Clinical Challenges

Case This 42-year-old woman presents to your urgent care center with a 2-hour history intermittent dizziness and vomiting. She denies diarrhea or exposure to ill persons. Further history reveals that she has recently had some epigastric discomfort. In the exam room, she is alert and oriented. She seems comfortable, in fact. In addition, you find: Lungs: Minimal bilateral symmetric wheezing Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding. No epigastric discomfort with palpation Extremities: No pain or swelling ofRead More
The patient is a 37-year-old man who reports a two-day history of chest pain. It worsens with exertion, and when he lays back; it improves when he’s sitting or leaning forward. He denies any diaphoresis, radiation, or back pain. No pleuritic aspect. During the exam, he is alert and oriented, and in no distress. In addition, you find: Lungs: Clear to auscultation bilaterally Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding. No pulsatile abdominal mass Extremities: No pain orRead More
Case A 28-year-old woman presents to urgent care with elbow pain and swelling following a mechanical fall. She reports the pain is worse with range of motion. There is no shoulder or wrist pain, and no paresthesias. Exam confirms pain with palpation and decreased range of motion. The radial pulse is 2+; sensation distal to the elbow is grossly intact. The patient is afebrile, has a pulse of 104, respirations 20, and BP 124/80. View the image taken (Figure 1) and consider what your diagnosis and next steps would be.Read More
Case A 67-year-old male presents with acute mid-low back pain following a fall. He describes the pain as “dull and constant.” When asked if the pain is worse with range of motion, he replies, “I think so.” Physical exam reveals he is afebrile, has a pulse of 102, respirations 20, and blood pressure 122/78. His abdomen is soft and nontender without rigidity, rebound, or guarding; there is no bruising or distention. His back appears normal, though there is mild discomfort with deep palpation in the right low back musculature. TheRead More

Posted On February 28, 2017 By In Clinical Challenges

Glass in Foot

Case The patient is an 8-year-old boy with pain in the right foot for the last several hours. He refuses to walk on the foot. There is no reported injury. On physical exam, you find there is a normal appearance to the foot (no erythema,  swelling). However, there is pain with palpation over the plantar aspect of the mid aspect of the right foot. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.Read More

Posted On January 31, 2017 By In Clinical Challenges

Lateral Humeral Condyle Fracture

  Case A 14-year-old boy presents to urgent care complaining of lateral right elbow pain that began after a fall on the playground yesterday, in which he landed on his outstretched hand. He has no significant medical or surgical history. The elbow pain is worse with range of motion. He denies any wrist or shoulder pain, and there is no head trauma. There are no paresthesias to the hand or arm. View the images taken (Figures 1 and 2) and consider what your diagnosis would be. Resolution of the caseRead More

Posted On January 5, 2017 By In Clinical Challenges

Dry Cough in a 19-Year-Old Male

Case A 19-year-old man presents to urgent care with a 5-day history of a dry cough. He says he has “felt warm” but didn’t think to check his temperature. He also complains that he has been weak, with a decreased appetite. He notes that his girlfriend had an upper respiratory infection a couple of weeks ago, but other than that he’s had no exposure to anyone who’s been sick. He has not traveled anywhere recently, and he has no recent history of weight loss or medication use. View the imagesRead More
Case A mother brings her 10-year-old son to an urgent care center with a fever, conjunctival injection, and pharyngitis. She points out a smooth papule on his face that developed over the last few days. She says that he played with some kittens at a friend’s house about a week earlier, and she wonders if maybe he is extremely allergic to cats, because he has been rubbing his eyes ever since. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is describedRead More