Clinical Challenges

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.  

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 …

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. …

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 …

The patients is a 47-year-old woman undergoing chemotherapy for breast cancer with 1 day of  several red, flaccid bullae on her leg as well as fever, cough, and shortness of breath. View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

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 …

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 …

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 …

Case The patient is a 45-year-old male construction worker who felt pain immediately after stepping down from a truck into a pothole. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.   Figure 1.