Clinical Image Challenges

A 27-year-old woman who has been training for a marathon presents to the urgent care center with epigastric pain. She states the pain is worse after she consumes tomato sauce or orange juice, and wonders if she may have reflux. She denies shortness of breath, exertional component, pleuritic pain, leg swelling, use of hormonal therapy, or sweating. No right upper quadrant pain. Improves with antacids. No FH or heart disease or other risk factors. Upon exam, you find: General: A&O, NAD, conversational and interactive. Normal body habitus Lungs: Clear bilaterally …
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Case The patient is a 45-year-old male construction worker who felt pain immediately after stepping down from a truck into a pothole. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1 …
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The patient is a 43-year-old man who presents to urgent care after work with an extremely pruritic fine scaly plaque and tense vesicles covering his hands and arms. He had been  gardening the previous weekend, worked on his car, and prepared his boat for its first voyage of the season. He wasn’t sure which activity might have caused such a terrible rash. 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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Figure 1. Case A 10-year-old boy visited urgent care complaining of multiple skin lesions on the rim of his ear. They had begun as vesicles and some were beginning to crust. He also had enlarged cervical lymph nodes. His mother was concerned because the symptoms developed after an early spring camping trip with his scout troop and two other boys had similar symptoms. View the photo 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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Case The patient is a 70-year-old female who presents with gradual onset of constant pain in her left lower chest and back. She is unsure when she first noticed the pain, but reports that it has worsened since she experienced a fall several days ago. She denies shortness of breath, diaphoresis, or an exertional component. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page …
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