Clinical Challenges

The patients is a 25-year-old woman who presents with 1 month of smooth, red-brown plaques on her elbows and the tops of her feet which are pruritic. The lesions are round with a slightly darker ring on the outside, with no scaling or significant surface change to the skin. She has no systemic symptoms. View the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

A 74-year-old female presents to urgent care complaining of two episodes of chest pain in the past 2 days. The pain is midsternal, squeezing, does not radiate, and began at rest. The patient denies associated nausea, vomiting, diaphoresis, cough, lower extremity swelling or pain. Personal medical history is remarkable for hypertension, asthma, and diabetes.             View the ECG ordered and consider what your diagnosis and next steps would be. Resolution of the case is described …

The patient is a 28-year-old male who presents with a complaint of diarrhea and a 1-week history of abdominal pain. He reports no food allergies, recent travel, or known exposure to sick contacts.             View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

The patient is a 24-year-old man who presents with excessive foot odor that he describes as “worse than anything I could have imagined.” He denies pain or burning, but reports that the soles of his feet itch occasionally. He also says his feet sweat heavily when he plays recreational ice hockey a few nights a week. Upon examination, several shallow rounded pits are found on the pressure-bearing areas of the soles.             View the image …

The patients is a 48-year-old female with a family history of breast cancer who complains of 2 months of fatigue, nausea, and generalized body aches, including chest pain. She reports 40 pounds of unintentional weight loss during this time. Review the ECG taken and consider what other tests you would order, as well as possible diagnoses. (Case presented by Tom Fadial, MD, McGovern Medical School Department of Emergency Medicine.)

The patient is a 52-year-old male who presents with a chief complaint of 1 month of right shoulder pain. View the image taken and consider what your diagnosis and next steps would be.

A 33-year-old woman presents to urgent care with symmetrical multiple blanching nodules that developed on her lower legs over the course of 2 weeks. The lesions were round and tender. She had also been fighting a fever, fatigue, and joint pain over the same period. Her only current prescription was for oral contraceptives.             View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on …

The patient is a 46-year-old male who presents epigastric pain that started several hours ago after a large meal. He describes the pain as a “burning” sensation. His personal medical history is notable for seizures. View the ECG and consider what your diagnosis and next steps would be. (Case presented by Benjamin Cooper, MD, FACEP, The University of Texas Health Science Center at Houston.)