A 42-Year-Old Man with a ‘Flipping’ Sensation in his Heart

A 42-Year-Old Man with a ‘Flipping’ Sensation in his Heart

Figure 1. The patient is a 42-year-old man with a sensation he describes as his heart “flipping” intermittently for the last 3 days. He denies chest pain, shortness of breath, diaphoresis, or dizziness. Upon exam, you find: General: Alert and oriented X 3, sitting comfortably in a chair Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop Abdomen: Soft and NT View the ECG taken and consider what the diagnosis and next steps would be. …

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A 35-Year-Old HIV-Infected Patient

A 35-Year-Old HIV-Infected Patient

Case A 35-year-old, HIV-infected patient who recently started highly active antiretroviral therapy (HAART) presents to your urgent care center very concerned about a large group of vesicles that had appeared on her leg. She recalls feeling a burning sensation for several days before they appeared. Upon probing, she tells you that she’s also had headache, neck pain, and fatigue. View the photo and consider what your diagnosis and next steps would be. Resolution of the …

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A 74-Year-Old Man with Epigastric Pain

A 74-Year-Old Man with Epigastric Pain

Case The patient is a 74-year-old man who complains of epigastric pain. He is an alcoholic who has had multiple episodes of pancreatitis. He has no chest pain, shortness of breath, or diaphoresis. An ECG is performed by staff prior to provider evaluation. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop, occasional irregular beats Abdomen: Soft and NT without r/r/g View the ECG taken and consider …

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A 42-Year-Old Man with Skin Petechia and Palpable Purpura on His Legs

A 42-Year-Old Man with Skin Petechia and Palpable Purpura on His Legs

The patient is a 43-year-old man who presents to urgent care with widespread skin petechia and palpable purpura on his legs. He reports these symptoms occurred around 2 weeks after he recovered from an upper respiratory tract infection. In addition, he’s experienced fever, diarrhea, and vomiting. He mentions pain in his scrotum, as well. View the photo (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described …

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A 60-Year-Old Man with a 2-Year History of Dizziness

A 60-Year-Old Man with a 2-Year History of Dizziness

The patient is a 60-year-old man with a 2-year history of dizziness. He denies chest pain, shortness of breath, diaphoresis, vomiting/diarrhea, or fever. Upon exam, you find: General: Alert and oriented Lungs: CTAB Cardiovascular: RRR without murmur, rub, or gallop, occasional irregular beats Abdomen: Soft and NT without r/r/g View the ECG taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. …

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A 45-Year-Old Male with Sudden Eye Pain

A 45-year-old man presents with bilateral ocular pain, excessive tearing, and bloodshot eyes. He reports that his symptoms began 2 days ago with the sensation of a foreign body lodged in his eye, and that his eyes have been unusually sensitive to light. He has not worn his contacts since the onset of symptoms. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

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