Clinical Image Challenges

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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A 75-year-old female with a history of hypertension and diabetes presents with 1 day of dizziness and nausea. She is markedly bradycardic with a heart rate of 32 beats per minute and blood pressure of 88/52 on arrival. She was awake, alert, and oriented. Figure 1. Initial ECG. Case presented by Sagar Patel, DO (PGY2); Akshay Elagandhala, MD, Assistant Professor of Emergency Medicine, McGovern Medical School at UTHealth Houston …
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A 51-year-old male presents to urgent care after falling while skiing. He reports catching an edge in a patch of slushy snow, causing him to pitch forward and land forcefully onto his left anterior chest. He immediately experienced localized pain over the left chest, worsened by deep inspiration and coughing. He denies shortness of breath, syncope, and neck or head trauma. On exam, vital signs are normal. There is focal tenderness over the left anterior chest wall at the level of the 4th rib but no visible ecchymosis, crepitus, or …
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A 64-year-old female presents to urgent care complaining of right thumb pain. The patient states she removed a wooden splinter from her thumb herself about 2 weeks prior, she denies any other trauma or systemic symptoms. The patient has a history of Type II diabetes and her last A1C 2 months prior was 9.3. Physical examination reveals the patient is afebrile with normal vital signs. There is a small, scabbed wound on the palmar surface of the thumb and moderate tenderness, induration, edema and erythema are noted surrounding the wound …
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