A 72-year-old man presents with leg pain that usually follows mild exertion. The pain is centered in both calves.

A 40-year-old African-American man presents with headache. He had been well until 1 week previously when he had become fatigued and developed a dull headache.

A 44-year-old woman presents with severe right upper quadrant pain and mild fever.

A 60-year-old man collapses at the community center after complaining of a severe tearing pain in the chest.

A 23-year-old man presents with a rapidly expanding red mass of the right calf.

An 85-year-old man presents to the ER complaining of fever and cough. Three years earlier, the patient had become increasingly forgetful and disoriented, and he was placed in a nursing home.

A 1-year-old boy presents with progressive cyanosis. The child was born after a normal 38-week gestation.

A 10-year-old boy presents with 1 month of recurring dizziness, headaches, and nosebleeds.

A 52-year-old man acutely develops chest pain and shortness of breath. He arrives at the emergency room 6 hours after the pain started.

A 62-year-old woman collapses at home and cannot be aroused. When the paramedics arrive 15 minutes later, she is pulseless.

A 74-year-old man develops a severe headache, dizziness, and weakness of his right arm. The patient has a long-standing history of type-2 diabetes mellitus.

A 42-year-old African-American man presents to the emergency room with 1 hour of severe chest pain radiating to his jaw. On physical examination, the blood pressure is 190/120 mmHg, pulse 83/min, and respirations 24/min.

A 68-year-old woman presents with severe shortness of breath. She has a 10-year history of progressive dyspnea.

A 72-year-old man presents with 8 weeks of fever, anorexia, weight loss, and night sweats.

A 20-year-old woman presents with severe shortness of breath. Her symptoms started approximately 6 months ago when she developed fatigue and mild dyspnea on exertion.

A 45-year-old man presents with jaundice and fatigue. He has a 5-year history of diabetes mellitus. One month earlier, he noted that his eyes were yellow.

A 44-year-old man presents with fever and productive cough that began 12 hours previously. The patient has and appendectomy at age 12.

A 28-year-old Cambodian woman presents to her family physician with shortness of breath and cough. The patient states that her symptoms began approximately 3 months prior and had been getting progressively worse.

A 72-year-old man who is currently undergoing a course of chemotherapy and radiation therapy for malignant lymphoma presents to the emergency room with a 1-day history of fever and chills.

A 39-year-old Caucasian woman presents for lung transplant evaluation. Her respiratory symptoms initially began 5 years ago, when the patient noticed shortness of breath with exertion.

A 58-year-old white man presents to his primary care physician with dyspnea on exertion.

A 24-year-old African-American woman is taken to the emergency department following a minor car accident.

A 63-year-old man presents with a 6-month history of productive cough. He had lost approximately 20 pounds over the past 4 months.

A 23-year-old woman presents with jaundice. She noted 2 weeks earlier that her eyes were yellow. She complains that she is fatigued.

A 57-year-old previously health man complains of indigestion. He experiences severe heartburn following meals.

A 43-year-old man presents with a 3-month history of abdominal pain. He states that the pain is unrelated to food intake.

An 18-year-old woman presents with a change in bowel habits. Since starting college 7 months before, she has noticed recurrent bouts of diarrhea with bloating and abdominal cramps.

A 10-month-old male infant refuses to eat. He has not passed stool in over 24 hours.

A 50-year-old man presents for a routine colonoscopy. The patient has adult onset diabetes mellitus, which has been well-controlled with diet modification.

A 27-year-old male presents with chronic diarrhea. He has been experiencing symptoms over the past 2 years.

A 23-year-old woman undergoes a routine Pap smear of the cervix. Atypical cells are detected. A biopsy of the cervix is performed.

A 41-year-old woman presents to the emergency room with abdominal pain, fever, nausea, and vomiting.

A 59-year-old presents with 3 days of diffuse abdominal pain. The patient states that he feels tired all the time.

A 22-year-old woman presents to the emergency room with severe abdominal pain. The symptoms began approximately 2 days prior.

A 57-year-old woman complains of 3 months of pruritus. The pruritus is not responsive to over-the-counter topical medication.

A 30-year-old man presents with jaundice of 1 week's duration. He had been well until 1 week ago when he noted dark urine and yellowing of his eyes.

A 45-year-old man has blood work drawn for insurance physical. The AST is 100 IU/L and the ALT 110 IU/L.

A 25-year-old woman is brought by her husband to the emergency room with severe lethargy. She had been depressed in the last few weeks.

A 57-year-old man presents to the emergency room with severe abdominal pain and vomiting. The patient describes the pain as knife-like, centered around his umbilicus and radiating towards his back.

A 40-year-old man presents with abdominal pain and diarrhea. He has a long history of alcohol abuse and has been admitted several times over the past 5 years for acute pancreatitis.

A 62-year-old man presents with decreased appetite and vague abdominal pain. The patient has lost 20 lbs in the last 4 months.

A 41-year-old woman presents to the emergency room after being found unresponsive in her apartment.

An 82-year-old man presents with shortness of breath and swelling of the legs and feet.

A 6-year-old boy presents for a physical examination prior to entering elementary school.

A 37-year-old African-America man presents with leg swelling. The patient has been otherwise asymptomatic.

A 67-year-old man presents with the complaint of blood in his urine, which he has noticed intermittently over the past 6 months.

A 52-year-old man presents to his family physician for a routine physical. The patient last saw a physician 12 years earlier.

A 10-year-old boy is brought to his pediatrician for lassitude. The child's mother states the child appears full in his face.

An 18-year-old white male presents to his primary care physician for a pre-college physical examination.

A 62-year-old African-American man is found unresponsive in his home. Despite multiple attempts to resuscitate the patient, he dies while in the ambulance.

A 73-year-old man presents with recurrent right flank pain. The patient has a long-standing history of passing renal stones.

A 60-year-old man presents with cough and hemoptysis. A chest x-ray shows a large left lung mass. A needle biopsy shows squamous cell carcinoma.

An 82-year-old man with a history of hypertension and osteoarthritis presents with lower back pain.

An 85-year-old male resident of a nursing home develops fever and obtundation. He had been complaining of pain on urination for 2 days.

A 62-year-old man presents with the complaint of blood in his urine. He has noticed the blood over the past 4 weeks.

A 33-year-old man presents with a painless, rapidly enlarging left scrotal mass.

A 55-year-old man presents with drowsiness. He had been well until 1 week ago when he developed severe and persistent headaches.

A 24-year-old nulliparous woman presents for her annual gynecologic exam.

A 64-year-old post-menopausal woman presents with vaginal bleeding for 5 months duration.

A 43-year-old woman presents with heavy menstrual periods. She has been noticing increasing bleeding over the past year.

A 73-year-old woman presents with increasing abdominal girth. The patient has noticed her abdomen to be increasing in size over the past several months.

A 41-year-old Asian woman presents with vaginal bleeding. The patient is 14 weeks pregnant.

A 45-year-old man develops severe substernal chest pain and shortness of breath. The pain started 1 hour previously.

A healthy 21-year-old woman presents to her physician with a breast mass. She palpated a small lump upon self-breast examination.

A 59-year-old woman presents with an ill-defined density on her mammogram. She has a history of atypical ductal hyperplasia, diagnosed in her right breast 2 years prior.

A 50-year-old man presents with weakness. He was well until approximately 1 month ago when he began to feel lethargic and occasionally dizzy.

A 25-year-old woman presents with 2 weeks dizziness, easy bruisability, and nose bleeds.

A 52-year-old woman presents with several months of fatigue. She has a long history of Crohn's disease for which she has had multiple small bowel resections.

A 19-year-old woman presents with severe shortness of breath. She also complains of severe pain in her arms and legs.

A 15-year-old boy presents with diffuse purpura. Laboratory testing reveals a platelet count of 5,000/microliter.

A 26-year-old woman presents for delivery after a 38-week gestation. She has had a low-grade fever for 24 hours.

A 62-year-old man presents with 2 months of vague abdominal fullness and increasing fatigue. He has last 10 pounds in the last month.

A 60-year-old man presents with 1 week of fatigue, fever, and chills. He reports a 10-pound weight loss in the last 2 weeks.

A 20-year-old man presents with painless swelling of the lymph nodes on his right inguinal region.

A 70-year-old man presents with 2 months of mild fatigue and a swollen neck.

A 46-year-old man presents with 2 months of fatigue and back pain. An outpatient x-ray revealed lytic lesions of the skull and spine.

An 18-year-old college student presents to the student health clinic with a high fever, headache, vomiting, and marked nuchal rigidity.

A 34-year-old man presents to the physician after his wife proclaimed he looked different.

A 32-year-old woman presents for a pre-employment physical examination. The patient states she has no health problems.

A 29-year-old woman presents with a neck mass. The patient has noticed the lesion over the past 3 months.

A 45-year-old woman presents to her family physician with abdominal pain.

A 37-year-old man presents to his physician with anxiety attacks. The patient states that he has experienced several episodes of sweating, palpitations, increased heart rate, and headache.

A 35-year-old man presents with 3 months of severe weakness. Approximately 6 months previously, he lost his appetite and sustained a 10-pound weight loss.

A 42-year-old woman on chronic dialysis presents with substernal pain and shortness of breath. The pain started 2 days ago and is now constant.

A previously healthy 12-year-old girl is brought by her parents to her pediatrician because of a recent history of drinking very large amounts of water and soft drinks and frequent urination.

A 59-year-old man presents with crushing substernal chest pain, shortness of breath, and sweating.

A 42-year-old man presents with 2 months of abdominal pain and indigestion. He recounts considerable bloating and his wife has complained about his breath.

A 50-year-old man presents with increasing shortness of breath on exertion.

A 30-year-old professional basketball player presents because of decreased exercise tolerance. A chest x-ray shows numerous bilateral lung densities and mediastinal fullness.

A 37-year-old woman presents with complaints of an itchy rash.

An 18-year-old man presents with recent onset of blisters on his arms and legs.

A 32-year-old woman presents with a facial rash. The rash extends over her nose and bilateral cheeks.

A 42-year-old man presents to his family physician complaining of an intensely itchy and blistering rash.

A 30-year-old woman presents with complain of thickened skin. The patient has had a 6-month history of dysphagia.

A 59-year-old woman presents to her doctor with a pigmented lesion on her arm.

A 78-year-old man is seen for a nodule on his forehead. The lesion has been present for several months.

A 52-year-old man presents with a firm, painless nodule below his left ear.

A 43-year-old woman presents with a mass involving the right side of her face.

A 59-year-old man presents with a tongue ulcer. The lesion has been present for over 3 months.

A 43-year-old Asian man presents with fullness in the neck and difficulty swallowing.

An 81-year-old white man is seen in the emergency department following a fall from his bed.

A 22-year-old previously healthy man complains of right knee pain over the past 6 weeks.

A 52-year-old woman presents with increasing pain and swelling in her left knee.

A 14-year-old girl has a chest x-ray after demonstrating a positive PPD skin test.

An 82-year-old woman presents to the emergency department following a fall.

A 43-year-old woman presents with pain in her hand and knee joints, fatigue, and muscle pain.

A 3-year-old boy is brought by his parents to the pediatrician because of delayed development.

A 54-year-old woman presents with a 2-month history of progressive muscle weakness.

A 62-year-old woman presents to her family physician with complaints of urinary frequency for the past 3 months.

A 31-year-old man presents with increasing deterioration of vision.

A 67-year-old man presents to the emergency department with sudden onset of left eye pain.

A 2-year-old boy is seen by his pediatrician for a routine check-up. On examination, he appears healthy and is within the 50 percentile for both height and weight.

A 59-year-old man is admitted with severe shortness of breath. Two months previously, the patient had open heart surgery to replace the aortic valve.

A 55-year-old woman presents to the emergency room after vomiting bright red blood. Her past medical history is significant for chronic hepatitis B infection contracted 20 years ago following intravenous drug use.

An 8-year-old presents with marked shortness of breath and wheezing. The child had been playing in his backyard when he was stung on his right arm by a bee.

A 23-year-old woman presents with weakness. She had been well until 10 days ago when she developed a sore throat and fever.

A 25-year-old woman presents with skin rash and fever. She was well until 1 month ago when she noted that her face was reddened.

A 63-year-old woman presents with hematemesis. She describes 2 months of continuous, burning epigastric pain, with only mild relief after eating.

A 63-year-old man presents with a history of constipation for 1 month. During the last week, he developed vague abdominal pain.

A 51-year-old man presents with a 2-cm nodule in the left upper lung discovered upon routine chest x-ray.

A 10-year-old African boy presents with swelling of the jaw. The child was well until 1 month ago, when he had difficulty swallowing.

A 5-year-old boy complains that he cannot see well out of his left eye. The left pupil is white (leukocoria). The eye is surgically removed.

A 4-year-old boy presents to the emergency department with right lower quadrant pain and fever.

A 5-year-old boy is seen for a routine medical visit. He has been deaf from birth. The child was adopted from Africa.

A 3-year-old girl is evaluated for cardiac surgery. She is the product of a term pregnancy of a 42-year-old mother and a 48-year-old father.

A 28-year-old man collapses at work after complaining of sever chest pain. Upon arrival at the emergency department his blood pressure is 40 mm Hg systolic.

A 20-year-old man presents with severe pneumonia. The patient has a lifelong history of chronic cough with copious production of sputum.

An 8-month-old infant is noted by her pediatrician to have missed several developmental milestones.

A male infant is born after the onset of premature labor at 27 weeks gestation. The baby weighs 950 g and develops severe respiratory distress.

A 63-year-old man presents with shortness of breath. The patient has a long history of angina pectoris and had a myocardial infarction 1 year earlier.

A 40-year-old woman is admitted to the hospital after sustaining a left leg fracture while skiing. Examination reveals a clean break in the middle of the femoral shaft.

A 22-year-old solider is airlifted off the battlefield after sustaining a bullet wound to the abdomen. The paramedic in the field administers morphine and starts intravenous fluid administration with volume expanders.

A 62-year-old man presents with cough and hemoptysis. He had been well until approximately 1 month ago when he developed a persistent nonproductive cough.

A 40-year-old man presents with massive hematemesis. The patient had numerous hospital admissions for management of liver failure.

A 22-year-old woman is found unconscious in a motel room. The room contains several phials of heroin and drug paraphernalia

A 50-year-old man presents with 3 days of profound fatigue and fever. The previous day he noted bloodied eyes.

A 42-year-old woman presents after 6 months of therapy for breast cancer with contracture of the left arm.

A 3-year-old boy is brought to the emergency room with growth retardation and irritability. The child had been taken from a foster home that had been reported to the authorities for squalid conditions.

A 5-year-old African boy presents with a diffuse rash. The child had been well until 4 days earlier when he presented with fever, cough, and a runny nose.

A 23-year-old woman develops severe lethargy and is brought to the emergency room by her roommate. One week earlier she had the flu.

A 3-year-old boy developed a skin rash on his left leg over the last week. Several other children in his nursery developed similar rashes.

A 33-year-old woman presents with fever and a swollen and painful right knee. She also complains of vague right lower abdominal pain.

A 43-year-old man develops a red lesion on his penis. He has been healthy until now and has no other symptoms.

A 53-year-old man presents with 1 month of intermittent fever. He has had several drenching night sweats.

A 47-year-old man with chronic HIV infection presents with painful oral lesions.

A 27-year-old woman complains of recent onset of shortness of breath, a nonproductive cough, and fever.