Diagnoses in acute care medicine practice are commonly made using observations from the physical examination, lab results, and radiographs. Often, the clinician-focused exam looks for specific entities to rule out life- or limb-threatening illness or predictors of poor outcomes. Because of the breadth of practice in the acute care setting, clinicians may not have seen many entities that are pathognomonic of specific illness, such as Ludwigrsquo;s angina (rapidly spreading dental infection) or septal hematoma by the end of residency training. These are important to recognize both for patient care and, specifically in emergency medicine, because board examinations across specialties rely heavily on visual recognition of clinical entities (approximately 15% of the American Board of Emergency Medicine (ABEM) certification examination presents questions). Patients typically present with a ldquo;chief complaint,rdquo; and clinicians must use deductive reasoning to narrow a differential diagnosis. Many medical books organize topics based upon disease categories. We propose organizing this book randomly, as patientrsquo;s actually present in acute care settings. The visual findings with a brief history will be presented on the first page, followed by a discussion (which may also include a differential diagnosis), and specific topic references on the next page. We propose to create a book of common visual diagnoses that are either pathognomonic or suggestive of specific illnesses. The target audience for this book will be all physicians who see patients in acute care settings: emergency physicians, intensivists, internists, family practioners, pediatricians, residents, medical students, and nurses. The book will be composed of approximately 250 cases from the sections outlined below and presented in a random fashion, such as they would be in a natural clinical setting. The first page will have the case presentation, one or more pictures (physical exam finding, radiograph, or electrocardiogram), and a ldquo;board typerdquo; question. The second page will have the answer to the question, the diagnosis, discussion and references. Page two will have the same picture with an arrow pointing out the abnormality or an additional picture (in the case of additional leads required to diagnose posterior AMI) that provides information NOTE: This will be in a similar format to ECGs for the Emergency Physician (Amal and Brady) and should sell alongside it. Sales for the ECG book are approximately 1000 since September 2003. REVIEWS 1 Feedback from juniors was very positive about the visual diagnosis book. I personally would purchase such a book also. Pasted below are just a few of the comments I received when I elicited feedback about the proposal. Hope this helps. Amal I would be very interested in such a book. I have a particular interest in "Visual Diagnosis" stuff - I think it is easier to learn (it doesn't feel like you are really studying), it is more interesting, it is retained longer, and it is clinically very important. I have always liked Rob's visual diagnosis lecture, and I stole his idea and gave such a lecture to the medicine department last year. I'm definitely a sucker for books like this, but I do think the are an important part of medical education. — Joe (junior level attending) Yes, I would purchase a book like this. There are few books out that do a good job of reviewing visual diagnosis for the written boards. The best that I know of are put out by Ohio ACEP and are similar to what is described here, except that they are arranged by category and do not use the device of a "board type" question. I also happen to like picture books. I typically find them a pleasant way to review. If this book has an index, it would double also as a source of photos for presentations. The sample case seems to balance nicely the need for photos