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Ascending "doughnuts" on a boy's legs
What's causing the "doughnut-shaped bumps" on a boy's legs? You are asked to evaluate "doughnut-shaped bumps" on the legs of a 9-year-old boy that have been present since 2 months of age. The asymptomatic eruption has progressed over time from the ankles, up the legs, and onto the hips. The patient is healthy and active in after-school sports, and does not take any medications.
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Update on fever in the returning traveler
Returning travelers who are febrile require an urgent diagnostic workup and appropriate consultation even if signs on the physical exam are unremarkable. Here's how you should proceed.
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Abdominal pain, a cardiac history, and an unusual diagnosis
A 71-year-old man who emigrated from Argentina 30 years earlier presents with mild right upper quadrant tenderness, mild jaundice of several weeks' duration, and mild fatigue. The patient describes occasional postprandial nausea with no vomiting, GI disturbances, or weight changes. He reports having quit social drinking 10 years earlier. History is remarkable for an MI 10 years earlier and for heart failure and ventricular tachycardia that were managed medically and by pacing defibrillator, respectively.
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An athletic young woman with acute back pain
A healthy, athletic 24-year-old woman presents with acute low back pain that began after she stepped forward with her back fully extended while playing Ultimate Frisbee earlier in the day. The pain is midline, sharp, without radiation, and rates a 10 on a scale of 1 to 10. She denies direct trauma, lower-extremity numbness or tingling, and bowel or bladder dysfunction.
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