Clinical Image Challenges

A 4-year-old male presents to urgent care with a swollen, painful right elbow. The mother reports that the child had a witnessed fall from the monkey bars 1 hour prior to arrival. He fell onto his outstretched right hand, was in immediate pain that has not subsided, and has refused to let anyone touch his arm. On initial examination, vital signs are stable, and patient is afebrile. Swelling is noted over the right elbow, and there is diffuse tenderness over the elbow joint. The patient is unable to flex or …
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A 53-year-old woman visits urgent care for dark patchy spots on her neck and face that have been spreading over the past 3 months. The lesions are not painful or itchy, she denies exposure to allergens or irritants, and has no systemic symptoms. The patient states that sun exposure darkens the spots further and she has not tried any treatments to date. On examination she appears well with normal signs; hyperpigmented gray macular patches are seen on the chin and bilateral neck. View the image taken and consider what your …
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A 60-year-old male with a past medical history of prior myocardial infarction (MI) is presenting with left-sided chest pain for 1 day. He reports nonadherence to his clopidogrel for 2 weeks after running out of his medications. 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 Alexander Goay, MD, University of Texas Health Science Center at Houston …
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A 7‑year‑old male presents to the urgent‑care clinic with left‑knee pain that began after gym class and has gradually worsened over the past several weeks. The mother reports no significant trauma and notes that the pain improves with rest. Physical examination reveals a slightly overweight child with a visible bowing deformity just distal to the knee. The patient demonstrates a full range of motion and normal knee strength, and no bony tenderness, effusion, or laxity is noted. An anteroposterior (AP) radiograph of the left knee is ordered to further evaluate …
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A 52-year-old man presents to urgent care with a 2-day history of left calf pain, described as dull, non-radiating, and worsened by walking. He recently flew from Los Angeles to New York. His history includes hypertension managed with lisinopril. He denies fever, chest pain, shortness of breath, recent surgery, or prior clots. He appears well and is hemodynamically stable. Exam reveals mild swelling and tenderness in the left calf and popliteal region without erythema or warmth. A Wells score of 1 places him at moderate risk for deep vein thrombosis …
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