Clinical Challenges

Case A 67-year-old male presents with acute mid-low back pain following a fall. He describes the pain as “dull and constant.” When asked if the pain is worse with range of motion, he replies, “I think so.” Physical exam reveals he is afebrile, has a pulse of 102, respirations 20, and blood pressure 122/78. His abdomen is soft and nontender without rigidity, rebound, or guarding; there is no bruising or distention. His back appears normal, though there is mild discomfort with deep palpation in the right low back musculature. TheRead More

Posted On February 28, 2017 By In Clinical Challenges

Glass in Foot

Case The patient is an 8-year-old boy with pain in the right foot for the last several hours. He refuses to walk on the foot. There is no reported injury. On physical exam, you find there is a normal appearance to the foot (no erythema,  swelling). However, there is pain with palpation over the plantar aspect of the mid aspect of the right foot. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.Read More

Posted On January 31, 2017 By In Clinical Challenges

Lateral Humeral Condyle Fracture

  Case A 14-year-old boy presents to urgent care complaining of lateral right elbow pain that began after a fall on the playground yesterday, in which he landed on his outstretched hand. He has no significant medical or surgical history. The elbow pain is worse with range of motion. He denies any wrist or shoulder pain, and there is no head trauma. There are no paresthesias to the hand or arm. View the images taken (Figures 1 and 2) and consider what your diagnosis would be. Resolution of the caseRead More

Posted On January 5, 2017 By In Clinical Challenges

Dry Cough in a 19-Year-Old Male

Case A 19-year-old man presents to urgent care with a 5-day history of a dry cough. He says he has “felt warm” but didn’t think to check his temperature. He also complains that he has been weak, with a decreased appetite. He notes that his girlfriend had an upper respiratory infection a couple of weeks ago, but other than that he’s had no exposure to anyone who’s been sick. He has not traveled anywhere recently, and he has no recent history of weight loss or medication use. View the imagesRead More
Case A mother brings her 10-year-old son to an urgent care center with a fever, conjunctival injection, and pharyngitis. She points out a smooth papule on his face that developed over the last few days. She says that he played with some kittens at a friend’s house about a week earlier, and she wonders if maybe he is extremely allergic to cats, because he has been rubbing his eyes ever since. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is describedRead More

Posted On December 14, 2016 By In Clinical Challenges

Hip Pain in an 80-Year-Old Woman

Case An 80-year-old woman presents to an urgent care center with left hip pain that she has had for 4 years but that has worsened in the last week. She reports that before the pain worsened, she had gone on a long walk with her grandson. The pain is worse with movement through the range of motion. She has taken ibuprofen, but it did not reduce her pain. She says that she has not had any back pain or knee pain and has not fallen. She has no fever orRead More

Posted On November 2, 2016 By In Clinical Challenges

Knee Pain in a 78-Year-Old

Case A 78-year-old man presents to an urgent care center with bilateral knee pain that he has had for 1 week. The pain is worse in his right knee and is worse with ambulation. He says that he has not experienced any recent trauma, but he does note that he has been helping his son move into an apartment. He reports no fever, dizziness, chest pain, or shortness of breath. He has hypertension, for which he takes lisinopril. He is a nonsmoker. View the image taken (Figure 1) and considerRead More
Case A 20-year-old previously healthy man presents with sudden onset of substernal chest pressure after completing football practice. His chest pain is nonradiating, nonreproducible, and nonpositional. He does not have associated palpitations, dyspnea, or diaphoresis. He reports that he has not had recent upper respiratory tract infections or contact with ill people. He does not have a history of using alcohol, tobacco, or illicit drugs. He has no family history of sudden cardiac death or early coronary artery disease. View the electrocardiogram obtained (Figure 1) and consider what your diagnosisRead More