Case A 42-year-old woman presents with pain in her right shoulder that suddenly began after she caught herself with her raised right arm as she fell. She reports that she had been standing on a step stool and reaching for an object, and then fell forward. She has severe pain in the right shoulder, and it worsens with movement even through a minimal range of motion. She has associated numbness over the lateral portion of …
Read MoreA 48-Year-Old Female with Pruritic Lesions
Case A 48-year-old woman presents with several red lesions that are extremely pruritic. They are scattered haphazardly on the back of her leg. A few of the lesions are still smooth nodules, but others are now excoriations; she just can’t stop scratching them no matter how hard she tries. She estimates they appeared nearly a month ago. She reports a history of atopic dermatitis, but “this doesn’t feel like the same thing.” View the photo …
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A 26-Year-Old Man with Palpitations
The patient is a 26-year-old man who presents after 3 days of palpitations. He denies any chest pain, shortness of breath, diaphoresis, fever, or dizziness. He does use home oxygen (2 L/min), but denies any new shortness of breath. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain …
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A 9-Year-Old Boy with Pain After Twisting His Knee
The patient is a 9-year-old boy who was brought in by his parents with right knee pain. He reports that he twisted it while reenacting Star Wars battles in the backyard with friends. His parents did not witness the injury. 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.
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Clinical Challenge 3: October 2017
A 40-year-old woman visits your urgent care center several days after first noticing a rash of pruritic smooth papules on her trunk and intertriginous areas. She reports that she had been spending a lot of time in the pool with her children before they returned to school. Now she also has a fever and swollen glands, and complains of general malaise. View the photo and consider what your diagnosis and next steps would be. Resolution …
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Clinical Challenge 2: October 2017
A 42-year-old woman with a history of anxiety presents, complaining of intermittent palpitations over the past 2 weeks. She says she has not taken any medication and denies chest pain, shortness of breath, diaphoresis, fever, or dizziness. Upon exam, you find: General: Alert and oriented X 3 Lungs: Clear to auscultation bilaterally Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, or guarding Extremities: No pain or swelling, …
Read MoreClinical Challenge: October 2017
The patient is a 25-year-old male who presents with pain over the distal phalanx of the middle finger. He says he hit it with a hammer while hanging a picture frame in his new apartment a short while ago. Pain is evident upon palpation over the distal phalanx of the middle finger, but there are no cuts or breaks in the skin. Neurovascular status is intact. View the image taken (Figure 1) and consider what …
Read MoreA 30-Year-Old Woman with a ‘Burning’ Tongue
Case A 30-year-old woman visited urgent care complaining of a burning sensation on her tongue. At first, she had blamed it on a spicy meal, but the feeling didn’t go away and now she feels as though she isn’t able to taste food as usual. Looking back, she recalls that over a month ago she noticed a white plaque on her tongue. However, that had had disappeared within a day so she hadn’t thought much …
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A 73-Year-Old Man with a 2-Week History of Palpitations
Case The patient is a 73-year-old male smoker who complains that he has had intermittent palpitations for the past 2 weeks. He denies chest pain, diaphoresis, fever, or dizziness. He uses home oxygen, 2 L/min, but denies any new shortness of breath. Upon exam, you find: General: Alert and oriented x 3 Lungs: Scattered minimal wheezing, which is symmetric Cardiovascular: Regular and tachycardic without murmur, rub, or gallop Abdomen: Soft and nontender without rigidity, rebound, …
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A 21-Year-Old Male with Foot Pain
Case A 21-year-old male presents with pain after dropping a piece of furniture on his right foot. He is physically able to bear weight during the assessment, though his pain is evident and he is unsteady when shifting his weight to the injured foot. 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.
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