at NEJM.org.

A 20-year-old Woman with Pain in Her Throat and the Left Side of Her Neck, Fever, and Foul-smelling Breath

This interactive feature describes the case of a 27-year-old man who presented to the emergency department with weakness in both legs that was so severe he could not stand. Test your diagnostic and therapeutic skills at NEJM.org. ...

A 27-year-old Man with Weakness in Both Legs

This interactive feature presents the case of a 61-year-old man who was transferred to the cardiac care unit after having cardiac arrest the day after arthroplasty of the left knee. Test your diagnostic and therapeutic skills at NEJM.org. ...

A 61-year-old Man with Cardiac Arrest the Day after Arthroplasty of the Left Knee

This interactive feature describes a man who presented to the emergency department (before Covid) with vomiting, abdominal pain, and fever, after emigrating from Mexico to the United States. Test your diagnostic and therapeutic skills at NEJM.org. ...

A Man Who with Vomiting, Abdominal Pain, and Fever, After Emigrating from Mexico to the United States

This interactive case features a 60-year-old woman who presented with a 5-day history of fevers and chills early in the Covid-19 pandemic. In the 3 days before presentation, dyspnea, a dry cough, nausea without vomiting, and watery diarrhea also developed. Test... ...

A 60-year-old Woman Who Presented with a 5-day History of Fevers and Chills Early in the Covid-19 Pandemic

This interactive case features a patient with a 3-week history of worsening chills and intermittent fevers. He also reported the recent onset of drenching night sweats, generalized malaise, fatigue, anorexia, and dull headaches. No recent travel or sick... ...

A Man with a 3-week History of Worsening Chills and Intermittent Fevers

This interactive case features a woman with systemic lupus erythematosus who presents with a 1-month history of worsening fatigue, diffuse arthralgias, a rash on her face and arms, swelling in her legs, and frequent urination. Test your diagnostic and therapeutic... ...

A 24 Year Old Woman with Systemic Lupus Erythematosus Who
Presents with a 1-month History of Worsening Fatigue, Diffuse Arthralgias, a Rash on Her Face and Arms, Swelling in Her Legs, and Frequent Urination

Approximately 10 minutes after being stung on the right lower leg by a yellow jacket (a type of wasp), a 45-year-old man began to feel light-headed and nauseated. He called emergency medical services, and paramedics arrived 10 minutes later. They found...

A Stinging Sensation

This interactive features a 63-year-old woman with a history of multiple fractures who presents with progressively worsening pain in both ankles and difficulty walking. Test your diagnostic and therapeutic skills at NEJM.org.

A 63-year-old Woman with a History of Multiple Fractures
Who Presents with Progressively Worsening Pain in Both Ankles and Difficulty
Walking

This interactive feature describes a patient who presents with pain and numbness in the lower abdomen, lower back, and groin. Test your diagnostic and therapeutic skills at NEJM.org.

A 58-year-old Man with a 2-week History of Lower Abdominal, Lower Back and Groin Pain

Interactive Learning Resources

This section contains curated, high-yield learning tools in two formats:
<ul style="font-style: normal; font-weight: 400; line-height: 28px; /* or 156% *//* blacks / 100 */color: #000000;">
<li>Interactive Medical Cases are based on a real patient&rsquo;s experience with illness.</li>
<li>Interactive Learning Elements cover specific topics, like eosinophilia or acid-base disorders, in an engaging format.</li>
</ul>
These resources are organized from introductory to advanced topics.

Images in Clinical Medicine

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Abdominal pain and large-volume hematochezia developed in a man who was in the hospital for a ruptured cerebral aneurysm. Findings on endoscopy and colonoscopy were unremarkable, so CT angiography was performed.

Small-Bowel Bleeding

A 57-year-old woman presented with a 3-day history of shortness of breath and dizziness. Laboratory studies showed severe anemia with hemolysis, along with cellular abnormalities in peripheral blood.

Drug-Induced Oxidative Hemolysis

A 35-year-old man received an incidental diagnosis of hypertension during a routine medical assessment. Computed tomographic angiography revealed aortic coarctation.

Aortic Coarctation

A 15-year-old boy presented with a 1-hour history of hearing loss and pain in the left ear after he had tripped and fallen on the street. An otoscopic examination of the left ear showed blood behind the tympanic membrane. ...

Hemotympanum with a Basilar Skull Fracture

A 32-year-old man presented with a 4-month history of recurrent abscesses and a 3-day history of a skin lesion on his face. On examination, a skin ulcer with a violaceous border was seen on the right lower portion of the face. ...

Evolution of Pyoderma Gangrenosum

A 35-year-old man being treated for leprosy presented with a 4-day history of anxiety, insomnia, and resting tremor of the hands and feet. Bluish discoloration of the lips and tongue was seen on examination.

Central Cyanosis in Acquired Methemoglobinemia

A healthy 14-year-old boy presented with a 6-hour history of hoarseness and difficulty swallowing after having accidentally swallowed a coin. Bronchoscopy showed a coin situated vertically within the subglottis (shown in a video).

A Coin in the Airway

A 55-year-old woman with a 29-pack-year smoking history presented with a 1.5- year history of pain in her fingers, wrists, hips, knees, and ankles. Clubbing of the fingers and toes was seen on examination.

Secondary Hypertrophic Osteoarthropathy

An 82-year-old man presented with a 3-year history of progressive generalized weakness. PET-CT showed a metabolically active adrenal mass on each side.

Adrenal Involvement in Disseminated Histoplasmosis

An 82-year-old man with type 2 diabetes and recent glucocorticoid use presented with a 2-week history of headache and spontaneous bruising around his eye. Black eschars were observed in the nasal cavity (shown in a video).

Rhino-orbital-cerebral Mucormycosis

A 72-year-old man who began receiving continuous renal-replacement therapy in the ICU was noted to have green-colored dialysis effluent and plasma.

Green Dialysis Effluent and Plasma

A 76-year-old man presented with a 2-day history of blood-filled blisters on the tongue. Multiple hemorrhagic bullae on the tongue and gingiva and purpura on the arms and legs were noted.

Spontaneous Oral Purpura in Immune Thrombocytopenia

A 40-year-old man was referred to the otorhinolaryngology clinic with a 1-month history of a sore throat. Nonulcerated white plaques were present in a butterfly shape across the posterior oropharynx, upper uvula, and tonsils.

Syphilitic Pharyngitis

A 32-year-old man presented with a 2-week history of epigastric pain, nausea, anorexia, and weight loss. Endoscopy revealed ulcers in the gastric antrum and the greater antral curvature.

Gastric Syphilis

A 28-year-old woman presented with a 6-month history of dry cough. CT of the chest showed diffuse ground-glass opacities with areas of superimposed interlobular and intralobular septal thickening.

Crazy-Paving Pattern in Pulmonary Sarcoidosis

A man with a history of well-controlled HIV infection presented with an 11-day history of progressive painful tongue lesions and 1-week history of sore throat and fevers. On examination, four ulcers were seen on the tongue.

Mpox Tongue Lesions

A 63-year-old man with a history of follicular lymphoma presented with a 3-day history of dyspnea. A chest radiograph showed pleural effusions, and milky, yellow fluid was removed during thoracentesis.

Chylothorax

A 33-year-old woman with septic shock from E. coli pyelonephritis was found to have large kidneys on imaging. A kidney biopsy showed histiocytic infiltration and round, basophilic intracytoplasmic inclusions.

Renal Malakoplakia

A 42-year-old woman presented with a 10-day history of symmetric exanthema in her axillary, abdominal, and inguinal regions after taking a nonsteroidal antiinflammatory medication.

Symmetric Drug-Related Intertriginous and Flexural Exanthema

A 39-year-old woman presented with a 4-year history of fatigue and progressively worsening dysphagia to solids. Laboratory tests showed severe iron-deficiency anemia, and upper endoscopy revealed two esophageal strictures.

Plummer–Vinson Syndrome

Image Challenge

A 63-year-old woman who had presented to the ophthalmology clinic for evaluation of cataracts was found to have white-yellow rings in both eyes. Over the past few years, she had noticed mild worsening of her vision. She reported no history of...

Deposition of what substance is responsible for this finding?

A 57-year-old woman presented to the emergency department with a 3-day history of shortness of breath and dizziness. The physical examination was notable for pallor. Laboratory studies showed a hemoglobin of 4.4 g per deciliter (reference range, 11.6 to 15.5), an...

Which of the following is the most likely etiology of this patient’s hemolytic anemia?

A 35-year-old man presented to his primary care physician for evaluation of previously unknown asymptomatic hypertension. The blood pressure was 146/89 mm Hg in the left arm, 146/99 mm Hg in the right arm, 104/83 mm Hg in the left leg,...

Which of the following findings would not be typical of this condition?

A 35-year-old man presented to the dermatology clinic with a 4-day history of anxiety, insomnia, and resting tremor of the hands and feet. One month before presentation, the patient had begun taking multidrug therapy for leprosy. On physical examination, bluish discoloration...

What drug is the most likely cause of this presentation?

A 55-year-old woman with a 29-pack-year history of smoking presented with a 1.5-year history of pain in her fingers, wrists, hips, knees, and ankles. On physical examination, clubbing and slight thickening of the skin of the fingers and toes were noted...

Which of the following is the most appropriate next test in her evaluation?

A healthy 14-year-old boy presented with a 6-hour history of hoarseness and difficulty swallowing after accidentally swallowing a coin. On physical examination, the patient was breathing comfortably without stridor or drooling. Radiographs of the chest (left, posteroanterior view) and neck (right,...

Which of the following is NOT an indication for urgent removal for this diagnosis?

An 82-year-old man presented to the emergency department with a 3-year history of progressive generalized weakness. Four months before presentation, a left adrenal mass had been identified incidentally on computed tomography (CT) that had been performed to evaluate an episode of...

The organism causing this disease is predominantly found in what geographic regions?

A 76-year-old man presented to the dermatology clinic with a 2-day history of blood-filled blisters on the tongue. He reported no prior trauma or other bleeding symptoms. Physical examination was notable for hemorrhagic bullae on the tongue and gingiva, and purpura...

What is the diagnosis?

A 40-year-old man was referred to the otorhinolaryngology clinic with a 1-month history of a sore throat. He reported no upper respiratory symptoms, fever, rash, or genital lesions. The physical examination was notable for nonulcerated white plaques that formed a butterfly...

A 28-year-old woman presented to the hospital with a 6-month history of dry cough. She was a lifetime nonsmoker and reported no fevers, joint aches, eye pain, or rashes. On physical examination, auscultation of both lower lungs revealed fine crackles. High-resolution...

A 63-year-old man with a history of follicular lymphoma presented with 2 weeks of fatigue and 3 days of dyspnea. On physical examination, he had decreased breath sounds at the base of both lungs. A chest radiograph revealed pleural effusions, which...

An otherwise healthy 42-year-old woman presented with a 10-day history of a rash in her axillae and on her groin and abdomen. One and a half weeks before the onset of the rash, she had started taking dexketoprofen (a nonsteroidal antiinflammatory...

A 44-year-old man presented to the emergency department with a 3-day history of vision loss and pain in the left eye. The symptoms had started after he had passed out for 3 hours in a position that put pressure on his...

A 66-year-old man with a history of hypertension, diabetes mellitus, and ischemic stroke was transferred to a tertiary hospital after a cardiac arrest. For 6 months before presentation, he had recurrent exertional angina but had not sought evaluation. On the morning...

A 9-year-old boy who had recently emigrated from Brazil presented to the emergency department with a 3-week history of neck swelling, fevers, and weight loss. On physical examination, there was fixed, tender lymphadenopathy in the posterior auricular, submandibular, and occipital chains....

A 55-year-old woman presented to the dermatology clinic with a 1-year history of skin darkening on her face. Two years before presentation, she had started applying a skin-lightening cream containing hydroquinone to her face daily to treat melasma. On physical examination,...

A 26-year-old man presented to the dermatology clinic with a 1-week history of an asymptomatic rash on his hands and feet. He also reported having had a fever — which had resolved 6 days before presentation — but no joint pains...

A 25-year-old woman with severe obesity presented to the emergency department with a 1-week history of blurred vision, headaches, and transient visual obscurations. Neurologic examination showed optic disk swelling and retinal hemorrhages in both eyes. An MRI and MRV of the...

A 49-year-old woman with a history of Graves’ disease presented to the endocrinology clinic with a 3-year history of skin changes on her arms and legs and a 1-year history of thyrotoxicosis symptoms. She had intermittently adhered to carbimazole therapy since...

A previously healthy 26-year-old man presented to the emergency department with a 5-day history of an asymptomatic rash, sore throat, fevers, chills, and malaise. On physical examination, scattered, erythematous papules and macules could be seen across the upper chest and anterior...