A 27-Year-Old Marathon Runner with Epigastric Pain

A 27-Year-Old Marathon Runner with Epigastric Pain

A 27-year-old woman who has been training for a marathon presents to the urgent care center with epigastric pain. She states the pain is worse after she consumes tomato sauce or orange juice, and wonders if she may have reflux. She denies shortness of breath, exertional component, pleuritic pain, leg swelling, use of hormonal therapy, or sweating. No right upper quadrant pain. Improves with antacids. No FH or heart disease or other risk factors. Upon …

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A 43-Year-Old Man with Pruritic, Scale Plaque and Vesicles on His Hands and Arms

A 43-Year-Old Man with Pruritic, Scale Plaque and Vesicles on His Hands and Arms

The patient is a 43-year-old man who presents to urgent care after work with an extremely pruritic fine scaly plaque and tense vesicles covering his hands and arms. He had been  gardening the previous weekend, worked on his car, and prepared his boat for its first voyage of the season. He wasn’t sure which activity might have caused such a terrible rash. View the image and consider what your diagnosis and next steps would be. …

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A 10-Year-Old Boy with Multiple Lesions on His Ear

A 10-Year-Old Boy with Multiple Lesions on His Ear

Figure 1. Case A 10-year-old boy visited urgent care complaining of multiple skin lesions on the rim of his ear. They had begun as vesicles and some were beginning to crust. He also had enlarged cervical lymph nodes. His mother was concerned because the symptoms developed after an early spring camping trip with his scout troop and two other boys had similar symptoms. View the photo taken, and consider what your diagnosis and next steps …

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A 70-Year-Old Female with ‘Bony’ Pain in Her Chest

A 70-Year-Old Female with ‘Bony’ Pain in Her Chest

Case The patient is a 70-year-old female who presents with gradual onset of constant pain in her left lower chest and back. She is unsure when she first noticed the pain, but reports that it has worsened since she experienced a fall several days ago. She denies shortness of breath, diaphoresis, or an exertional component. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described …

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A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

The patient is a 28-year-old man who presents to urgent care with a single annular ecchymosis lesion on his leg the morning after returning home from a trip to visit his family’s cabin in the mountains of North Carolina. He “thought” he noticed a small insect bite in the vicinity. The lesion has become increasingly painful. View the photo taken and consider what your diagnosis and next steps would be. Resolution of the case is …

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An 18-Year-Old Female with Sudden Sharp Chest Pain

An 18-Year-Old Female with Sudden Sharp Chest Pain

Figure 1.   Case The patient is an 18-year-old female who presents to urgent care with 1–2 hours of “sharp” chest pain that worsens with range of motion. She reports it began suddenly while lifting boxes at work. Pain is not improved with acetaminophen. She denies exertional discomfort, pleuritic pain, and use of hormone therapy. There is no leg swelling, shortness of breath, or sweating. Physical exam reveals: General: Sitting comfortably on the cart, breathing …

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A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

Case The patients is a 57-year-old man with a complaint of syncope 3 hours before arrival. He states he was sitting on the couch and the next thing he knew he was waking up. No preceding dizziness. No seizure activity, biting of the tongue, blood in the mouth, or post ictal symptoms. No cp, sob, leg pain, head pain, or back pain. He drank 2 glasses of water and felt better, but was encouraged to …

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A 37-Year-Old Man with Multiple Symptoms Following a Trip to Japan

A 37-Year-Old Man with Multiple Symptoms Following a Trip to Japan

Case The patient is a 37-year-old man who presents to urgent care complaining of fever, nausea, and abdominal pain. He had attributed these symptoms to a recent trip to Japan, where he ate lots of new foods along with old favorites like sushi. However, he became concerned when a pruritic, serpiginous lesion appeared on his flank. View the photo taken, and consider what your diagnosis and next steps would be. Resolution of the case is …

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