A 37-Year-Old Male with an ‘Itchy’ Lesion on his Face

A 37-Year-Old Male with an ‘Itchy’ Lesion on his Face

The patient is a 37-year-old male who presents with a red, round lesion with a fine, scaly plaque on his face which developed over the past month. He also reports seeing similar lesions on his scalp while combing his hair. None of the lesions are painful, though he describes them as “slightly itchy.” No history of injury to the area. View the image and consider what your diagnosis and next steps would be.

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Chest Pain in a 44-Year-Old Male: Is It Too Early for Emergent Coronary Intervention?

Chest Pain in a 44-Year-Old Male: Is It Too Early for Emergent Coronary Intervention?

The patient is a 44-years-old previously healthy male who presents with continuous, typical cardiac chest pain of a few hours’ duration, with no associated symptoms. He reports that this is a first-time occurrence. He also relays that he is a nonsmoker, nonalcoholic with no family history of heart disease. On physical examination, you find his vital signs are stable. Cardiac auscultation reveals normal first and second heart sounds with no murmurs. Labs reveal slightly elevated …

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A 42-Year-Old Male with an Abnormal ECG

A 42-Year-Old Male with an Abnormal ECG

The patient is a 42-year-old male who presents after referral from a diagnostic testing site with an abnormal ECG, obtained during a preoperative evaluation. He reports a history of hypertension and symptomatic inguinal hernia, and acknowledges chronic right groin pain. He is otherwise asymptomatic, including robust exercise tolerance. View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Tom …

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A 24-Year-Old Male with Papules in His Mouth

A 24-Year-Old Male with Papules in His Mouth

  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. …

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A 67-Year-Old Male with Classic Signs of Myocardial Infarction

A 67-Year-Old Male with Classic Signs of Myocardial Infarction

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 …

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A 67-Year-Old Male with Shoulder and Neck Pain

A 67-Year-Old Male with Shoulder and Neck Pain

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 …

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A 20-Year-Old Female with an Array of Gastro Symptoms

A 20-Year-Old Female with an Array of Gastro Symptoms

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 24-Year-Old Female with a New, Unexplained ‘Rash’ on Her Leg

The patient is a 24-year-old woman who presents to urgent care with several linear lesions on her leg, accompanied by a burning skin sensation which developed days after starting a job as an outdoor bartender at a local beach resort. View the image 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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