Challenge your diagnostic acumen: Study the following x-ray images, electrocardiograms, and photographs and consider what your diagnosis might be in each case. While the images presented here are authentic, the patient cases are hypothetical.

Femoroacetabular impingement syndrome

29-Year-Old With Chronic Hip Pain

A 29-year-old man presents to urgent care complaining of chronic right hip pain with movement and exercise. He’s an avid mountain climber and used to play sports in college. Review the images and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page …
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Myxedema Coma

70-Year-Old With Fatigue and Edema

A 70-year-old male with a history of atrial fibrillation presents to urgent care for 1 week of fatigue and edema of the lower extremities and face. An ECG is obtained. View the ECG captured above and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Case presented by Joe Stockhausen, MD Figure 1: Initial ECG …
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Acrokeratosis Paraneoplastica

56-Year-Old With Cancer and Developing Rash

A 56-year-old woman presents to urgent care for a rash that developed on her hands, ears, and nose over the last couple of months. She has a recent diagnosis of esophageal cancer. On examination, hyperkeratotic plaques were seen on the palm and fingers, and scaly papules were seen on her helices and nose. Her nails displayed subungual hyperkeratosis, onychodystrophy, and onycholysis along with erythema and edema on her nail folds. View the image below and consider what your diagnosis and next steps would be. Resolution of the case is described …
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Lower Lobe Cystic Bronchiectasis

60-Year-Old With Annoying Cough

A 60-year-old man presents to urgent care complaining of an annoying cough for several months. He states that he frequently has sputum production with his cough. He denies any fever, chills, or other symptoms. Review the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page …
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Brugada syndrome

15-Year-Old Gasping for Air

A 15-year-old male with no significant past medical history presents after he was noted to be gasping for air and difficult to arouse after taking a nap. At the urgent care, an ECG is obtained. View the ECG captured above and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1. Initial EKG Case presented by Erik Alvarado, MD, McGovern Medical School at the University of Texas Health Science Center at Houston …
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