A 48-Year-Old Female with Months of Fatigue, Nausea, and Body Aches—Including Chest Pain

A 48-Year-Old Female with Months of Fatigue, Nausea, and Body Aches—Including Chest Pain

The patients is a 48-year-old female with a family history of breast cancer who complains of 2 months of fatigue, nausea, and generalized body aches, including chest pain. She reports 40 pounds of unintentional weight loss during this time. Review the ECG taken and consider what other tests you would order, as well as possible diagnoses. (Case presented by Tom Fadial, MD, McGovern Medical School Department of Emergency Medicine.)

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A 33-Year-Old Woman with Blanching on Her Lower Legs

A 33-Year-Old Woman with Blanching on Her Lower Legs

A 33-year-old woman presents to urgent care with symmetrical multiple blanching nodules that developed on her lower legs over the course of 2 weeks. The lesions were round and tender. She had also been fighting a fever, fatigue, and joint pain over the same period. Her only current prescription was for oral contraceptives.             View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on …

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A 46-Year-Old Man with ‘Burning’ Epigastric Pain of Several Hours Duration

A 46-Year-Old Man with ‘Burning’ Epigastric Pain of Several Hours Duration

The patient is a 46-year-old male who presents epigastric pain that started several hours ago after a large meal. He describes the pain as a “burning” sensation. His personal medical history is notable for seizures. View the ECG and consider what your diagnosis and next steps would be. (Case presented by Benjamin Cooper, MD, FACEP, The University of Texas Health Science Center at Houston.)

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A 35-Year-Old Man with Shoulder Pain Weeks After a Car Accident

A 35-Year-Old Man with Shoulder Pain Weeks After a Car Accident

The patient is a 35-year-old male who presents with shoulder pain and weakness. He reports that the pain began when he had a “fender bender” 3 weeks ago. At the time, he didn’t think the pain was severe enough to warrant attention but he’s concerned that it’s “taking too long to get over this.” View the images taken and consider what your diagnosis and next steps would be.

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An 8-Year-Old Girl with Lesions on Her Arms

An 8-Year-Old Girl with Lesions on Her Arms

The patient is an 8-year-old girl with a smattering of brown to black lesions on her arms. They’re not painful or causing discomfort, but her mother is concerned because they look darker than the average freckle. Exam reveals small (less than 0.5 mm), round, hyperpigmented macules.             View 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 60-Year-Old Woman with a 4-Day History of Intermittent Exertional Chest Pain

A 60-Year-Old Woman with a 4-Day History of Intermittent Exertional Chest Pain

The patient is a 60-year-old female with no past medical history presents with intermittent exertional chest pain for 4 days. She reports the pain is substernal with radiation to her left arm, is associated with nausea and diaphoresis, and is worsened by exertion. The patient says she experiences pain every 4-5 hours, but currently is pain-free.             View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case …

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A 37-Year-Old Male with an ‘Itchy’ Lesion on his Face

A 37-Year-Old Male with an ‘Itchy’ Lesion on his Face

The patient is a 37-year-old male who presents with a red, round lesion with a fine, scaly plaque on his face which developed over the past month. He also reports seeing similar lesions on his scalp while combing his hair. None of the lesions are painful, though he describes them as “slightly itchy.” No history of injury to the area. View the image and consider what your diagnosis and next steps would be.

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Chest Pain in a 44-Year-Old Male: Is It Too Early for Emergent Coronary Intervention?

Chest Pain in a 44-Year-Old Male: Is It Too Early for Emergent Coronary Intervention?

The patient is a 44-years-old previously healthy male who presents with continuous, typical cardiac chest pain of a few hours’ duration, with no associated symptoms. He reports that this is a first-time occurrence. He also relays that he is a nonsmoker, nonalcoholic with no family history of heart disease. On physical examination, you find his vital signs are stable. Cardiac auscultation reveals normal first and second heart sounds with no murmurs. Labs reveal slightly elevated …

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