Clinical Image Challenges

The patient, a 6-year-old boy, presented to a pediatric urgent care center for a well-child visit. In the exam room, the father pointed out a red lesion on the helical rim of the patient’s ear. The papule was smooth and well-defined and didn’t seem to bother the boy. The father reports that he and the boy’s mother have grown concerned as they’ve noticed it develop over several months. View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next …
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Figure 1 A 65-year-old male with a history of heart failure presents to an urgent care center with shortness of breath of 2 days duration. He denies chest pain, nausea, or vomiting. He reports that he ran out of his medications about a week ago. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Catherine Reynolds, MD, McGovern Medical School, Department of Emergency Medicine, The University of Texas Health Science Center of Houston.) …
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The patient is a 75-year-old male who presents with a primary complaint of pressure in his chest. He denies chest pain, dizziness, or “anything like a heart attack.” View the x-ray 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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Figure 1. A 7-year-old boy is brought to your urgent care center by his mother because she’s concerned about a rash of scaly papules on his trunk, some of which had crusted or healed. A few of the lesions are hemorrhagic. She notes that they appeared a few days ago, accompanied by a mild fever. She dismissed the possibility that the source could be chickenpox because her son had been vaccinated. The boy reports that the papules are “really itchy.” During the exam, you detect generalized lymphadenopathy. View the photo …
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A 61-year-old female presents to urgent care with chest pain for 2 days. She describes it as “mild right now” but that it varies in intensity; it was so severe the previous night that it kept her from sleeping. Today the pain has been stuttering, lasting a couple of minutes at a time. Pain is substernal, nonradiating, and is associated with vomiting and diaphoresis. Vital signs are normal. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next …
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