A 10-Year-Old with Fever, Headache, Muscle Aches, Nausea—and a Suspicious Rash

A 10-Year-Old with Fever, Headache, Muscle Aches, Nausea—and a Suspicious Rash

The patient is a 10-year-old girl who presents to urgent care with 3 days of fever, headache, muscle aches, nausea, and a skin rash. She has a temperature of 102°F. On examination you find numerous erythematous macules and purpura on her palms and the soles of her feet. The patient is immunocompetent with an unremarkable medical history. Her mother recounts no recent travel from their home in North Carolina, but notes that the patient spent …

Read More
A 35-Year-Old with a Persistent, Frequent Cough

A 35-Year-Old with a Persistent, Frequent Cough

The patient is a 35-year-old woman who presents with a frequent, light cough of several months’ duration. Her medical history is unremarkable, including no history of COVID-19. She is a former “social smoker” who worked out on a treadmill sporadically before the cough began.  View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Read More
A 58-Year-Old Male with Chest Pain

A 58-Year-Old Male with Chest Pain

The patients is a 58-year-old male who presents with chest pain. He describes it as sharp, lasting seconds, and worsened by lifting objects at work. Review the initial ECG taken and consider what your diagnosis and next steps could be. Resolution of the case is described on the next page. (Case presented by Tom Fadial, MD, Assistant Professor, McGovern Medical School, The University of Texas Health Sciences Center of Houston.)

Read More
A 57-Year-Old Female with Shortness of Breath and Weeks of Chest Pain

A 57-Year-Old Female with Shortness of Breath and Weeks of Chest Pain

The patient is a 57-year-old female who presents to urgent care with progressive shortness of breath and chest pain of “several weeks” duration. On exam, she is nonobese, normotensive, slightly tachycardic, and tachypneic with clear lungs and distant heart sounds. View the initial ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Read More
A 6-Year-Old Girl with Papules on Her Abdomen

A 6-Year-Old Girl with Papules on Her Abdomen

A 6-year-old girl presents to urgent care for vaccinations at the start of the school year. Her father asks the pediatric provider to look at bumps that developed on her abdomen about 4 weeks ago. They consist of tiny papules, some scattered and some in linear configurations. The patient is asymptomatic without pain or itching. Her father is concerned because they have not resolved. View the image in this context and consider what your diagnosis …

Read More
A 36-Year-Old Male with Chronic, Worsening Hip Pain

A 36-Year-Old Male with Chronic, Worsening Hip Pain

The patient is a 36-year-old male who presents with left hip pain for “years.” The pain is motion- or position-related and over time there has been occasional pain in his buttock, back, and thigh.  Additionally, he has stiffness, clicking, locking, and catching.               View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Read More
A 46-Year-Old Male Who Presents Due to His Defibrillator Firing

A 46-Year-Old Male Who Presents Due to His Defibrillator Firing

The patient is a 46-year-old male with a history of hypertension and congestive heart failure who presents complaining of his defibrillator firing—twice yesterday and once today. He denies chest pain, shortness of breath, fever, nausea or vomiting. He ran out of his carvedilol about 1 month ago.  View the initial ECG and consider what your diagnosis and next steps would be.

Read More
A 60-Year-Old Woman with Dark, Painful Plaques on Her Legs

A 60-Year-Old Woman with Dark, Painful Plaques on Her Legs

The patient is a 60-year-old woman who presents to urgent care after developing dark areas over both legs over the course of the past few days. They are extremely painful. On examination, there were violaceous and dark brown, retiform plaques, some depressed and some crusted, over the legs. The patient has a history of diabetes, hypertension, and chronic renal insufficiency for which she required hemodialysis. View the image and consider what your diagnosis and next …

Read More
An 81-Year-Old Female with a History of A-Fib and a Recent Syncope Event

An 81-Year-Old Female with a History of A-Fib and a Recent Syncope Event

The patient is an 81-year-old female with past medical history of atrial fibrillation on apixaban who presents to urgent care after a syncopal episode 30 minutes prior to arrival. The patient felt lightheaded while being pushed in her wheelchair and then lost consciousness. There was no trauma. She returned to baseline approximately 2 minutes after the event. There was no seizure activity. The patient denied associated chest pain, shortness of breath, headache, urinary or fecal …

Read More