Test your knowledge and clinical acumen with JAMA Network Clinical Challenges. Can you make the diagnosis and order the next best test or treatment?
A 24-year-old farmworker had 3 weeks of persistent fever and worsening polyarthralgias, and maculopapular truncal rash that spread to her palms and soles. Results of laboratory tests were normal except for a mildly elevated WBC count and a blood culture gram stain showing filamentous gram-negative rods. What would you do next?
A 61-year-old man with 1 day of dyspnea and weakness was febrile (38.4°C), hypotensive, tachycardic, diaphoretic, and had poor dentition, a soft S1, and basilar bilateral crackles on examination and aortic regurgitation on transesophageal echocardiography. What is the diagnosis and what would you do next?
An adolescent boy presented with a choroidal mass. During many visits, his vision worsened and the tumor mass extended closer to the fovea. What would you do next?
An 80-year-old man with acromegaly due to a hypoenhancing pituitary microadenoma opted for transsphenoidal resection, but preoperative MRI examination of the sella revealed a left-sided pituitary microadenoma and lobulated polypoid soft tissue masses in the superior nasal cavities arising from the olfactory clefts. What is your diagnosis?
A woman in her 50s with refractory acute myeloid leukemia and a history of breast cancer presented with new pulmonary nodules, elevated serum β-D-glucan levels, and subsequent pink papules on trunk and extremities. What is your diagnosis?
A 27-year-old man presented to the clinic for evaluation of a painless, red mass in his right eye present since birth. What would you do next?
A woman in her 60s with a history of end-stage renal disease who had a kidney transplant 9 months ago presented with progressive cough, dyspnea, and hoarseness. What is your diagnosis?
A 71-year-old healthy woman has an enlarging, immobile, painless mass in her right gluteal area, with no neurovascular deficits; computed tomography reveals an 11-cm heterogeneous lipomatous tumor involving the right gluteal musculature. What is the diagnosis and what would you do next?
A 25-year-old woman presents with a 6-month history of intermittent diplopia that occurs when she looks to the right. What would you do next?
A 27-year-old man with a history of pharyngeal gonorrhea presented with a 7-day history of severe sore throat and odynophagia, worse when swallowing solids than liquids. What is your diagnosis?
A 43-year-old healthy human leukocyte antigen B27–positive man presents with progressively worsening blurry vision in both of his eyes. What would you do next?
A woman in her 30s presents with bilateral papilledema and visual loss and eventual blindness in the right eye. What would you do next?
An 8-year-old girl with a history of bilateral lateral rectus muscle recession for exotropia presented with preretinal lesions in the maculas of both eyes. What would you do next?
An elderly woman with ptosis and blurred vision has a history of cataract surgery and cancer. What would you do next?
A 53-year-old male patient presents with a nonhealing corneal ulcer that does not respond to first-line treatment. What would you do next?
A white man in his 20s with a history of medulloblastoma and meningioma presented with multiple pink and brown papules and plaques on the head, neck, and back. What is your diagnosis?
A 41-year-old woman with stage IIa melanoma of the upper thigh presented with diffuse erythematous induration of the upper thigh expanding to the lower left abdominal area and palpable subcutaneous nodules on the ipsilateral gluteal region and leg during nivolumab therapy. What is your diagnosis?
A man presents with bullae and vesicles on his face, neck, and hands with irregular hyperplasia and spongiosis of the epidermis, among other histological abnormalities. What is your diagnosis?
A woman in her 60s presents with a 3-month history of pain, swelling, and erythema on her face, plus a history of breast cancer with lymph node metastasis. What is your diagnosis?
A man in his 50s presented with an abdominal skin eruption of 2 days’ duration; his medical history included hepatitis C, cirrhosis, and an orthotopic liver transplant 3 years prior. What is your diagnosis?
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