Clinical Image Challenges

The patient is a 42-year-old woman who presents to urgent care after a child weighing approximately 70 pounds fell on her hand at a family gathering. Pain is severe around the base of the fifth metacarpal. On exam, you note soft tissue swelling in the ulnar aspect of the hand. View the images taken and consider what your diagnosis and next steps would be …
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The patient is an 18-year-old male who presents to urgent care complaining of 1-day history of intermittent shortness of breath, as well as a sore throat. He reports that he woke up with “chest tightness” and “discomfort.” He is unable to take a deep breath. 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 an 8-year-old girl who is brought to your urgent care center by her father, who reports his daughter has had a sore throat and a fever for “a few days.” Most recently, a petechial rash has appeared, spreading from her head and neck down to her torso. She also started complaining of nausea. The father also observes that her tongue appears redder than usual. 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 50-year-old man who presents with foot pain at the site of a right-foot amputation. He has a history of chronic renal disease, diabetes mellitus, and hypertension. View the ECG 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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Figure 1. Case The patient is a 65-year-old man with symptoms of epigastric pain over the last 2 hours, with some dyspnea and a “clammy feeling.” He has a history of GERD and has used both an oral antacid and omeprazole within the past hours without relief. Upon exam, you find: General: Alert and oriented. Skin cool and moist Lungs: CTAB Cardiovascular: Regular rate and rhythm without f/r/g Abdomen: Soft and nontender without rigidity, rebound, or guarding. No epigastric pain with palpation Extremities: No pain or swelling of the LE, …
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