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Interactive Medical Cases

This interactive feature describes a 44-year-old woman with a 2-year history of shortness of breath with minimal exertion, cough, fatigue, and unintentional weight loss. Test your diagnostic and therapeutic skills at NEJM.org.

A 44-year-old Woman with a 2-Year History of Shortness of Breath with Minimal Exertion, Cough, Fatigue, and Unintentional Weight Loss

This interactive feature describes a 40-year-old man who presented to the ED with a 5-day history of worsening sore throat, diffuse muscle aches, joint pains, and fevers with temperatures of up to 38.9°C. Test your diagnostic and therapeutic skills at NEJM.org. ...

A 40-year-old Man with a a 5-Day History of Worsening Sore Throat, Diffuse Muscle Aches, Joint Pains, and Fevers with Temperatures of up to 38.9°C

This interactive feature describes a 66-year-old man who presented to the ED with 3 days of progressively worsening chest discomfort. Test your diagnostic and therapeutic skills at NEJM.org.

A 66-year-old Man with 3 Days of Progressively Worsening Chest Discomfort

This interactive feature describes a 44-year-old woman with sickle cell disease who presented to the emergency department with pain throughout her body. She was found to be positive for severe acute respiratory syndrome coronavirus 2. Test your diagnostic and therapeutic skills...

A 44-year-old Woman with Sickle Cell Disease and Pain Throughout Her Body

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

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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A 50-year-old man presented with a 1-year history of progressive headaches. On examination, there was neck stiffness and dysmetria in both arms. An MRI of the head showed Eiffel-by-night sign.

Eiffel-by-Night Sign

An 18-month-old girl was evaluated for sudden-onset abdominal distention, diarrhea, and vomiting. An abdominal radiograph showed three circular radiopaque objects in the intestines and dilated loops of bowel.

Complications from Accidental Ingestion of Magnets

A 30-year-old man who had recently traveled internationally presented with a 6-month history of itchy, scaly plaques that had worsened despite treatment with antifungal and glucocorticoid creams.

Tinea Corporis and Tinea Cruris from T. indotineae

A 30-year-old man presented with a 6-month history of depressed skin lesions on his back. Numerous well-defined, erythematous, atrophic plaques across the back were noted on physical examination.

Atrophying Pityriasis Versicolor

A 35-year-old woman presented with a 4-year history of itchy, wartlike lesions in her pubic region. Examination was notable for hyperpigmented, hyperkeratotic papules forming three plaques over the mons pubis.

Angiokeratoma of Fordyce

A 3-year-old boy presented with an 18-month history of bowing of the left leg that impaired his ability to walk. In addition, testicular enlargement and café au lait spots were found on examination.

McCune–Albright Syndrome

A 2-year-old boy was brought to the ED after he had had four generalized seizures in the previous week. Physical examination was notable for brisk tendon reflexes and Chvostek’s sign (shown in a video).

Chvostek’s Sign in Familial Hypoparathyroidism

A 44-year-old man with infliximab-treated Crohn’s disease presented with a 2-day history of rash on his face. Well-demarcated, warm, erythematous, confluent plaques were seen across the cheeks, nose, and glabella.

Erysipelas

An 18-year-old man with type 1 diabetes mellitus who had been admitted with diabetic ketoacidosis had unexpected elevations in aminotransferase levels. CT of the abdomen showed hepatomegaly without parenchymal changes.

Glycogenic Hepatopathy

A 2-year-old boy presented with a 6-month history of diarrhea and poor weight gain. Tests for infectious diarrhea were negative, but a colonoscopy revealed mobile, white worms on the colon wall (shown in a video).

Trichuriasis

A 19-year-old man presented with a 10-day history of rapidly worsening acne, along with fever, muscle aches, and knee pain. Diffuse papulonodular and pustular lesions were noted on physical examination.

Acne Fulminans

A 55-year-old man with a history of smokeless tobacco use was evaluated for a white patch on his left inner lip. On examination, a velvety, fissured patch of mucosa was seen where the patient had regularly placed snuff tobacco. ...

Smokeless Tobacco Keratosis

A 25-year-old woman receiving daily prednisolone treatment for systemic lupus erythematosus presented with a 3-month history of erosive, violaceous plaques in the antecubital fossae, popliteal fossae, and inguinal regions.

Intertriginous Rash in Secondary Syphilis

A 32-year-old man with well-controlled human immunodeficiency virus infection presented with painful nodules on his forehead and a rash on his trunk. A bone scan showed uptake in the nodules.

Secondary Syphilis with Osteitis

A woman was transferred to a specialty hospital for endovascular treatment of a ruptured intracranial aneurysm that led to a subarachnoid hemorrhage. During intraoperative angiography, the aneurysm reruptured (shown in a video).

Rerupture of an Aneurysmal Subarachnoid Hemorrhage

A 26-year-old man presented with a 1-week history of fevers and bloody stools. A CT scan of the pelvis showed rectal thickening, and a flexible sigmoidoscopy showed nodular, ulcerated mucosa.

Chlamydial Proctitis

An 11-month-old girl presented with a 2-week history of progressive dysphagia and cough. A chest radiograph showed a foreign body with a “double-ring” sign. Torrential hematemesis subsequently developed.

Button-Battery Ingestion

A 42-year-old woman presented with a 2-year history of a facial rash. A skin examination after removal of her makeup showed an indurated plaque, areas of hyperpigmentation and hypopigmentation, and scattered nodules.

Discoid Lupus Erythematosus

A 44-year-old man presented with a 5-year history of heat intolerance and burning pain in his hands and feet. He had periumbilical angiokeratomas and nonnephrotic proteinuria. A kidney biopsy was performed.

Fabry’s Disease

A 59-year-old man was brought to the emergency department after a motor vehicle collision. Paradoxical movement of a segment of his chest wall during respiration was noted on examination (shown in a video).

Flail Chest

Image Challenge

A 40-year-old man presented with a 2-day history of a burning rash on both hands. Physical examination was notable for a confluent region of erythema extending from the dorsal aspect of the thumbs to the medial aspect of the second finger....

What is the most likely diagnosis?

A previously healthy 18-month-old girl was brought to the emergency department with sudden-onset abdominal distention that had been preceded by 3 days of diarrhea and 1 day of vomiting. On physical examination, the patient appeared lethargic and dehydrated. The abdomen was...

What is the most appropriate next step in this case?

A 30-year-old man presented with a 6-month history of depressed skin lesions on his back. On physical examination, numerous well-defined, erythematous, atrophic plaques were noted across the back. A fluorescence staining preparation of skin scrapings showed thick fungal hyphae and yeast...

What is the most likely causative organism for this skin infection?

A 3-year-old boy was brought to the endocrinology department with an 18-month history of bowing of the left leg that had resulted in regression of his ability to walk. On physical examination, there was lateral bowing of the left femur and...

What is the most likely diagnosis in this case?

A 44-year-old man with Crohn’s disease that was being treated with infliximab presented with a 2-day history of a facial rash. In the previous week, his daughter had had a sore throat, and his mother had developed a similar rash on...

Which of the following is the most likely culprit organism for the underlying diagnosis?

A 2-year-old boy from a rural village was brought to the pediatric clinic with a 6-month history of diarrhea and poor weight gain. His body weight was 12.1 kg (below the 25th percentile for his age) and height 90 cm (1...

What is the most likely culprit organism?

A 19-year-old man with a history of mild acne vulgaris presented with a 10-day history of rapidly worsening acne, along with fever, muscle aches, and knee pain. His temperature was 38.5°C. On physical examination, diffuse papulonodular and pustular lesions with areas...

A 25-year-old woman with systemic lupus erythematosus (SLE) presented with a 3-month history of a rash on her arms, legs, and groin. She had been having condomless sexual intercourse with one male partner during the year preceding presentation. During the 9...

Which of the following is the most likely diagnosis?

A 26-year-old man presented with a 1-week history of fevers and bloody stools. On physical examination, there was a small external hemorrhoid but no abdominal pain, genital lesions, or inguinal lymphadenopathy. Computed tomography of the pelvis showed thickening of the wall...

After a tissue biopsy of the lesion, which of the following is the most appropriate next step?

A 42-year-old woman with a 20-pack-year smoking history presented to the dermatology clinic with a 2-year history of a facial rash. One year before presentation, the patient’s rash had been evaluated without a request for removal of her makeup, and treatment...

A 44-year-old man presented with a 5-year history of heat intolerance and burning pain in his hands and feet. He also had exertional dyspnea, decreased perspiration, sinus tachycardia, and proteinuria of unclear cause. On physical examination, there were periumbilical vascular skin...

A previously healthy 53-year-old woman presented with a recurrent episode of severe, diffuse abdominal pain. During the previous month, she had been having sudden, self-limited bouts of abdominal pain twice per week. She had no history of swelling of the face...

Which of the following is the most likely cause?

A 9-year-old girl presented to the dermatology department with a 7-day history of a lesion on the left cheek and a 4-day history of fever. On physical examination, a round plaque 3 cm in diameter on an erythematous base was observed...

A 57-year-old man called emergency medical services to report a 1-hour history of chest pain. When he arrived at the hospital, his heart rate was 125 beats per minute, the blood pressure 128/84 mm Hg, and the oxygen saturation 99% while...

What does the electrocardiogram most likely represent?

A 61-year-old woman presented to the emergency department with a 2-day history of dull, intermittent lower abdominal pain. She reported no vomiting, diarrhea, bloody stools, or hematuria. The vital signs were normal with the exception of the blood pressure, which was...

What is the most appropriate initial management?

A 58-year-old man presented to the dermatology clinic with a 2-year history of eyelid lesions and with weight loss and fatigue over the past several months. On physical examination, scattered periorbital petechiae and purpura were noted, as well as coalescing, waxy...

What is the most likely explanation for the spontaneous periorbital petechiae and significant bruising after the biopsy in this case?

A 70-year-old woman with a history of hypothyroidism presented to the dermatology clinic with a 1-year history of progressive indentation and darkening of the skin of her forehead. The skin changes had occurred along a wrinkle that had been present for...

What is the diagnosis?

A 73-year-old woman had sudden chest pain during pulmonary-function testing. She had a history of breast cancer, for which a double mastectomy with breast reconstruction had been performed 23 years earlier, followed by the insertion of silicone breast implants 12 years...

What radiographic finding is shown?

A 29-year-old woman with a history of systemic lupus erythematosus presented to the dermatology clinic with a 2-week history of an itchy, painful rash on her nose and hands. The rash had first appeared 1 day after the weather had turned...

Which of the following is an important intervention to prevent this finding?

A 26-year-old man presented to the ophthalmology clinic with a 2-month history of a painless, reddish growth on his left eye. A physical examination was notable for the presence of a sessile mass protruding just above the lower eyelid. When the...