The patient is a 2½-year-old female who presented after falling, unobserved, from an unknown height with tenderness and swelling around the elbow. Neurovascular exam was 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. Resulotion The correct diagnosis is a supracondylar fracture; note the loss of the normal angle at the distal humerus. The injury was managed …
Read MoreClinical Challenge 2: April, 2007
The patient is a 25-year-old male who presented to urgent care after falling from a height of two stories, landing flat on his feet. He is able to ambulate, though only with pain. In addition, he complains of back pain. He is generally healthy, and no neurological deficit was found. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: April, 2007
The patient is a 3-year-old female who presented after a fall while running and complaining of pain over the foot. There was minimal local tenderness over the foot and minimal limp, but no other remarkable findings. View the x-ray taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge 2: March, 2007
The patient is a healthy 37-year-old who reports falling on his hand, with his thumb outstretched. Upon examination, you find local mild swelling and tenderness and decreased range of motion of the thumb. There is no snuffbox tenderness, however. View the x-rays taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: March, 2007
The patient is a healthy 30-year-old male who presents with pain shortly after “twisting” his ankle while playing soccer. Pain is severe enough to prevent him from putting weight on the ankle. There are no other remarkable findings from exam or patient history. View the x-rays taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge 2 : February, 2007
A 78-year-old woman presents to your urgent care clinic with new onset palpitations that began a few hours before presentation. Upon examination, you find: Pulse is 123 Blood pressure is 152/83 The only existing issue she admits is hypertension, for which she is taking thiazides as Consider Figure 1, above, and what your possible diagnosis might be, based on the evidence available. Resolution of the case is on the next page. >!–nextpage–> Resolution The patient …
Read MoreClinical Challenge: February, 2007
The patient is a healthy 38-year-old who presents with progressive abdominal pain. There is no fever, vom- iting, or diarrhea. Upon examination, you find: No peritoneal signs Pulse is 55 Blood pressure is 118/50 The only remarkable finding when the history is taken is that the patient had corrective heart surgery as a child. View the x-rays taken (Figure 1 and Figure 2) and consider what your next steps would be. Resolution of the case …
Read MoreInsights in Images – Clinical Challenge: Case 1
A 2 1⁄2-year-old child presents with a three-day history of cough but no fever. Upon examination, you find: Oxygen percent saturation 95% Resting respiration 31/min Pulse 145/min Decreased air entry over the left chest View Figure 1, take these findings into account, and consider what your next steps would be. Resolution of the case is described on the next page.
Read MoreClinical Challenge: January, 2007
Right Hip Pain on 3-year-old Girl
A 3-year-old girl presents to the urgent care center with right hip pain. She has no fever, and the parents report there was no trauma. The child has a limp and reproducible pain on external rotation of the right hip. White blood count is 11,900 with 40.7% lymphs. The erythrocyte sedimentation rate (ESR) is 3 mm/hour. The x-ray (Figure 1) shows fluid around the right hip joint; this finding was confirmed by ultrasound. View the …
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