Clinical Challenges

A 17-year-old girl presents to urgent care complaining of easy bruising, especially on her legs. She couldn’t recall having any injuries, even minor bumps, that might have caused the red and purple ecchymoses that had appeared. She insisted no one else had caused her harm. She also complained of headache and nausea. A high school student, she was about to complete her final exams and was concerned she would have bruises on her legs during …

The patient is a 78-year-old man who says he has felt dizzy for several hours. He denies chest pain, shortness of breath, or diaphoresis. Upon exam, you find: General: Alert and oriented; breathing comfortably Lungs: Clear bilaterally Cardiovascular: RRR without m/r/g Abdomen: Soft and nontender, no pulsatile mass Extremities: No pain or swelling, pulses normal and equal in all 4 extremities   Review the ECG and consider what your diagnosis and next steps would be. …

The patients is an obese 46-year-old man who complains of a painful skin lesion located between folds of skin that were touching each other. He reports looking in the mirror at home and seeing the area was very red and erythematous. He also says sometimes it feels like a burning sensation on his skin. This was most evident after being outside in the hot, humid weather. View the image taken and consider what your diagnosis …

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.