Clinical Image Challenges

A 13-year-old boy presents to urgent care after “rolling” his left foot. He explains that he tripped on a cement curb while riding his skateboard. He has foot and ankle pain that is worse with weight. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page. Figure 1. The X-ray …
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A 33-year-old female presents to urgent care with pleuritic chest pain that is gradual in onset over the preceding several days and worse when lying flat. She denies fever, cough, and shortness of breath. She is well appearing with normal vital signs. 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 …
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A 63-year-old man presents to urgent care with sudden-onset floaters and blurred vision in his right eye for one day. He denies trauma, headache, or flashes of light. He has no history of similar symptoms. His past medical history includes hypertension and type 2 diabetes. Vital signs are normal. Visual acuity measures 20/40 OD and 20/25 OS. No facial asymmetry or eyelid swelling is noted. Visual fields are intact bilaterally. A non-dilated fundoscopic exam is attempted but is limited. Blood glucose is within normal limits. With concern for retinal pathology, …
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A 55-year-old woman presents to urgent care because of skin dryness and scaling on her legs that developed 2 weeks prior. The patient was recently diagnosed with psoriasis by a different provider and was treated with a combination therapy of tazarotene and a topical steroid for over 4 weeks. Diffuse dryness and white scales were seen on her legs. View the image below and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page …
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A 51-year-old man presents to urgent care complaining of night sweats and a productive cough with visible blood for the past 2 weeks. He says he’s been feeling rather tired lately. A chest x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page. Figure 1. The X-ray …
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