The patient is a 29-year-old white male who presented three weeks after returning from a camping trip, during which he removed three ticks from his chest and back after being bitten. He reports a one-week history of fever, fatigue, hot and cold spells, and arthralgia, and a one-day history of popular rash on the dorsum of his feet (Figure 1 and Figure 2).
Read MoreClinical Challenge: February, 2009
Clinical Challenge: January, 2009
The patient is a 35-year-old female who got her finger caught in a metal staircase banister one day prior to presentation. Physical examination is significant for R 5th finger PIP hyperextension and DIP hyperflexion (swan neck deformity). Her PIP flexion limited to about 20°, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits noted. View the x-rays taken (Figure 1 and 2) and consider what your diagnosis and …
Read MoreClinical Challenge: December, 2008
The patient is a 55-year-old female who experienced a blow to the back when she fell while riding a bus. She complains of pain in her neck, shoulder, and back. On examination, you find that her vitals are stable and she has no significant past medical history. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Hint: this …
Read MoreClinical Challenge: November, 2008
The patient is a 23-year-old male who presents with a complaint of pain in the heel area after slipping down four steps. He is limping but able to bear weight. On exam, you note local tenderness and swelling over the area of the Achilles tendon. Other findings are unremarkable. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: October, 2008
The patient is an 82-year- old man who slipped on the street, experiencing a blow to his right shoulder. He has significant local swelling in the injured shoulder specifically, over the acromioclavicular joint as well as significantly limited range of motion. His distal pulses are normal. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: September, 2008
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 increasing chest pain, which began after the visit to the primary care physician. On exam, you find the child is not in respiratory distress, but has decreased air entry on the left side …
Read MoreClinical Challenge: August, 2008
Clinical Challenge 2: July 2008
The patient is a 73-year-old woman who presents with a foreign body (a piece of wood, specifically) sticking out of a scratch on her hand. She reports that she fell in her yard. In addition, you discover that she has local pain and swelling of the left wrist. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: July 2008
The patient is a 2-year-old girl who experienced a blow to the left foot when she jumped from an unspecified height while playing. The parents were unaware at the time the injury occurred, but toward evening the girl refused to apply weight to her left foot. On exam, the foot is mildly swollen and tender. Otherwise, there are no remarkable findings. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps …
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