Clinical Challenges

Case A 35-year-old, HIV-infected patient who recently started highly active antiretroviral therapy (HAART) presents to your urgent care center very concerned about a large group of vesicles that had appeared on her leg. She recalls feeling a burning sensation for several days before they appeared. Upon probing, she tells you that she’s also had headache, neck pain, and fatigue. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More
Case The patient is a 74-year-old man who complains of epigastric pain. He is an alcoholic who has had multiple episodes of pancreatitis. He has no chest pain, shortness of breath, or diaphoresis. An ECG is performed by staff prior to provider evaluation. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop, occasional irregular beats Abdomen: Soft and NT without r/r/g View the ECG taken and consider what the diagnosis and next steps would be. Resolution of the case id described onRead More
Case A 51-year-old woman presents with wrist pain and swelling after tripping on a loose piece of carpeting and falling on her outstretched hand. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.  Read More
The patient is a 43-year-old man who presents to urgent care with widespread skin petechia and palpable purpura on his legs. He reports these symptoms occurred around 2 weeks after he recovered from an upper respiratory tract infection. In addition, he’s experienced fever, diarrhea, and vomiting. He mentions pain in his scrotum, as well. View the photo (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.Read More
The patient is a 60-year-old man with a 2-year history of dizziness. He denies chest pain, shortness of breath, diaphoresis, vomiting/diarrhea, or fever. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop, occasional irregular beats Abdomen: Soft and NT without r/r/g View the ECG taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.   Figure 1.Read More
 The patient is a 35-year-old male who presents with chest pain, which he reports started after he was hit in the chest with an errant pass during his son’s basketball practice. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.Read More
A 45-year-old man presents with bilateral ocular pain, excessive tearing, and bloodshot eyes. He reports that his symptoms began 2 days ago with the sensation of a foreign body lodged in his eye, and that his eyes have been unusually sensitive to light. He has not worn his contacts since the onset of symptoms. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More
The patient is a 20-year-old female who presents with sudden onset of left sided chest pain. A collegiate cross-country runner, she reports that she also felt lightheaded when lacing up her running shoes earlier in the day. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.Read More