Clinical Challenges

The patient is a 42-year-old woman who presents to urgent care after a child weighing approximately 70 pounds fell on her hand at a family gathering. Pain is severe around the base of the fifth metacarpal. On exam, you note soft tissue swelling in the ulnar aspect of the hand. View the images taken and consider what your diagnosis and next steps would be.

The patient is an 18-year-old male who presents to urgent care complaining of 1-day history of intermittent shortness of breath, as well as a sore throat. He reports that he woke up with “chest tightness” and “discomfort.” He is unable to take a deep breath. View the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

The patient is an 8-year-old girl who is brought to your urgent care center by her father, who reports his daughter has had a sore throat and a fever for “a few days.” Most recently, a petechial rash has appeared, spreading from her head and neck down to her torso. She also started complaining of nausea. The father also observes that her tongue appears redder than usual. View the image and consider what your diagnosis …

The patient is a 2-year-old boy who presents with a painful, swollen foot after jumping off a bed. You observe that he limps when trying to walk. View the image taken and consider what your diagnosis and next steps would be.

Figure 1.   Case The patient is a 65-year-old man with symptoms of epigastric pain over the last 2 hours, with some dyspnea and a “clammy feeling.” He has a history of GERD and has used both an oral antacid and omeprazole within the past hours without relief. Upon exam, you find: General: Alert and oriented. Skin cool and moist Lungs: CTAB Cardiovascular: Regular rate and rhythm without f/r/g Abdomen: Soft and nontender without rigidity, …

The patient is a 57-year-old man who reports to urgent care complaining of right-sided pain in his ribs when taking deep breaths. He reports that he worked out at his health club that morning before work, but denies any pain at the time or potential cause of injury related to that. Rather, he said the pain began suddenly a couple of hours later while he was at work. View the images taken and consider what …

The Case The patient is a 65-year-old woman who presents with pain in her left hip after stumbling down the last step of her front stoop. Her daughter, who witnessed the incident, reports that her mother did not fall and insists she “didn’t even land that hard” on her left leg. Review the image taken and consider what our diagnosis and next steps would be.

The patient is a 13-year-old boy who complains of pain in his right hip and groin after playing soccer. His mother says she didn’t see what happened, but reports that she looked up from a magazine she was reading to see him limping suddenly. View the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.