42-Year-Old With Facial Injury

42-Year-Old With Facial Injury

A 42-year-old man presents to urgent care on a Sunday afternoon. He explains that he was playing a game of pick-up football in his neighborhood and suffered a rough kick to the face from another player. His nose is swollen, and he’s clearly in pain. An x-ray is ordered to capture a lateral view of the nasal bones. Review the image and consider what your diagnosis and next steps would be. Resolution of the case …

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56-Year-Old With Episodes of Chest Pain

56-Year-Old With Episodes of Chest Pain

A 56-year-old female with no past medical history presents to urgent care with 2 episodes of chest pain that woke her up this morning. She had 2 additional episodes while walking and while bathing earlier in the day. The episodes lasted about 10 minutes each, and she is currently free from chest pain. The pain is pressure-like and left-sided, radiating to her back. An ECG is obtained. View the ECG and consider what your diagnosis …

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3-Week-Old With Scaly Skin Rash

3-Week-Old With Scaly Skin Rash

A 3-week-old girl presents to urgent care with widespread scaly skin. On physical examination, her vital signs are normal. She is noted to have ectropion and large, thick, plate-like scales covering most of her body. The patient had a personal history of prematurity and collodion membrane at birth. There is no family history of dermatological or genetic disorders.   View the image below and consider what your diagnosis and next steps would be. Resolution of …

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55-Year-Old With Hand Rash

55-Year-Old With Hand Rash

A 55-year-old woman presents to urgent care with complaints of arthralgia and a pustular rash on her hands. She has a past medical history of Crohn disease and has taken infliximab as treatment for the past year. The patient has no recent history of travel or infections and no history of any skin conditions. On dermatological examination, multiple pustules, some becoming confluent to form “lakes of pus,” were seen on the palms and fingers. Bacterial …

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28-Year-Old With Foot Pain

28-Year-Old With Foot Pain

A 28-year-old woman presents to urgent care after an indoor rock-climbing event. She fell 10 feet from the wall without any safety gear to break the fall. She describes deep pain in her left foot, and she is limping. An exam reveals dorsal and plantar midfoot tenderness and bruising across the dorsal foot. A 3-view x-ray series is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the …

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36-Year-Old With Hair Loss

36-Year-Old With Hair Loss

A 36-year-old man presents to urgent care with asymptomatic hair loss that developed on multiple sites of his scalp over the previous 2 months. The hair loss developed in round patches that expanded to involve most of the back of his scalp. His past medical history is notable for hyperthyroidism. View the image above and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.

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Clinical Challenge: October, 2009

  A 57-Year-Old Woman with Acute Pain After a Fall The aptient is a 57-year-old woman who presented to urgent care complaining of severe pain in her right foot, leg, hip, and elbow. She reported that she fell three to four hours prior to presentation while outside walking her dog; she was “tripped up” in the pet’s leash. She presented ambulatory, but was unable to bear any weight on her right leg. Past medical history …

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