Improve your skills in visual diagnosis

Speed and accuracy of diagnosis is the key to saving lives in emergency and critical care medicine. Careful visual inspection of the patient, the data (radiography, electrocardiogram), and related clues can often help providers choose the right diagnosis and ultimately the best treatment but this knowledge comes with experience. This book provides 110 randomly presented visual diagnosis cases for self-testing, imitating real-life situations found in the emergency department setting.

Written by distinguished emergency and critical care physicians, and thoroughly revised and updated throughout, this second edition includes 25% new cases and is an ideal aid for trainees preparing for Board examinations as well as an invaluable refresher for qualified emergency and critical care providers.This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now fromGoogle Play or theMedHand Store.

CHRISTOPHER P. HOLSTEGE MD, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia

ALEXANDER B. BAER MD, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia

JESSE M. PINES MD, Center for Health Care Quality, Department of Emergency Medicine and Health Policy, George Washington University

WILLIAM J. BRADY MD, Department of Emergency Medicine, University of Virginia

List of contributors ix

Foreword xii

Preface xiv

Illustration credits xv

Part I Case Presentations and Questions 1

1 Slash Wound to the Neck 3Kevin S. Barlotta MD and Alexander B. Baer MD

2 Ive Got Blood in My Eye 3Chris S. Bergstrom MD and Alexander B. Baer MD

3 Forearm Fracture After Falling 4Alexander B. Baer MD

4 A Neonate with Fever and Rash 4David L. Eldridge MD

5 A Missing Button Battery 5Brendan G. Carr MD and Sarah E. Winters MD MSCE

6 Anorexia Hair Loss and Fingernail Bands 6Christopher P. Holstege MD

7 Wide Complex Tachycardia in a Young Adult 6William J. Brady MD

8 Wide Complex Tachycardia in an Older Male Patient 7William J. Brady MD

9 Muscle Spasms Following a Spider Bite 8J. Michael Kowalski DO and Adam K. Rowden DO

10 Necrotic Skin Lesion 8David A. Kasper DO MBA Aradhna Saxena MD and Kenneth A. Katz MD

11 Intense Pain Following High-pressure Injection Injury 9David T. Lawrence DO

12 Prenatal Vitamin Overdose 9Christopher P. Holstege MD and Adriana I. Goldberg MD

13 Blurred Vision Following Yard Work 10Allyson Kreshak MD

14 Foot Pain in a Gymnast 11Hoi K. Lee MD

15 A Child with Bruises of Different Ages 11David L. Eldridge MD

16 Sudden Shortness of Breath after Removal of a Central Line 12Christopher P. Holstege MD

17 My Eyes Are Yellow! 13David T. Lawrence DO

18 Pleuritic Chest Pain in a Young Adult Male 13William J. Brady MD

19 Exposed During a Blizzard 14Joseph D. Forrester MD and Christopher P. Holstege MD

20 FAST Evaluation of a Trauma Patient 15John S. Rajkumar MD and James H. Moak MD RDMS

21 Chest Pain with Sudden Cardiac Death 15William J. Brady MD

22 Wrist Sprain in a Child 16Jennifer S. Boyle PharmD MD

23 Acute Eye Pain and Blurred Vision in an Elderly Female 17Chris S. Bergstrom MD and Alexander Baer MD

24 Heel Pain Following a Fall 17Jennifer S. Boyle PharmD MD

25 Confluent Rash on a Child 18Sarah E. Winters MD MSCE and Brendan G. Carr MD

26 Bradycardia Following an Herbal Ingestion 18Alexander B. Baer MD

27 A Pain-free Adult with Persistent T Wave Abnormalities 19William J. Brady MD

28 Caustic Ingestion with Cardiotoxic Effects 20Heather A. Borek MD and Christopher P. Holstege MD

29 Chemical Eye Exposure 21Chris S. Bergstrom MD and Alexander B. Baer MD

30 Acute Abdominal Pain in Pregnancy 22James H. Moak MD RDMS and John S. Rajkumar MD

31 Coma Following Head Trauma 22Andrew L. Homer MD and William J. Brady MD

32 Tongue Swelling in a Hypertensive Female 23Kevin S. Barlotta MD and Alexander B. Baer MD

33 Purulent Eye Discharge in an Adult 24Chris S. Bergstrom MD and Alexander B. Baer MD

34 Shoulder Pain Following Direct Blow 24Nathan P. Charlton MD

35 A Gagging Child 25Maureen Chase MD and Worth W. Everett MD

36 Adult Male with a Sudden Severe Headache 25Andrew L. Homer MD and William J. Brady MD

37 New Facial Droop 26Andrew D. Perron MD and Christopher T. Bowe MD

38 Eye Pain After Tree Branch Strike 26Chris S. Bergstrom MD and Alexander B. Baer MD

39 An Elderly Woman with Groin Pain 27Brendan G. Carr MD

40 Rash and Joint Pain in a Child 28Mara L. Becker MD

41 Radiology Findings after Laparoscopy 28Munish Goyal MD

42 Postprandial Abdominal Pain in an Elderly Woman 29Hoi K. Lee MD

43 Pink Eye in a Contact Lens Wearer 30Chris S. Bergstrom MD and Alexander B. Baer MD

44 Suspicious Hand Pain 30Rex G. Mathew MD

45 Fever and Rash in a Child 31David L. Eldridge MD

46 An Alcoholic with Dyspnea 31James H. Moak MD RDMS and John S. Rajkumar MD

47 Dark Urine from an Immigrant 32Suzanne M. Shepherd MD

48 Chest Pain and Lead aVR ST Segment Elevation 33William J. Brady MD

49 Hand Pain after Striking a Wall 34William J. Brady MD and Kevin S. Barlotta MD

50 A Refugee with Skin Lesions 35Roger A. Band MD and Jeanmarie Perrone MD

51 Pain out of Proportion to Examination 35J. Michael Kowalski DO and Adam K. Rowden DO

52 Leg Pain Following a Motor Vehicle Collision 36Nathan P. Charlton MD

53 Deformed Globe Following Trauma 36Worth W. Everett MD

54 Foot Pain Following Breaking 37Munish Goyal MD

55 Lamp Oil Ingestion 38David L. Eldridge MD

56 Intermittent Abdominal Pain in a Female 38John S. Rajkumar MD and James H. Moak MD RDMS

57 Hallucinations in a Botanist 39Joseph D. Forrester MD and Christopher Holstege MD

58 Altered Mental Status with an Abnormal Electrocardiogram 40William J. Brady MD

59 Fishing in the Stomach 41Joseph D. Forrester MD and Christopher P. Holstege MD

60 Overdose-induced Boiled Lobster Skin 41Heather A. Borek MD and Christopher P. Holstege MD

61 Back Pain Following a Fall 42Andrew D. Perron MD and Christopher T. Bowe MD

62 Painful Facial Rash 42Chris S. Bergstrom MD and Alexander B. Baer MD

63 Intense Wrist Pain Following Trauma 43Rex G. Mathew MD

64 Fever and Drooling in a Child 44Sarah E. Winters MD MSCE and Brendan G. Carr MD

65 Syncope and Flank Pain in an Elderly Man 44John S. Rajkumar MD and James H. Moak MD RDMS

66 Get Them Undressed! 45Munish Goyal MD

67 A Blue Hue Following Endoscopy 46Saumil Vaghela PharmD and Christopher P. Holstege MD

68 Acute-onset Blurred Vision 46Chris S. Bergstrom MD and Alexander B. Baer MD

69 Elbow Pain in a Child After a Fall 47Elizabeth Cochran Ward MD and Alexander B. Baer MD

70 Confusion Anemia and Abdominal Pain in a Toddler 47Christopher P. Holstege MD and Joseph T. Vance

71 A Ground-level Fall with Ankle Pain 48Christopher T. Bowe MD

72 Traumatic Eye Pain and Proptosis 49Chris Bergstrom MD and Alexander Baer MD

73 Diffuse Ankle Pain Following a Fall 49Andrew D. Perron MD and Christopher T. Bowe MD

74 Rash Following Brush Fire 50Christopher P. Holstege MD and Alejandro C. Stella MD

75 Abdominal Pain in a Trauma Victim 51Esther H. Chen MD

76 Skin Target Lesion 51Mara L. Becker MD

77 Chest Pain and a Confounding Electrocardiogram Pattern 52William J. Brady MD

78 Sudden Sedation in a Student 53David T. Lawrence DO

79 Skin Lesions in a Comatose Patient 53Christopher P. Holstege MD and Matthew D. Wilson MD

80 Raccoon Eyes 54Angela M. Mills MD

81 Fall on an Outstretched Hand in a Young Adolescent 55William Brady MD and Kevin S. Barlotta MD

82 Eye Pain and Facial Swelling 55Adam K. Rowden DO and Chris S. Bergstrom MD

83 Wrist Pain Following Fall on an Outstretched Hand 56William J. Brady MD and Kevin S. Barlotta MD

84 Rash on a Child with Epilepsy 56Heather A. Borek MD and Christopher P. Holstege MD

85 Abdominal Pain in an Alcoholic 57Angela M. Mills MD

86 Chest Pain with Electrocardiographic ST Segment and T Wave Abnormalities 58William J. Brady MD

87 A Heroin Abuser with Multiple Skin Lesions 58Christopher P. Holstege MD and Ashley L. Harvin MD

88 Chest Pain in a Middle-aged Male Patient with ST Segment Elevation 59William J. Brady MD

89 Fire Victim with Hoarseness 60Kathryn Mutter MD and Christopher P. Holstege MD

90 A Gardener with a Non-healing Rash 60Roger A. Band MD and Steve Larson MD

91 A Bite to the Leg in Tall Grass 61Alejandro C. Stella MD and Christopher P. Holstege MD

92 An Elderly Man with Diffuse Facial Edema 62Kevin S. Barlotta MD and Alexander B. Baer MD

93 Acute-onset Double Vision 62Chris S. Bergstrom MD and Alexander B. Baer MD

94 Low Back Pain in a Car Accident Victim 63Edward G. Walsh MD and William J. Brady MD

95 Pain and Rash Following Contact with a Caterpillar 64Nathan P. Charlton MD and Mairin Smith MD

96 Moonshine-induced Basal Ganglion Necrosis and Metabolic Acidosis 64Nathan P. Charlton MD and Christopher P. Holstege MD

97 A Rock Climber with Finger Pain Swelling and Redness 65Joseph D. Forrester MD and Christopher P. Holstege MD

98 Vomiting and Syncope Following Ingestion of Ramps 66Christopher P. Holstege MD and Justin H. Price MD

99 Chest Pain and Subtle ST Segment Elevation 66William J. Brady MD

100 Herbalist with Bradycardia and Vision Changes 67William J. Brady MD

101 Painless Penile Ulcer 68Andrea L. Neimann MD

102 Hyperthermia Autonomic Instability and Confusion in a Traveler 68Christopher P. Holstege MD and Alexander B. Baer MD

103 An Immigrant with Neck Swelling 69Suzanne M. Shepherd MD and William H. Shoff MD

104 Eyelid Laceration Following a Brawl 70Chris S. Bergstrom MD and Alexander B. Baer MD

105 Young Athlete with Back Pain 71Edward G. Walsh MD and William J. Brady MD

106 Chest Pain and Hypotension in an Adult Male Patient 71William J. Brady MD

107 Adult Male with Atraumatic Lower Back Pain and Leg Weakness 72William J. Brady MD

108 Facial Swelling in a Patient with Poor Dentition 73Alexander B. Baer MD and Christopher P. Holstege MD

109 Weakness and Bradycardia in an Elderly Female Patient 73William J. Brady MD

110 Lightning Strike Induced Skin Changes 74Christopher P. Holstege MD

Part II Answers Diagnoses and Discussion 75

Index 183