Rocky Mountain spotted fever

A 10-Year-Old with Fever, Headache, Muscle Aches, Nausea—and a Suspicious Rash

The patient is a 10-year-old girl who presents to urgent care with 3 days of fever, headache, muscle aches, nausea, and a skin rash. She has a temperature of 102°F. On examination you find numerous erythematous macules and purpura on her palms and the soles of her feet. The patient is immunocompetent with an unremarkable medical history. Her mother recounts no recent travel from their home in North Carolina, but notes that the patient spent a day gardening with her grandmother approximately 1 week prior to the appearance of the …
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frequent cough x-ray

A 35-Year-Old with a Persistent, Frequent Cough

The patient is a 35-year-old woman who presents with a frequent, light cough of several months’ duration. Her medical history is unremarkable, including no history of COVID-19. She is a former “social smoker” who worked out on a treadmill sporadically before the cough began.  View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1 …
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A 58-Year-Old Male with Chest Pain

The patients is a 58-year-old male who presents with chest pain. He describes it as sharp, lasting seconds, and worsened by lifting objects at work. Review the initial ECG taken and consider what your diagnosis and next steps could be. Resolution of the case is described on the next page. Figure 1. Initial ECG. (Case presented by Tom Fadial, MD, Assistant Professor, McGovern Medical School, The University of Texas Health Sciences Center of Houston.) …
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Weeks of Chest Pain ECG

A 57-Year-Old Female with Shortness of Breath and Weeks of Chest Pain

The patient is a 57-year-old female who presents to urgent care with progressive shortness of breath and chest pain of “several weeks” duration. On exam, she is nonobese, normotensive, slightly tachycardic, and tachypneic with clear lungs and distant heart sounds. View the initial ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1. (Case presented by Archana Reddy, MD, PGY3 in the McGovern Medical School Department of Emergency Medicine, The University of Texas Health Sciences Center …
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Papules on Abdomen Feature Image

A 6-Year-Old Girl with Papules on Her Abdomen

A 6-year-old girl presents to urgent care for vaccinations at the start of the school year. Her father asks the pediatric provider to look at bumps that developed on her abdomen about 4 weeks ago. They consist of tiny papules, some scattered and some in linear configurations. The patient is asymptomatic without pain or itching. Her father is concerned because they have not resolved. View the image in this context and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page …
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