Clinical Image Challenges

A 68-year-old woman presents to urgent care with her husband after tripping on a rug at home the previous day and falling onto her left hand. She has experienced persistent pain and swelling in the hand since the fall. Ibuprofen provided modest pain relief. Physical examination reveals normal vital signs with focal edema and tenderness over the dorsal surface of the 4th and 5th metacarpals. Decreased range of motion and knuckle contour at the 5th metacarpophalangeal (MCP) joint are noted, and ecchymosis is seen to the palmar surface on the …
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A 52-year-old woman visits the urgent care clinic for itchy bumps that have been present on her back for the past 3 months. The lesions are very itchy, and it is difficult for the patient to stop scratching.  She has not tried any treatments for her symptoms since onset. On dermatological examination, pink scaly papules with dark exterior rims are seen on her back, some of which appear excoriated. Laboratory results for complete blood count, comprehensive metabolic panel, and thyroid function tests are all within normal limits. View the image …
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A 79-year-old female presents to urgent care complaining of sharp, severe lower back pain for the past 2 months. The pain began when she was bending over to pick something up from the floor and has not improved. The pain occasionally radiates to her flank area but not down her legs, and she denies any bowel or bladder pattern changes. She tried acetaminophen, cold and warm compresses, and rest without any relief. The pain worsens when she sits for long periods of time with slight improvement with rest. Her main …
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An 8-year-old male is brought to urgent care by his mother reporting a widespread, itchy facial rash. The patient says that the rash is severely painful and pruritic, and that he feels tingling and pain in his lips. The facial rash presented 3 days prior, and the mother states that her son repeatedly scratches the legions. The patient and is family are from Honduras; they deny any recent travel. The patient is otherwise well and denies any systemic symptoms. No treatments were tried for symptoms at home. Physical exam reveals normal …
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A 64-year-old woman with a history of chronic obstructive pulmonary disease, diabetes mellitus, osteoarthritis, and obesity presents to urgent care with acute right posterior ankle pain after stumbling on a curb earlier that day. She says she felt a sudden sharp pain in the back of her ankle and experienced immediate difficulty walking and climbing stairs. She reports 10 days of mild posterior ankle discomfort before this event, which she treated with ice, an elastic wrap, and intermittent crutch use. Approximately 2 weeks prior to presentation, she was treated with …
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