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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A 22-Year-Old Female with Frequent Nosebleeds and Abnormalities on Her Lips and Tongue

A 22-Year-Old Female with Frequent Nosebleeds and Abnormalities on Her Lips and Tongue

The patient is a 22-year-old woman who presents complaining of frequent nosebleeds. On exam, you note bright red macules and spider veins on her lips and tongue. They disappear briefly when you press on them. Review the image below and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

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A 55-Year-Old Female with Hip Pain

A 55-Year-Old Female with Hip Pain

The patient is a 55-year-old woman who presents with what she calls minor pain in her left hip. She denies any trauma, and insists the pain “isn’t that bad.” She’s only seeking care as a precautionary measure in advance of a family camping trip. View the image 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 72-Year-Old Female with Lesions on Her Lower Legs

A 72-Year-Old Female with Lesions on Her Lower Legs

The patient is a 72-year-old woman who complains of multiple skin lesions on her lower legs. She says she first noticed them several months ago, appearing in a net-like pattern, then becoming painful ulcerations, and finally leaving atrophic scars. She is concerned because she had already had several bouts of deep vein thrombosis. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

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