2-year-old boy with Williams syndrome suffers fever and cough

2-year-old boy with Williams syndrome suffers fever and cough

The patient is 2-year-old boy with Williams syndrome who presents two days after a trip to the emergency room for a three-day history of fever, cough, and wheezing. In the ED, the parents report, he received three doses of nebulized albuterol and was diagnosed with reactive airway disease and bilateral otitis media. He was discharged on oral amoxicillin and albuterol MDI. Today, you find he has similar symptoms, plus vomiting. His parents say he vomited …

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7-year-old boy with persistent fever and cough

7-year-old boy with persistent fever and cough

The patient is a 7-year-old boy who presents to urgent care at midnight with a four-day history of fever and cough. Two days prior, a throat culture administered elsewhere showed nothing suspicious. The parents brought him to urgent care tonight because of subsequent increasing chest pain. On exam, you find the child is not in respiratory distress, but has decreased air entry on the left side of his chest. His temperature is 101.3 degrees F, …

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44-year-old male suffering shortness of breath

44-year-old male suffering shortness of breath

A 44-year-old black male presents to the urgent care center complaining of worsening shortness of breath. On examination, the patient exhibits a dry cough, but his lung sounds are essentially normal. The patient\’s temperature is 100.3°F, and his vital signs are within normal limits. The only remarkable finding is papules seen at the rim of his nose. View the photo taken and consider what your diagnosis and next steps would be.

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56-year-old man experiencing chest pain, fevers and rash

56-year-old man experiencing chest pain, fevers and rash

The patient is a 56-year-old man who emigrated from Mexico to Texas two months ago. He first presented about two weeks ago with a dry cough, chest pain, fevers, and night sweats. Chest x-ray showed a focal consolidation. He had received BCG vaccination as a child, so a PPD was not placed. He was started on isoniazid, rifampin, and ethambutol for tuberculosis. Now, he presents complaining of the same symptoms, plus a rash that erupted …

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A 45-Year-Old Man with Cough and Sore Throat: A Two-Step Approach to Avoiding a Bounceback

Urgent message: The clinician must address unexpected findings with further questions or testing. Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP This is the first article in a series that will appear every other month in JUCM, in which we will recount scenarios of actual patients who presented to an emergency department or urgent care facility, were evaluated and discharged, and then “bounced back.” Each of these cases is detailed in the book Bouncebacks! …

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