Clinical Challenges

Case The patients is a 48-year-old woman who presents with a single lesion on her cheek/face. As a healthcare worker herself, she says she is concerned that the excoriation might get infected. She denies knowing anything about the possible cause, but insists on receiving treatment. Notably, she is a frequent visitor to your urgent care center in spite of the fact that she is in excellent physical health. However, she has been diagnosed with borderline …

A 27-year-old woman who has been training for a marathon presents to the urgent care center with epigastric pain. She states the pain is worse after she consumes tomato sauce or orange juice, and wonders if she may have reflux. She denies shortness of breath, exertional component, pleuritic pain, leg swelling, use of hormonal therapy, or sweating. No right upper quadrant pain. Improves with antacids. No FH or heart disease or other risk factors. Upon …

Case The patient is a 45-year-old male construction worker who felt pain immediately after stepping down from a truck into a pothole. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.   Figure 1.

The patient is a 43-year-old man who presents to urgent care after work with an extremely pruritic fine scaly plaque and tense vesicles covering his hands and arms. He had been  gardening the previous weekend, worked on his car, and prepared his boat for its first voyage of the season. He wasn’t sure which activity might have caused such a terrible rash. View the image and consider what your diagnosis and next steps would be. …

Figure 1. Case A 10-year-old boy visited urgent care complaining of multiple skin lesions on the rim of his ear. They had begun as vesicles and some were beginning to crust. He also had enlarged cervical lymph nodes. His mother was concerned because the symptoms developed after an early spring camping trip with his scout troop and two other boys had similar symptoms. View the photo taken, and consider what your diagnosis and next steps …

Case The patient is a 70-year-old female who presents with gradual onset of constant pain in her left lower chest and back. She is unsure when she first noticed the pain, but reports that it has worsened since she experienced a fall several days ago. She denies shortness of breath, diaphoresis, or an exertional component. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described …

The patient is a 28-year-old man who presents to urgent care with a single annular ecchymosis lesion on his leg the morning after returning home from a trip to visit his family’s cabin in the mountains of North Carolina. He “thought” he noticed a small insect bite in the vicinity. The lesion has become increasingly painful. View the photo taken and consider what your diagnosis and next steps would be. Resolution of the case is …

Figure 1.   Case The patient is an 18-year-old female who presents to urgent care with 1–2 hours of “sharp” chest pain that worsens with range of motion. She reports it began suddenly while lifting boxes at work. Pain is not improved with acetaminophen. She denies exertional discomfort, pleuritic pain, and use of hormone therapy. There is no leg swelling, shortness of breath, or sweating. Physical exam reveals: General: Sitting comfortably on the cart, breathing …

Case The patients is a 57-year-old man with a complaint of syncope 3 hours before arrival. He states he was sitting on the couch and the next thing he knew he was waking up. No preceding dizziness. No seizure activity, biting of the tongue, blood in the mouth, or post ictal symptoms. No cp, sob, leg pain, head pain, or back pain. He drank 2 glasses of water and felt better, but was encouraged to …