Clinical Image Challenges

Case A 55-year-old man presents to urgent care with 3 hours of epigastric pain which began gradually and is constant. He has associated diaphoresis and minimal dyspnea. There is family history of hypertension and high cholesterol. Personal medical history is significant for diabetes mellitus and hypertension. The patient reports that he stopped smoking 2 years ago. Upon exam, you find: General: Alert, breathing comfortable, skin clammy Lungs: CTAB Cardiovascular: RRR, without m,r,g Abdomen: Soft and NT, no distention, without r/r/g, no pulsatile mass Ext: No peripheral edema, pulses are 2+ …
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A mother and father bring their 2-year-old son to your urgent care center because of a smooth nodule on his face, which they noticed the previous day. They also reveal they noticed a small lump on his testicle about a week ago, and that they’ve been going through diapers faster than usual because he seems to be urinating more frequently over the past few days. 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 A 10-year-old girl presents with pain after falling from a tree, landing on her right foot. On examination, the pain emanates from the second through fifth metatarsals and proximal phalanges. 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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The patient is an 11-year-old boy who presents complaining of pain in his left and right forearm and wrist after falling from a height of approximately 5 feet. His parents report that he was attempting to hang upside down by his knees from a chin-up bar in his school’s gymnasium when he slipped. View the images taken and consider what the diagnosis and next steps would be. Resolutions of the case is described on the next page …
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A 27-year-old man presents complaining of a single skin lesion on his hand. He reports that it first appeared as a smooth nodule that ulcerated and spread in a lymphangitic fashion. He grew worried when he started to have a fever. The only unusual activity he’d done in the last few weeks was clean out one of his large saltwater aquariums to prepare for purchasing new fish. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page …
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