Clinical Challenges

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
The patient is a 51-year-old man with shortness of breath and an intermittent burning sensation in his chest. His symptoms began 2 days ago. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop Abdomen: Soft and NT without r/r/g View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.Read More
A mother brings her 3-year-old son to urgent care with multiple skin lesions on his thumb, which he frequently sucked for comfort. The grouped configuration of lesions was painful and had developed over the last 5 days to become vesicles. Upon exam, you note that the boy has a nearly healed cold sore on his lip, pain in his wrist, and an elevated temperature. 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 21-year-old male who presents with persistent ankle pain 4 weeks after suffering a trauma. He fell while scaling the exterior of his dormitory, trying to gain entry into a second-floor window because he’d locked his keys inside. 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
A 22-year-old man presents to urgent care with a round, hyperpigmented patch on his arm. He reports that it’s “itchy,” and that it appeared soon after taking a second dose of a sulfonamide he’s taking for a persistent sinus infection. 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
An 82-year-old man presents with complaints of palpitations. He denies chest pain, shortness of breath, dizziness, fever, vomiting, or confusion. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.Read More
A 42-year-old man arrived at your urgent care center complaining of thumb pain a day after taking a fall while skiing. You find that the pain is worse with movement in any direction; in addition, he exhibits limited ability to grip anything using his thumb. 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. <1–nextpage–> Differential Diagnosis Avulsion fracture at the ulnar collateral ligament attachment Distal metacarpal fracture Extensor tendon rupture Metacarpophalangeal jointRead More