Choose a patient case

You are the ER doctor evaluating a 54-year-old man with chest pain that started 30 minutes ago while walking up stairs.

It came on when I was walking up the stairs…

A 42-year-old woman presents with a sudden, severe headache that started one hour ago.

I've never had a headache like this in my life.

A 60-year-old man presents with sudden onset shortness of breath.

I just can't seem to catch my breath.

A 19-year-old college student presents with abdominal pain.

My stomach has been killing me since last night.

A 70-year-old woman presents with fever and acute confusion.

She just hasn't been herself since yesterday.

You are evaluating Ethan Parker, a 16-year-old high school student in a pediatric clinic with weeks of sneezing, runny nose, and itchy eyes that worsen outdoors and during soccer.

I've been sneezing nonstop, and my nose won't stop running.

Maya Singh, an 18-year-old college freshman, presents to the emergency department 15 minutes after eating Pad Thai with lip swelling, throat tightness, hives, and hypotension.

My lips feel funny, and my throat feels tight.

Noah Martinez, an 8-year-old boy, is referred to pediatric immunology for recurrent ear infections, pneumonias, poor growth, and a family history of immune problems.

He gets infections constantly.

Sarah Johnson, a 17-year-old track athlete, presents to sports medicine with six months of chest tightness and cough starting about 10 minutes into running, with improvement at rest.

I get short of breath during practice.

Olivia Chen, a 7-year-old girl, is seen in pediatric clinic for years of itchy rash behind the knees and elbows that worsens in winter and disrupts sleep.

She scratches all night.

Robert Wilson, a 61-year-old truck driver, presents to the emergency department with 45 minutes of crushing chest pressure that began while lifting heavy boxes.

My chest feels like someone is sitting on it.

Patricia Nguyen, a 72-year-old retired librarian, presents with four hours of sudden palpitations, irregular heartbeat, mild dyspnea, and lightheadedness.

My heart suddenly started fluttering.

Samuel Ortiz, a 68-year-old retired mechanic, is referred to cardiology with weeks of exertional dyspnea, leg swelling, orthopnea, and paroxysmal nocturnal dyspnea.

I get out of breath doing almost anything.

Jason Patel, a 17-year-old basketball player, collapsed during intense practice with brief loss of consciousness, prior exertional chest tightness, and a family history of sudden death.

I blacked out during basketball practice.

Amanda Lee, a 24-year-old graduate student, presents with two days of sharp positional chest pain worse lying flat and improved leaning forward after a recent viral illness.

My chest pain changes depending on position.

Ethan Collins, a 15-year-old wrestler, presents with a two-week enlarging itchy circular rash on his arm after teammates had similar skin problems.

I noticed this weird itchy circle on my arm.

Karen Mitchell, a 54-year-old real estate agent, is concerned about a pigmented lesion on her shoulder that has darkened, enlarged, and developed irregular borders over months.

My mole doesn't look the way it used to.

Sophia Ramirez, a 17-year-old student, presents with over a year of worsening facial and back acne with flares around her menstrual periods despite OTC products.

My acne keeps getting worse.

David Reynolds, a 63-year-old retired electrician, presents with three days of burning left chest pain followed by a painful blistering rash in a dermatomal distribution.

My skin burns and stings.

Ashley Kim, a 22-year-old college student, presents to the emergency department with fever, painful rash, mucosal sores, and skin peeling after starting a new seizure medication two weeks ago.

My skin and mouth feel like they're burning.

Jennifer Ross, a 48-year-old office manager, presents with sudden maximal headache, vomiting, neck stiffness, and photophobia after lifting groceries 30 minutes ago.

My head suddenly exploded with pain.

Rachel Morris, a 34-year-old marketing executive on oral contraceptives, presents with sudden dyspnea, pleuritic chest pain, and hypoxia two hours after an 8-hour flight.

I suddenly became short of breath.

Brandon Patel, a 19-year-old college student with type 1 diabetes, presents vomiting with abdominal pain after stopping insulin during a viral illness.

I feel sick and can't stop throwing up.

Kevin Diaz, a 20-year-old college student, presents with migratory abdominal pain from periumbilical to right lower quadrant with fever and peritoneal signs.

My stomach pain moved.

Marcus Evans, a 58-year-old construction supervisor with hypertension, presents with sudden tearing chest pain radiating to the back and unequal arm blood pressures.

It feels like something ripped inside my chest.

Jessica Carter, a 29-year-old fitness instructor, presents with three months of unintentional weight loss despite increased appetite, anxiety, palpitations, heat intolerance, and tremor.

I keep losing weight even though I'm eating more.

Melissa Green, a 43-year-old accountant, presents with months of fatigue, weight gain, cold intolerance, dry skin, constipation, and hair thinning.

I feel exhausted all the time.

Ryan Shah, a 13-year-old middle school student, is brought by his mother for weeks of extreme thirst, nocturia, weight loss, and irritability; evaluation shows new-onset type 1 diabetes.

My son drinks water constantly.

Amanda Lewis, a 35-year-old teacher, presents with one year of weight gain, easy bruising, proximal weakness, mood changes, facial fullness, and purple striae.

I feel like my body changed.

George Patel, a 57-year-old engineer, presents with recurrent kidney stones, fatigue, constipation, bone pain, and hypercalcemia with elevated PTH.

I've had multiple kidney stones.

Sarah Ahmed, a 34-year-old elementary school teacher, presents with four months of fatigue, exertional dyspnea, dizziness, and heavy menses with iron deficiency on labs.

I feel exhausted no matter how much I sleep.

Michael Torres, a 52-year-old restaurant owner, returns for persistently elevated blood pressure with lifestyle risk factors and normal secondary workup.

They keep telling me my pressure is high.

Linda Brooks, a 61-year-old retired nurse, presents with eight days of productive cough, fever, fatigue, hypoxia, and right lower lobe infiltrate on chest X-ray.

I've been coughing all week.

Emily Jackson, a 27-year-old graduate student, presents with two months of persistent sadness, anhedonia, sleep disturbance, fatigue, and poor concentration with elevated PHQ-9 and normal medical labs.

I haven't felt like myself.

George Russo, a 66-year-old retired postal worker, presents with chronic bilateral knee pain, brief morning stiffness, crepitus, and osteoarthritis on X-ray.

My knees ache constantly.

Kevin Sharma, a 56-year-old small business owner with metabolic risk, presents with gradual hyperglycemic symptoms including polyuria polydipsia fatigue blurred vision and early neuropathy — consistent with undiagnosed type 2 diabetes mellitus.

I've just felt off lately.

Robert Daniels, a 71-year-old retired electrician with progressive exertional dyspnea orthopnea and edema — clinic presentation consistent with congestive heart failure with reduced ejection fraction and volume overload on exam and testing.

I can't do what I used to.

Melissa Chen, a 48-year-old office administrator with heavy menstrual bleeding presents with iron deficiency anemia manifesting as fatigue exertional dyspnea orthostatic dizziness pallor and microcytic indices.

I've been getting lightheaded.

William Foster, a 64-year-old retired teacher with long-standing diabetes and hypertension, presents with progressive fatigue anorexia pruritus and edema — laboratory findings consistent with chronic kidney disease and proteinuria.

My energy has slowly disappeared.

Thomas Rivera, a 42-year-old chef with progressive edema foamy urine weight gain and fatigue — nephrotic syndrome pattern with heavy proteinuria hypoalbuminemia and hyperlipidemia on testing.

My legs and ankles keep puffing up.

Olivia Grant, 17, develops easy bruising, gum bleeding, and epistaxis without trauma—isolated severe thrombocytopenia with normal coagulation screen suggests ITP before marrow evaluation.

I keep finding bruises everywhere.

Jessica Khan, 34, a teacher with months of fatigue, exertional dyspnea, menorrhagia, and pica for ice—microcytic anemia with low ferritin indicates iron deficiency.

I've had no energy lately.

Andrew Foster, 25, graduate student with progressive rubbery cervical lymphadenopathy, B symptoms, and mild splenomegaly—biopsy demonstrates Reed–Sternberg cells consistent with Hodgkin lymphoma.

I noticed lumps in my neck.

Marcus Johnson, 15, with known HbSS sickle cell disease—severe limb and back pain after dehydration at sports practice—smear and labs consistent with vaso-occlusive crisis.

My whole body hurts.

Noah Ellis, 9, has escalating infections fatigue bruising and bone pain—peripheral smear with blasts and pancytopenia plus marrow biopsy confirms acute leukemia.

He keeps getting sick.

Lauren Mitchell, a 43-year-old accountant, presents with rigors, high fever, dysuria, flank pain, and shock physiology concerning for urosepsis from pyelonephritis.

I've been shaking and feel terrible.

Michael Perez, a 36-year-old construction worker with IV drug use, has weeks of fevers, B-symptoms, new murmur, and peripheral stigmata with bacteremia and valvular vegetation on echocardiography.

I've had fevers for weeks.

David Khan, a 27-year-old graduate student, presents two weeks after return from sub-Saharan Africa with cyclic fevers, headache, myalgias, and smear-positive malaria without chemoprophylaxis.

I've had fevers since I got back.

Jason Reed, a 39-year-old restaurant worker with thrush, weight loss, night sweats, and pulmonary infiltrates, is diagnosed with untreated HIV and opportunistic pulmonary process.

I've been getting sicker and sicker.

Emma Rodriguez, a 19-year-old college student, presents with fulminant headache, fever, meningismus, photophobia, and confusion; CSF shows neutrophilic pleocytosis with low glucose and positive Gram stain.

My head and neck hurt really badly.

Anthony Marino, a 46-year-old restaurant manager, presents to the ED with eight hours of severe epigastric pain radiating to the back, vomiting, and heavy weekend alcohol use.

My stomach pain is unbearable.

Jennifer Park, a 39-year-old attorney, presents with two months of burning epigastric pain related to meals, night symptoms, frequent NSAIDs, and positive H. pylori testing.

I keep getting burning pain in my stomach.

Daniel Rivera, a 24-year-old graduate student, presents with six weeks of bloody diarrhea, urgency, cramping, fatigue, and weight loss with continuous colonic inflammation on colonoscopy.

I've had diarrhea for weeks.

Brian Foster, a 31-year-old personal trainer, presents with two weeks of fatigue, dark urine, nausea, jaundice, and acute hepatitis B serology.

My family says my eyes turned yellow.

Margaret Ellis, a 66-year-old retired librarian, presents with progressive fatigue, early satiety, weight loss, altered bowel habits, rectal bleeding, family history of colon cancer, and a colon mass on colonoscopy.

I get full quickly and something feels off.

Charles Bennett, a 68-year-old retired mail carrier with hypertension and diabetes, presents to the ED 50 minutes after sudden right facial droop, right arm weakness, and slurred speech.

My face suddenly feels funny.

Samantha Lee, a 24-year-old graduate student, describes disabling recurrent headaches for two years with visual aura, photophobia, and nausea; neuro exam normal between attacks.

My headaches completely shut me down.

Harold Jacobs, a 72-year-old retired engineer, reports a year's progression of resting tremor, stiffness, slow movements, and masked facies; exam shows pill-rolling tremor, cogwheel rigidity, and shuffling gait.

My hand tremor keeps getting worse.

Noah Patel, a 16-year-old high school student, is brought to the ED after witnessed generalized convulsive activity with postictal confusion and tongue bite; first seizure, afebrile.

I collapsed and people said I was shaking.

Rachel Simmons, a 28-year-old graphic designer, reports relapsing episodes of monocular visual blur and leg weakness with sensory symptoms over months; exam shows hyperreflexia and MRI shows demyelinating plaques with CSF oligoclonal bands.

My symptoms come and go.

Daniel Russo, a 39-year-old delivery driver, presents to the emergency department with sudden severe right flank pain, colicky course, nausea, and urinary symptoms concerning nephrolithiasis.

My back and side pain is unbearable.

Amanda Foster, a 28-year-old teacher, reports progressive facial and leg swelling, foamy urine, and fatigue—laboratory studies show heavy proteinuria, hypoalbuminemia, and hyperlipidemia.

My face and legs keep swelling.

Jacob Hernandez, an 11-year-old student, presents with cola-colored urine, edema, and hypertension weeks after sore throat—workup suggests post-streptococcal glomerulonephritis.

My pee looks like cola—it's freaking me out.

George Mitchell, a 67-year-old retired engineer, presents with weakness, oliguria, and dyspnea after vomiting and dehydration—labs reveal acute kidney injury with hyperkalemia.

I've felt terrible for days.

Richard Kim, a 58-year-old accountant with longstanding diabetes and hypertension, has rising blood pressure, fatigue, mild edema, and labs showing reduced GFR with proteinuria consistent with chronic kidney disease.

My doctor says my pressure keeps rising.

Jessica Morales, 26, presents to the ED with acute left lower quadrant pain, six-week amenorrhea, spotting, and tachycardia with hypotension—confirm intrauterine pregnancy location urgently.

My stomach hurts and my period never came.

Emily Shah, 19, has long-standing oligomenorrhea, acne, hirsutism, and weight gain—labs and ultrasound support PCOS after exclusion workup.

My periods are all over the place.

Ashley Foster, 31, at roughly eight weeks gestation by dates has worsening bleeding and cramping—ultrasound and hCG pattern indicate pregnancy loss.

I'm pregnant and bleeding.

Maria Gomez, 24, has fever, purulent discharge, dyspareunia, and cervical motion tenderness after a new partner—NAAT confirms gonorrhea with leukocytosis.

I've had pain and discharge.

Rebecca Turner, G1P0 at 34 weeks, has severe-range blood pressure, headache, visual changes, edema, and hyperreflexia—preeclampsia with proteinuria.

My swelling feels worse and my head won't stop hurting.

Jordan Miller, 19-year-old college soccer midfielder, pivoted during practice yesterday—heard a pop, developed a swollen knee, and now describes instability and difficulty cutting.

My knee gave out.

Margaret Lewis, 78, slips in her kitchen—now cannot bear weight with a shortened externally rotated leg—hip films show femoral neck fracture.

I can't stand up.

Brandon Carter, 23, personal trainer—landed awkwardly during pickup basketball with forced abduction external rotation—anterior shoulder dislocation on X-ray.

My shoulder popped out.

Tyler Brooks, 18, landed on an outstretched hand a week ago—snuffbox tenderness persists and initial films were read negative—MRI demonstrates scaphoid fracture.

My wrist still hurts.

David Russo, 31, construction worker with prior crush injury hours ago—pain escalating out of proportion, tense calf/anterior compartment, paresthesias, elevated compartment pressures and CK.

My leg pain keeps getting worse.

Susan Miller, a 46-year-old administrative assistant, reports eight months of prolonged morning hand stiffness, symmetric joint swelling, and fatigue with positive RF and anti-CCP.

My fingers feel frozen when I wake up.

Rachel Kim, a 24-year-old graduate student, has photosensitive malar rash, mucosal ulcers, arthritis symptoms, and autoimmune serologies consistent with systemic lupus erythematosus.

My skin reacts badly to sunlight.

Anthony Russo, a 58-year-old restaurant owner, develops abrupt first MTP podagra after dietary indulgence; synovial fluid shows monosodium urate crystals.

My toe suddenly became unbearable.

Linda Carter, a 68-year-old retired teacher, describes proximal shoulder and hip girdle pain and stiffness with marked ESR/CRP elevation and normal CK — polymyalgia rheumatica pattern.

I feel stiff everywhere.

Melissa Green, a 41-year-old accountant, has chronic Raynaud phenomenon, skin tightening, esophageal symptoms, and positive ANA with anti-Scl-70 consistent with systemic sclerosis.

My hands change color and feel tight.

Liam Turner, a 3-year-old boy, is brought to the emergency department by his mother with a barking cough, inspiratory stridor, and mild retractions after a recent cold — classic croup pattern with must-not-miss airway differentials.

He woke up sounding scary.

Ava Morris, a 2-year-old girl, presents with fever ear-pulling fussiness and recent URI — otoscopy shows bulging erythematous tympanic membrane consistent with acute otitis media.

She won't stop grabbing her ear.

Noah Garcia, an 11-month-old boy, presents with gastroenteritis symptoms and clinical dehydration — dry mucosa sunken eyes poor tear production and delayed capillary refill with mild laboratory derangement.

He hasn't had many wet diapers today.

Sophia Patel, a 5-year-old girl, presents with prolonged high fever rash mucosal changes and extremity findings concerning for Kawasaki disease with elevated inflammatory markers and need for echocardiography.

Her fever won't go away.

Ethan Brooks, a 7-year-old boy, presents with acute hip pain fever and refusal to bear weight — evaluation shows septic arthritis with synovial fluid infection and elevated inflammatory markers.

He suddenly refuses to walk.

Frank Russo, a 63-year-old warehouse worker, presents to the ED with a long-standing groin hernia that is now acutely painful, firm, and no longer reducible after lifting heavy boxes.

I've had a groin lump before, but now it really hurts.

Maria Torres, a 47-year-old administrative assistant, develops postprandial epigastric pain migrating to the right upper quadrant with fever, Murphy sign, and ultrasound showing gallstones and gallbladder wall thickening.

My upper stomach pain moved.

Richard Hayes, a 71-year-old retired mechanic with prior abdominal surgery, presents with progressive distention, cramping, vomiting, and obstipation; imaging shows dilated small bowel with a transition point.

My stomach keeps getting bigger and hurts.

Kevin Morris, a 36-year-old delivery driver, has progressive perianal pain worsened by sitting, fever, and a fluctuant tender mass — perirectal abscess on exam and imaging.

It hurts to sit.

Walter Green, a 59-year-old construction worker with chronic NSAID use for back pain, develops sudden generalized abdominal pain with rigid abdomen and free intraperitoneal air on upright chest X-ray.

My stomach suddenly exploded with pain.

Emily Carter, a 22-year-old college student, is seen in outpatient psychiatry for two months of persistent low mood, lost interest, poor sleep, fatigue, guilt, and slipping grades. PHQ-9 is elevated; screening labs are normal.

I've just felt different lately.

Brandon Ellis, a 29-year-old startup founder, presents to emergency psychiatry with five days of almost no sleep, euphoric mood, grandiosity, excessive spending, and family concern. Vitals show mild tachycardia; drug screen is negative.

I feel amazing. I don't need sleep.

Marcus Hill, a 24-year-old recently unemployed man, reports months of paranoia, hearing voices, withdrawal, and declining self-care. Exam suggests formal thought disturbance and negative symptoms. Screening labs are unremarkable.

I think people are following me.

Sophia Nguyen, an 18-year-old high school senior, describes over a year of contamination fears with excessive handwashing that derails mornings and schoolwork. She has insight that it is excessive. Y-BOCS and brief questionnaires show elevated severity.

I know it's weird but I can't stop.

Sarah Mitchell, a 31-year-old ER nurse, developed nightmares, flashbacks, avoidance, and hypervigilance after a traumatic event eight months ago. PCL-5 is positive; PHQ-9 shows depressive symptoms.

I can't stop thinking about it.

Margaret Russo, an 84-year-old retired teacher, is brought to the ED by family for acute confusion, urinary symptoms, and low-grade fever.

I'm not sure why everyone is fussing — I just feel tired and foggy.

Harold Green, a 76-year-old retired accountant, is evaluated in memory clinic for progressive memory problems reported by his son.

I forget where I put things — maybe I'm just stressed.

Richard Bennett, an 82-year-old retired postal worker with hypertension and BPH, reports recurrent dizziness on standing and multiple recent falls after antihypertensive intensification.

I get dizzy when I stand up — I've stumbled a few times.

Dorothy Mitchell, an 88-year-old retired librarian with polypharmacy, presents with unintentional weight loss, poor intake, and weakness. Her granddaughter is very concerned.

I just don't have an appetite like I used to.

Eleanor Foster, an 81-year-old former nurse on warfarin, presents to the ED with sudden focal deficits. Family witnessed abrupt face droop and arm weakness.

My right arm feels heavy — my words won't come out right.

Thomas Reynolds, a 72-year-old retired contractor, presents to the ED with painful inability to void, lower abdominal fullness, and a long history of weak stream and nocturia.

I feel like my bladder is going to explode.

Eric Patel, a 41-year-old delivery driver, arrives with sudden severe flank pain radiating to the groin, nausea, and restlessness—classic ureteral colic presentation.

My side pain is unbearable.

James Carter, a 67-year-old retired smoker with painless gross hematuria, presents to urology clinic for evaluation of visible blood in his urine.

My urine looked red.

Noah Brooks, a 16-year-old student, presents with sudden severe left testicular pain, nausea, and exam findings concerning testicular torsion—a urologic emergency.

My testicle hurts really bad.

Robert Kim, a 69-year-old retired teacher, reports progressive nocturia, weak urinary stream, and incomplete emptying—classic BPH-type lower urinary tract symptoms.

I barely sleep anymore.