Challenge your diagnostic acumen: Study the following x-ray images, electrocardiograms, and photographs and consider what your diagnosis might be in each case. While the images presented here are authentic, the patient cases are hypothetical.
24-Year-Old Male Hand Pain After a Golf Game
A 24-year-old male patient presents to urgent care with right wrist pain that started while playing golf 2 days ago. The patient recalls swinging the club and hitting the ground rather than the ball, felt a sharp pain in his hand which has been constant since the incident. He has not tried any treatments at home. The provider notes increased pain when the patient flexes his hand, along with a weakened grip compared to the left side. Tenderness is noted to the hypothenar eminence of the palm. Allen’s test is …
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60-Year-Old With 2 Weeks of Dyspnea
A 60-year-old male presents to urgent care with progressive dyspnea for 2 weeks associated with lower extremity edema. The patient is afebrile and slightly tachypneic with rales at the bilateral bases. An ECG is obtained. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1. Initial ECG. Case presented by Benjamin Cooper, MD, MEd, FACEP, McGovern Medical School at the University of Texas Health Science Center at Houston …
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28-Year-Old Female with Left Lower Quadrant Pain
A 28-year-old female presents to urgent care with mild left lower quadrant (LLQ) abdominal pain that began earlier in the day. The discomfort is dull, intermittent, and non-radiating. She denies vaginal bleeding, fever, nausea, vomiting, or urinary symptoms. Her last menstrual period was approximately 2 months ago, although she reports a history of irregular cycles. She appears well and is hemodynamically stable. An abdominal exam reveals mild LLQ tenderness without rebound or guarding. A pelvic exam shows no discharge, bleeding, adnexal tenderness, or cervical motion tenderness. No masses are appreciated …
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75-Year-Old Male with Facial Lesion
A 75-year-old male presents to the walk-in clinic with the chief complaint of an asymptomatic rash on the left temple of his face that developed over the past 2 months. On examination, a shiny deep red papule is visible with scaly macules (actinic keratoses) surrounding. The patient is on rituximab for chronic lymphocytic leukemia (CLL). View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page …
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11-year-old With Heel Pain While Running
An 11-year-old male presents to urgent care complaining of bilateral heel pain, right worse than left. The patient denies recent trauma and reports experiencing increased pain when running. He has not tried any treatment and denies any history of similar episodes in the past. Physical examination reveals bilateral pes planus and decreased dorsiflexion of the feet with weightbearing lunge against the wall. Pain is elicited with calcaneal compression test. The patient is noted to be favoring his right heel with barefoot gait. The Thompson’s test is normal, pulses are normal, …
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