47-Year-Old With Right Hand Pain

47-Year-Old With Right Hand Pain

A 47-year-old man presents to urgent care after trying out a new cardio boxing class at the local recreation center. He indicates that his right hand has been hurting ever since he hit a punching bag this morning, and the pain has been getting worse. X-rays are ordered, both anterior posterior (AP) and oblique views. Review the images and consider what your diagnosis and next steps would be. Resolution of the case is described on …

Read More
64-Year-Old With Facial Lesion

64-Year-Old With Facial Lesion

A 64-year-old man presents to urgent care with a lesion on his face for the last 2 months. On examination, a shiny, eroded, blue-black nodule was seen on his right cheek. He is a postal worker.  Histopathology examination showed aggregates of melanin and melanocytes within sheets of basaloid keratinocytes with peripheral palisading and surrounding clefts within a fibromyxoid stroma containing melanophages. View the image above and consider what your diagnosis and next steps would be. …

Read More
56-Year-Old With Cancer and Developing Rash

56-Year-Old With Cancer and Developing Rash

A 56-year-old woman presents to urgent care for a rash that developed on her hands, ears, and nose over the last couple of months. She has a recent diagnosis of esophageal cancer. On examination, hyperkeratotic plaques were seen on the palm and fingers, and scaly papules were seen on her helices and nose. Her nails displayed subungual hyperkeratosis, onychodystrophy, and onycholysis along with erythema and edema on her nail folds. View the image below and …

Read More
42-Year-Old With Stinging Sensation

42-Year-Old With Stinging Sensation

A 42-year-old woman presented to urgent care early in the morning saying that she felt a stinging sensation on her arm while she was cleaning her basement the previous day. She thinks it might be a bite but didn’t see anything. She had subsequent marked pain at the site and over the past few hours developed nausea and muscle aches. On physical examination, the patient had a temperature of 101.3°F (38.5°C). There were reddish-brown reticulate …

Read More