I N S I G H T S I N I MAG E S CLINICAL CHALLENGE CASE 1 CHALLENGE: In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and present- ing information to editor@jucm.com. FIGURE 1. A 2 1 ⁄ 2 -year-old child presents with a three-day Ⅲ Decreased air entry over the left chest history of cough but no fever. View F i g u r e 1 , take these findings into account, Upon examination, you find: and consider what your next steps would be. Ⅲ Oxygen percent saturation 95% Resolution of the case is described on the next Ⅲ Resting respiration 31/min page. Ⅲ Pulse 145/min w w w. j u c m . c o m JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J a n u a r y 2 0 0 7 29