Journal of General Internal Medicine

A 28-year-old male patient (188 cm, 72 kg) presents to the central emergency department with dorsal pain after returning from a trip to East Asia. He reports feeling a bit tired and listless without classic signs of infection. In the clinical examination, apart from an approximately fist-sized, deeply situated, sturdy and non-displaceable bulging of the abdominal wall sinistrally paraumbilically, a slight enlargement of the left testis with pain upon palpation is noticeable. What is your first suspicion, and what are your first diagnostic steps?

The 46-year-old male patient has been showing various signs of inflammation for 6–8 weeks: Sore throat, canker sores, joint pain and febrile rhinitis. There is an unintended weight loss of 2–3 kg. Physical examination reveals findings that are inconspicuous for the patient’s age. How do you proceed now?

A 76-year-old, overweight female patient with anaemia and type II diabetes noted by her family doctor presents with fatigue, forgetfulness and yellowish pallor in a neglected state. Moreover, she shows an increasingly unsteady gait. How do you proceed?

A 56-year-old man presents with concentration problems, dorsal pain, fatigue and a marked increase in urination. His family history is positive for bronchial carcinoma. Physical examination reveals tenderness upon percussion in the lumbar spine. How do you proceed?