Figure 1: Initial ECG (Case presented by Benjamin Cooper, MD, MEd, FACEP, Department of Emergency Medicine, McGovern Medical School at UTHealth Houston.)
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A 46-Year-Old with Evolving Sores on Her Hand and Arm
A 46-year-old female presents with an evolving eruption that developed on her right hand and spread to her forearm over the past several weeks. She is an immunocompetent commercial landscaper who lives in Brazil, and she does not recall any specific injury. She is regularly exposed to toxic plants and sustains minor scratches and cuts at work. She also suspects that she could have experienced bug bites. She appears well and is without systemic symptoms. …
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A 40-Year-Old with Swelling After a Direct Blow to the Eye
A 40-year-old male presents with pain and swelling in his right eye after being struck by a foul ball while coaching his daughter’s softball game. View the images 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 61-Year-Old Female with History of Hypertension and New Palpitations and Shortness of Breath
A 61-year-old female with a past medical history of hypertension presents to urgent care with palpitations and shortness of breath for 3 days. She also reports cough and fever, and denies nausea or vomiting. View the initial ECG 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 7-Year-Old Male with Lesions on His Knees
A mother brings her 7-year-old son to your urgent care center because she’s concerned about asymptomatic lesions that have developed on his knees over the past couple of weeks. On examination, you observe smooth, crusted and scaly, erythematous and whitish papules and nodules on both knees. There was no history of recent trauma. The patient had a history of dermatomyositis. View the image and consider what your diagnosis and next steps would be. Resolution of …
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A 12-Year-Old Boy with a Crush Injury
The patient is a 12-year-old boy who presents with pain after his foot became wedged in an escalator at the mall. The image on the left was taken upon presentation; the one on the right is from a 2-week follow-up. Review each 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 38-Year-Old Female with Persistent Pain Months After Being Bitten
The patient is a 38-year-old female who presents with persistent pain in her left thumb. She explains that she was bitten approximately 2 months prior. There is redness and swelling to the proximal phalanx area. The patient is febrile. View the x-ray and consider what your diagnosis and next steps would be. Resolution of the case is described on the next screen.
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A 35-Year-Old with Ankle Pain and a History of Gunshot Wound
A 35-year-old male presents with progressive pain in his ankle. He reports a history of a gunshot to the foot without any aftercare. Review 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 20-Year-Old Female with Weakness, Vomiting, and a History of Alcohol Abuse
The patient is a 20-year-old female who presents complaining of 1 day of generalized weakness and vomiting. She has a history of alcohol abuse and denies chest pain, shortness of breath, lower extremity swelling, fevers, chills, or any infectious symptoms. View the ECG 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 33-Year-Old with New, Painful ‘Lumps’ on Her Legs
A 33-year-old female presents with painful “lumps” on her legs that developed over the past few days. She decided to seek care when some of them began to drain pus. She had no trauma and feels well. Her past medical history is significant for type 2 diabetes mellitus. On examination she is afebrile, with scattered tender nodules, some with purulent drainage, on the legs. View the image taken and consider what your diagnosis and next …
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