Clinical Image Challenges

An 87-year-old male with past medical history of valvular atrial fibrillation, prior stroke, and heart failure presents to urgent care with chest pain and shortness of breath for 3 days. The pain and difficulty breathing are associated with bilateral lower extremity swelling for 1 week.               View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1. (Case presented by Whitney Skidmore, MD, PGY2 McGovern Medical School, Department of Emergency Medicine, UTHealth Houston with assistance …
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A 43-year-old woman presents with 2 weeks of a smooth nodule on her right hand. The patient denies recent travel but recalls that she “banged up” her hand while cleaning out a fresh-water fish tank prior to noticing the nodule. Past medical history is significant for renal transplantation. Exam reveals a tender, erythematous plaque with an ulcer on dorsal aspect of her hand.               View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page …
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The patient is a 12-year-old boy who presents with pain in his left knee. His mother reports that during a baseball game earlier in the day he slid hard into a base and came up limping. Review the x-rays taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page …
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History: A 39-year-old male with no known past medical history presents to urgent care for evaluation of several hours of sharp, non-radiating, left-sided chest pain. The pain is non-exertional, non-pleuritic, began after his last meal and resolved without intervention approximately 30 minutes prior to arrival. No history of similar pain in the past. No associated shortness of breath, nausea, vomiting, or diaphoresis. View the ECG taken and consider what your diagnosis and next steps would be. Figure 1. Initial ECG (Case presented by William Chavez, MD, McGovern Medical School, Department …
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A 55-year-old female presents to urgent care with a few weeks of a mildly pruritic rash on her trunk and arms. On examination, there are scattered erythematous, fine, scaly plaques. The coin-like plaques are round or oval in configuration and affect her extremities symmetrically. The patient denies current medications or any personal or family history of dermatologic conditions. She reports no systemic symptoms. However, she shares that she has been taking longer and more frequent bubble baths recently. View the image and consider what your diagnosis and next steps would …
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