Clinical Challenges

Case A 52-year-old man presented to urgent care with a 2-day history of dizziness. He denies chest pain, syncope, shortness of breath, or diaphoresis. He is not taking any medications, and has no noteworthy personal medical history. Upon exam, you find: General: Alert and oriented X 3, slightly pale Lungs: CTAB Cardiovascular: Irregularly irregular and tachycardic without murmur, rub, or gallop Abdomen: Soft and NT, no pulsatile mass Ext: No peripheral edema, pulses are 2+ …

Case A 3-year-old girl was brought to urgent care with small widespread vesicles, including on her palms and soles. She had begun to develop painful oral vesicles, as well, and was refusing to eat. The rash began a few days after flu-like symptoms of fever, sore throat, cough, and headache. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Case The patient is a 34-year-old woman who has just returned from the first camping trip of the year with her family. She relays that 2 days earlier, as she as she was setting up a tent, she “got stung” by something she didn’t see. As she struggled to free herself of the tent fabric, she was stung several more times on her hand and arm. She never saw the culprit. Not long after, she …

Case The patient is a 17-year-old male who presents to urgent care with anterior knee pain after a fall while mountain biking. However, he states that he’d been experiencing pain for an indeterminate period of time before the incident that preceded his visit. View the image taken (Figure 1) and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. Figure 1.

Figure 1. The patient is a 42-year-old man with a sensation he describes as his heart “flipping” intermittently for the last 3 days. He denies chest pain, shortness of breath, diaphoresis, or dizziness. Upon exam, you find: General: Alert and oriented X 3, sitting comfortably in a chair Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop Abdomen: Soft and NT View the ECG taken and consider what the diagnosis and next steps would be. …

Case The patient is a 51-year-old man who presents to urgent care complaining of a persistent cough. He reports it started “about a month ago,” but his wife, who is with him, insists it’s been at least 6 weeks. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Case A 35-year-old, HIV-infected patient who recently started highly active antiretroviral therapy (HAART) presents to your urgent care center very concerned about a large group of vesicles that had appeared on her leg. She recalls feeling a burning sensation for several days before they appeared. Upon probing, she tells you that she’s also had headache, neck pain, and fatigue. View the photo and consider what your diagnosis and next steps would be. Resolution of the …

Case The patient is a 74-year-old man who complains of epigastric pain. He is an alcoholic who has had multiple episodes of pancreatitis. He has no chest pain, shortness of breath, or diaphoresis. An ECG is performed by staff prior to provider evaluation. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop, occasional irregular beats Abdomen: Soft and NT without r/r/g View the ECG taken and consider …

Case A 51-year-old woman presents with wrist pain and swelling after tripping on a loose piece of carpeting and falling on her outstretched hand. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.