Leonie Gordon, MD

A 47-year-old woman complains ofepisodic headaches that began severalmonths earlier and are accompaniedby sweating, flushing, abdominal pain,and vomiting; these attacks have progressivelyworsened. She takes no medicationsand denies fever, chills, andnight sweats. The medical history isunrevealing.

A 32-year-old man recently noticed a dark lesion behind his right knee. The patientdenies trauma and fever and has no other medical problems. Since he started workingfor the parks and recreation department of the state of Florida 18 months ago, hehas spent an increased amount of time outdoors.

A 68-year-old man with severe emphysema complains ofchest pain that began that morning. He has also had intermittentdiarrhea and occasional blood in his stool for thepast 2 weeks.

A 72-year-old man complains that he has been losing weightfor the last 2 months. Colon cancer was diagnosed 2 yearsearlier, and the lesion was resected; he did not receive anyadditional therapy at that time. Except for hypertension,which is well controlled with propranolol, the remainder ofthe medical history is unremarkable.

A 52-year-old man complains of right knee pain that hasbeen increasing steadily for several weeks. Two years earlierhe underwent a total arthroplasty of the same knee to treatsevere osteoarthritis secondary to a meniscal injury. He hasno history of recent trauma or increased activity.

A 28-year-old woman complains of intermittentright upper quadrant pain.The patient is thin, and she is not inacute distress.

A 35-year-old woman has been losing weight and has hadworsening abdominal pain and fullness for the past 2 months.She denies nausea, vomiting, and fever. Medical history issignificant only for asthma.

A 56-year-old man comes to see you2 weeks after an emergency departmentvisit for GI bleeding, which resultedin a diagnosis of colon cancer.Endoscopy revealed a lesion in theproximal sigmoid colon that wasfound on biopsy to be a primary adenocarcinoma.A CT scan of the abdomenand pelvis that was performedto stage the lesion showed a liverlesion suggestive of metastatic diseasebut no evidence of extrahepaticdisease.

For the past several weeks, a 54-year-old man has had progressivelyworsening abdominal pain and general achiness.He has no nausea, vomiting, diarrhea, or fever and no historyof trauma.

A 42-year-old woman complains of anxiety, unexplained weight loss, and palpitationsthat started about 3 weeks earlier. She denies fever, trauma, and newstress. She has a history of several urinary tract infections for which imagingfailed to reveal any predisposing factors; all were successfully treated withmedication. The remainder of the history is unremarkable.

About 1 month ago, a 58-year-old man experienced malaiseand fatigue accompanied by mild diffuse swelling in his neck.After 3 days, the malaise and fatigue began to abate. They resolvedafter a week; however, minimal swelling on the left sideof the neck remains. The patient has no other symptoms.