A 62-year-old female presents to the urgent care center with a three-week history of a pruritic facial rash that initiated on one cheek, then spread to the rest of the face. The patient states the rash got worse after sun exposure. Initially, she self-treated with cold cream, Eucerin, and other over-the-counter moisturizers that did not help. Eventually, the patient tried a topical hydrocortisone cream that made the rash much worse. You note there is no …
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82-year-old man injured from falling to his back
The patient is an 82-year-old man who presents after having fallen backwards and landing on his back. He did not lose consciousness; nor did he vomit. The patient enters the clinic using a walker, which he reports using on a regular basis. Examination reveals an abrasion over his forehead and over the anterior right tibia. The neurological exam shows no acute changes. The patient is specifically tender over the shoulder, but there is no spiny …
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15-year-old boy experienced a blow to both ankles
The patient is a 15-year-old boy who experienced a blow to both ankles and the right knee two days ago. You observe that he can bear weight only minimally, with tenderness over the lateral and medial malleolus, as well as over the knee. You also observe there is marked swelling. View the x-ray taken and consider what your diagnosis and next steps would be.
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3-year-old girl falls from bicycle and recieves blow to elbow
The patient is a 3-year-old girl who fell from a bicycle, receiving a blow to the elbow a short time before presentation. You note marked swelling and local tenderness over the elbow. The only other remarkable finding is a pulse of 132. View the x-rays taken and consider what your diagnosis or next steps would be.
Read MoreCommunity-acquired Pneumonia
The patient is a 45-year-old woman (herself a surgeon) who presented three weeks after first visiting her family physician with a cough, at which time the x-ray shown in Figure 1 was taken. She was started on erythromycin for 10 days. After finishing that course of antibiotics with no improvement, she was started on amoxicillin-clavulanic acid. Four days later, there was still no improvement in her status. Second Presentation: Urgent Care By the time the …
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Type 2 diabetic male experiencing painful rash
The patient is a 51-year-old male with uncontrolled type 2 diabetes who presents with a painful, raised, pruritic rash that began after an afternoon of gardening eight days ago. In the interim, he self-treated with over-the-counter topical hydrocortisone 1 percent without relief. View the photo and consider what your diagnosis or next steps would be.
Read MoreClinical Challenge: July/August, 2009
9-year-old girl has painful breathing after falling on chest
The patient is a 9-year-old girl who presents after experiencing a fall and a blow to her right chest. She complains of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam is clear. She has an abrasion over her right chest. The patient is generally healthy, is on no medications, and has no significant past medical history. View the …
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32-year old female with fever, rash and scattered vesicles
The patient is a 32-year-old female who presents complaining of a fever and a rash, along with a sore throat, headache, and fatigue. On clinical examination, you note vesicles on the palms and soles. An erosion is present at the labial mucosa. A small vesicle is present on the hard palate. The patient\’s temperature is 100.5°F. Her blood pressure and vital signs are within normal limits. View the photos and consider what your next steps …
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8-year-old boy experiencing rash on abdomen
The patient is an 8-year-old boy whose mother brings him in with an acute, pruritic rash involving the inferior abdomen. On examination, you find a large, scaly plaque at the midline of the inferior abdomen. You observe the child scratching during the exam. View the image and consider what your next steps would be.
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