Test your knowledge and clinical acumen with JAMA Network Clinical Challenges. Can you make the diagnosis and order the next best test or treatment?
An older woman presents with chronic pain in her left eye that has recurred after several courses of treatment. What would you do next?
A 40-year-old woman with Graves disease presented with abdominal pain and constipation. Thyroid-stimulating hormone was undetectable and physical examination revealed a tender midline abdominal mass. Three months earlier she was evaluated for 3 to 4 months of amenorrhea, and a urine human chorionic gonadotropin test was negative for pregnancy. What would you do next?
A female neonate was born with stridor and respiratory distress, which required intubation. Laryngoscopy and bronchoscopy revealed a large laryngeal mass that was soft and fluctuant on palpation. What is your diagnosis?
A 55-year-old woman presents with decreased visual acuity, and magnetic resonance imaging shows thickening of the optic nerves and other areas of the brain. Over 5 years, she returns with multiple similar presentations. What would you do next?
A woman in her early 80s presented with a 6-month history of an asymptomatic, enlarging, partly infiltrated erythematous cutaneous patch localized to the periareolar area of her left breast. What is your diagnosis?
A 53-year-man presented with numbness in his right arm and difficulty walking, and a computed tomographic scan showed infiltrative soft tissue within the pericardium and intra-atrial septum and throughout the retroperitoneum. What is your diagnosis?
A man in his 50s with polyarticular inflammatory arthritis presented with numerous pink-purple papules on the trunk and extremities. What is your diagnosis?
A girl in her teens presented with punctate keratotic papules on the palm and third finger, which had been present since the age of 2 years. What is your diagnosis?
A 33-year-old black woman presents with bilateral retinal detachments after a flulike illness. Fundus and B-scan ultrasonographic examinations reveal several abnormalities. What would you do next?
An adolescent boy presented with bilateral eye redness, an erythematous chest rash, lip blistering, and worsening sore throat for 2 days while receiving ciprofloxacin and trimethoprim-sulfamethoxazole for community-acquired pneumonia. Bedside ophthalmic examination revealed bilateral limbus-sparing conjunctival hyperemia that blanched minimally with phenylephrine, bilateral nasal and temporal conjunctival epithelial ulcerations, and inferior forniceal pseudomembranes. What would you do next?
An 18-month-old girl presents with an intraocular mass near the optic nerve. What would you do next?
A woman in her 50s with a history of metastatic human papillomavirus cervical adenocarcinoma presented with multiple joint deformities. What is your diagnosis?
A 38-year-old man with an unremarkable medical history presented with bilateral macular lesions. What would you do next?
A woman in her 50s presented with a history of a painful subungual mass of the thumb that was initially believed to be an infection. What is your diagnosis?
A 31-year-old Hispanic woman had a 3-year history of a steadily growing, increasingly pruritic, painless mass behind the right ear. The T1-weighted postcontrast magnetic resonance imaging of the head and neck showed a heterogeneously enhancing mass with irregular borders in the right retroauricular space. What is your diagnosis?
A middle-aged woman presents with unilateral blurry vision, and imaging reveals a choroidal mass. What would you do next?
A 65-year-old man presents with an acute onset of aphasia for which he received intravenous thrombolysis. What would you do next?
A 20-year-old woman begins experiencing paranoia and delusions after the death of her father. An antidepressant medication has no effect. What would you do next?
A 30-year-old man with palpitations and heart rate 241/min had a temperature of 38.2°C, an erythematous oropharynx, tonsillar exudates, and a positive rapid strep test result; an ECG showed narrow complex tachycardia with an incomplete right bundle-branch block–like morphology, a right inferior axis, and atrioventricular dissociation. What is the diagnosis and what would you do next?
A woman in her 30s with a medical history of epilepsy and alcohol use disorder who was taking lamotrigine presented with severe head trauma. What is your diagnosis?
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: