Practice Management
The patient is a 60-year-old woman who presents to urgent care after developing dark areas over both legs over the course of the past few days. They are extremely painful. On examination, there were violaceous and dark brown, retiform plaques, some depressed and some crusted, over the legs. The patient has a history of diabetes, hypertension, and chronic renal insufficiency for which she required hemodialysis. View the image and consider what your diagnosis and next …
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The patient is a 31-year-old male who presents with lateral ankle pain after an inversion injury during a game of basketball. 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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KEY QUESTIONS What diagnosis explains the widened QRS? What are the electrocardiographic criteria for making this diagnosis? What rule(s) can help diagnose acute myocardial infarction with an ECG like this?
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The patient is an 81-year-old female with past medical history of atrial fibrillation on apixaban who presents to urgent care after a syncopal episode 30 minutes prior to arrival. The patient felt lightheaded while being pushed in her wheelchair and then lost consciousness. There was no trauma. She returned to baseline approximately 2 minutes after the event. There was no seizure activity. The patient denied associated chest pain, shortness of breath, headache, urinary or fecal …
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A mother brings her 13-year-old daughter to your urgent care center with a complaint of fever, chills, dry cough, and myalgia for 3 days. On exam, the patient is febrile (101°F). In addition, there is conjunctival injection and blanching erythematous patches on the face and neck. The mother mentions that the family returned from a trip to Brazil 10 days prior. While traveling they ate local food, drank local (unfiltered) water, sustained a few mosquito …
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The patient is a 30-year-old male who presents with 2 days of difficulty swallowing and what he calls a painful “bump” on the right side of his neck. 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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The patient is a 14-year-old boy who reports to urgent care with left shoulder pain after a junior high wrestling match. He is vague about the precise location and possible mechanism of injury but through the physical exam you notice a prominence of the sternoclavicular joint and pain radiating along the clavicle. View the x-ray taken and consider what your diagnosis and next steps would be.
Read MoreChamber Abnormalities: Pathologic or Not? A 27-year-old male with no reported medical history presents with chest pain. He relays several weeks of intermittent symptoms which started after lifting heavy boxes. The pain is sharp, located in the mid-chest and is otherwise non-tearing, non-pleuritic, non-positional and not associated with exertion. On examination, the patient is in no acute distress, and appears lean without cachexia or wasting. The pain is reproduced with shoulder extension. It resolves with …
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The patient is a 68-year-old woman who presents with a rash she says developed on her trunk over a span of several weeks. On examination, there were multiple confluent, orange-red plaques on the trunk and arms with “islands of sparing” within them. The rash had a primarily truncal distribution and was pruritic. She was feeling well otherwise. View the image and consider what your next steps and diagnosis would be. Resolution of the case is …
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The patient is a 15-year-old boy who presents to urgent care with a painful medial right elbow he and his parents attribute to pitching in a baseball game earlier in the day. 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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