A 57-Year-Old Woman with Acute Pain After a Fall The aptient is a 57-year-old woman who presented to urgent care complaining of severe pain in her right foot, leg, hip, and elbow. She reported that she fell three to four hours prior to presentation while outside walking her dog; she was “tripped up” in the pet’s leash. She presented ambulatory, but was unable to bear any weight on her right leg. Past medical history …
Read MoreClinical Challenge: September, 2009
A 62-year-old female presents to the urgent care center with a three-week history of a pruritic facial rash that initiated on one cheek, then spread to the rest of the face. The patient states the rash got worse after sun exposure. Initially, she self-treated with cold cream, Eucerin, and other over-the-counter moisturizers that did not help. Eventually, the patient tried a topical hydrocortisone cream that made the rash much worse. You note there is no …
Read MoreClinical Challenge: July/August, 2009
Clinical Challenge: June, 2009
The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports). The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find: BP: 154/102 Pulse: 68 Sat: 99% Temperature: 97.3°F View the electrocardiogram taken (Figure 1) and consider what your next steps …
Read MoreClinical Challenge: May, 2009
Clinical Challenge: April, 2009
The patient is a 17-year-old male who presents with a complaint of throat pain. He reports a history of colitis, for which he was treated with mesalamine and prednisone, 20 mg/day. On exam, you discover that he is also experiencing pressure over his chest. Blood pressure is 97/60, pulse is 93, and SAT is 97%. He is afebrile. you find no abnormalities except for crepitations over his left shoulder soft tissue. View the x-ray taken …
Read MoreClinical Challenge: March, 2009
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 …
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