A 70-Year-Old Female with ‘Bony’ Pain in Her Chest

A 70-Year-Old Female with ‘Bony’ Pain in Her Chest

Case The patient is a 70-year-old female who presents with gradual onset of constant pain in her left lower chest and back. She is unsure when she first noticed the pain, but reports that it has worsened since she experienced a fall several days ago. She denies shortness of breath, diaphoresis, or an exertional component. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described …

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A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

The patient is a 28-year-old man who presents to urgent care with a single annular ecchymosis lesion on his leg the morning after returning home from a trip to visit his family’s cabin in the mountains of North Carolina. He “thought” he noticed a small insect bite in the vicinity. The lesion has become increasingly painful. View the photo taken and consider what your diagnosis and next steps would be. Resolution of the case is …

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An 18-Year-Old Female with Sudden Sharp Chest Pain

An 18-Year-Old Female with Sudden Sharp Chest Pain

Figure 1.   Case The patient is an 18-year-old female who presents to urgent care with 1–2 hours of “sharp” chest pain that worsens with range of motion. She reports it began suddenly while lifting boxes at work. Pain is not improved with acetaminophen. She denies exertional discomfort, pleuritic pain, and use of hormone therapy. There is no leg swelling, shortness of breath, or sweating. Physical exam reveals: General: Sitting comfortably on the cart, breathing …

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A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

Case The patients is a 57-year-old man with a complaint of syncope 3 hours before arrival. He states he was sitting on the couch and the next thing he knew he was waking up. No preceding dizziness. No seizure activity, biting of the tongue, blood in the mouth, or post ictal symptoms. No cp, sob, leg pain, head pain, or back pain. He drank 2 glasses of water and felt better, but was encouraged to …

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A 37-Year-Old Man with Multiple Symptoms Following a Trip to Japan

A 37-Year-Old Man with Multiple Symptoms Following a Trip to Japan

Case The patient is a 37-year-old man who presents to urgent care complaining of fever, nausea, and abdominal pain. He had attributed these symptoms to a recent trip to Japan, where he ate lots of new foods along with old favorites like sushi. However, he became concerned when a pruritic, serpiginous lesion appeared on his flank. View the photo taken, and consider what your diagnosis and next steps would be. Resolution of the case is …

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An 18-Month-Old with an Itchy Rash and Wheezing

An 18-Month-Old with an Itchy Rash and Wheezing

Case The patient is an 18-month-old girl brought to your urgent care center by her parents. They report that she has been scratching her abdomen. When they lifted her shirt, they found multiple hyperpigmented macules widespread across the front and back of her trunk. She also has 1 hour of wheezing. View the photo 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 55-Year-Old Man with a 2-Day History of Respiratory Symptoms, Palpitations, and Dizziness

A 55-Year-Old Man with a 2-Day History of Respiratory Symptoms, Palpitations, and Dizziness

Case A 55-year-old male presented to urgent care with a chief complaint of coughing, shortness of breath, wheezing, chest palpitations, and dizziness for the past 2 days. The patient denied chest pain. He has a significant past medical history of diabetes mellitus II and takes metformin 500 mg once a day. The patient’s blood pressure is 88/60 mmHg, heart rate is 115, O2 sat 98%, weight 275 pounds, BMI 50.3. In addition: General: alert and …

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A 55-Year-Old Man with 3 Hours of Epigastric Pain

A 55-Year-Old Man with 3 Hours of Epigastric Pain

Case A 55-year-old man presents to urgent care with 3 hours of epigastric pain which began gradually and is constant. He has associated diaphoresis and minimal dyspnea. There is family history of hypertension and high cholesterol. Personal medical history is significant for diabetes mellitus and hypertension. The patient reports that he stopped smoking 2 years ago. Upon exam, you find: General: Alert, breathing comfortable, skin clammy Lungs: CTAB Cardiovascular: RRR, without m,r,g Abdomen: Soft and …

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