A 46-Year-Old Obese Man with a Painful Skin Lesion

A 46-Year-Old Obese Man with a Painful Skin Lesion

The patients is an obese 46-year-old man who complains of a painful skin lesion located between folds of skin that were touching each other. He reports looking in the mirror at home and seeing the area was very red and erythematous. He also says sometimes it feels like a burning sensation on his skin. This was most evident after being outside in the hot, humid weather. View the image taken and consider what your diagnosis …

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A 6-Year-Old Boy with Leg Pain After a Hard Impact

A 6-Year-Old Boy with Leg Pain After a Hard Impact

The patient is a 6-year-old boy who was brought to your urgent care center by his parents with pain in his right leg. They explain that he while playing with friends he tried to jump from one side of a concrete retaining wall to the other—and coming up short. 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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Multiple Findings Including STEMI, Low Voltage, and Type 2 AV Block in a 72-Year-Old Woman

Multiple Findings Including STEMI, Low Voltage, and Type 2 AV Block in a 72-Year-Old Woman

The patient is a 72-year-old woman who presents with 2 hours of chest pain with associated diaphoresis. She has a remote history of breast cancer. No leg pain or swelling or history of pulmonary embolism. On exam, you find her stated weight of 313 pounds is correct. In addition: General: Alert and oriented X 3, ambulatory Lungs: Clear to auscultation Cardiovascular: RRR without m/r/g, distant heart sounds Abdomen: Soft and NT without r/r/g Ext: Normal …

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An 88-Year-Old Woman with Several Weeks of Dizziness

An 88-Year-Old Woman with Several Weeks of Dizziness

The patients is an 88-year-old woman with 3 weeks of dizziness but no complaints of chest pain/discomfort, shortness of breath, focal neurological signs, or diaphoresis. An ECG is performed by staff prior to clinician evaluation. Upon exam, you find: General: Alert and oriented X 3, ambulatory Lungs: Clear to auscultation Cardiovascular: RRR without m/r/g Abdomen: Soft and NT without r/r/g Extremities: Normal Review the ECG and consider what your diagnosis and next steps would be. …

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A 59-Year-Old Man with a Painful Elbow After a Fall

A 59-Year-Old Man with a Painful Elbow After a Fall

The patient is a 59-year-old man who presents with pain in his elbow. He says he was experimenting with his son’s hoverboard, hanging on to a pole to steady himself. He lost his balance and fell, with his right arm taking the brunt of the impact. His range of motion is limited by both pain and swelling. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case …

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An 80-Year-Old Man with Rhinorrhea, Cough, and Intermittent Dizziness

An 80-Year-Old Man with Rhinorrhea, Cough, and Intermittent Dizziness

Case The patient is an 80-year-old man with history of hypertension and high cholesterol who presents with rhinorrhea and cough. On further history, he admits to 2 months of intermittent dizziness, not worsening.  He denies any chest pain/discomfort, SOB, or sweating. No neuro symptoms. On exam, you find:  General: A&O, NAD Lungs: Clear bilaterally Cardiovascular: Regular rhythm, without m,r,g Abdomen: Soft and nontender Ext: No edema or asymmetry, pulses are 2+ and equal in all …

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A 48-Year-Old Woman with a Facial Lesion

A 48-Year-Old Woman with a Facial Lesion

Case The patients is a 48-year-old woman who presents with a single lesion on her cheek/face. As a healthcare worker herself, she says she is concerned that the excoriation might get infected. She denies knowing anything about the possible cause, but insists on receiving treatment. Notably, she is a frequent visitor to your urgent care center in spite of the fact that she is in excellent physical health. However, she has been diagnosed with borderline …

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A 2-Year-Old Girl with Leg Pain After Jumping on a Trampoline

A 2-Year-Old Girl with Leg Pain After Jumping on a Trampoline

Case The patient is a 2-year-old girl who is brought to your urgent care center by her parents several hours after jumping on a trampoline with her friend, but that she “seemed fine” when the mother picked her up to come home. 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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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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