Clinical Image Challenges

A 26-year-old female presents to urgent care with a persistent productive cough for 1 week. Over the past 3 days, she reports progressive shortness of breath and fatigue. She has a history of recurrent pneumonia. Vital signs show the patient is afebrile with normal blood pressure, heart rate, respiratory rate, and oxygen saturation. Physical examination revealed clear lung sounds with diminished air movement in the bilateral bases. Jugular venous distension (JVD) at 4 cm above the sternal angle and trace bilateral lower extremity edema to the ankles are noted. Cardiac …
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A 67-year-old man visits urgent care for a lesion on his right ankle that was first noticed 25 years ago. He reports that it has progressively grown larger over the past 6 months. The lesion is painless but is intermittently mildly pruritic. The patient denies any recent injury or past medical history besides chronic venous insufficiency. On dermatologic examination, a discrete dark brown plaque is noted posterior to the lateral malleolus with numerous surrounding spider veins, and deeper varicose veins are seen. A biopsy is taken, showing a proliferation of …
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An 84-year-old woman presents to urgent care with palpitations that have lasted for several hours. The patient is afebrile, slightly tachypneic on exam, with a blood pressure of 148/97 mm Hg. 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, McGovern Medical School, The University of Texas Health Science Center at Houston, Department of Emergency Medicine …
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A 38-year-old otherwise healthy male presents to urgent care with acute right knee pain following a 6-foot fall from a ladder, landing directly on his right lower extremity 2 hours prior to arrival. He reports severe pain and the inability to bear weight since the injury. Physical examination reveals that he is afebrile with normal vital signs. Musculoskeletal exam is notable for moderate knee effusion with surrounding early ecchymosis, and medial joint line tenderness. There is pain with passive range of motion. Neurovascular assessment is unremarkable with normal sensation, brisk …
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A 53-year-old male butcher visits urgent care for a painful red rash that developed on his hand 3 days prior. There is no history of recent travel, but he accidentally cut himself when processing meat 1 week ago. Exam reveals that the patient is febrile at 100.2° F. Otherwise, his vital signs are within normal limits, and he is well appearing. On dermatologic examination, erythematous vesiculated papules, plaques, and associated edema are visible on the hand and fingers. View the image taken and consider what your diagnosis and next steps …
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