Clinical Image Challenges

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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A 55-year-old male with past medical history of alcohol use disorder presents to urgent care with frequent falls. He denies chest pain or shortness of breath. 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 …
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A 45-year-old woman presents to urgent care with a persistent productive cough for the past few months. Over the past week, she has noticed more sputum production, which is thick and dark in color, as well as fatigue and dyspnea on exertion. She denies fevers, pharyngitis, abdominal pain, or gastrointestinal upset. She denies tobacco use or occupational exposures to any inhaled chemicals. Physical exam reveals that the patient is afebrile with vital signs within normal limits. Coarse inspiratory and expiratory rales are heard in bilateral bases of lungs. View the …
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A 49-year-old male presents to urgent care with 3 days of progressively worsening fever and a widespread painful rash. He also reports dry mouth and painful lesions on his gums. The patient has a history of acute myeloid leukemia, and he received an allogeneic bone marrow transplant 2 weeks prior to onset of symptoms. Physical examination reveals a fever of 101.3°F (38.5°C), several ulcerated lesions on the buccal mucosa, and a violaceous papular rash to the trunk, extremities, palms, and soles. Some lesions follow a follicular distribution and are tender …
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