Clinical Image Challenges

The patient is a 24-year-old male who presents for a pre-employment physical. While undergoing his exam, he mentions being “curious” about tiny papules he noticed recently in his mouth on the inside of his cheek. They seemed to be a group of slightly yellow lesions, present on both sides of his mouth. He reports that they have been there “for a few months,” but they have not caused discomfort so he hasn’t sought care. Consider what your diagnosis and next steps would be. Resolution of the case is described on …
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The patient is a 67-year-old male with no medical history who presents with severe chest pain radiating to his left arm that started 1 hour prior to arrival. The patient also endorses progressive dyspnea on exertion of six months duration. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case contributed by Gregory J Ducach, MD.) Figure 1. ECG upon urgent care arrival, 1 hour after pain onset.   …
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The patient is a 67-year-old man who presents with pain in his right shoulder and posterior right neck pain that he says radiates to his right arm. He reports that he first noted the pain “a few months ago” and is seeking care now because it has become more severe and “constant.” View the image 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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The patient is a 20-year-old female who presents to urgent care with 2 days of nausea, vomiting, crampy abdominal pain, and inability to tolerate anything PO. Her personal medical history is remarkable for type I diabetes mellitus. View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page …
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A 28-year-old male presents with complaint of a dry cough “forever.” He admits to intermittent chest pain. Exam reveals decreased breath sounds on the right. View the image 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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