Clinical Challenge

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.

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 …

The patient is an 80-year-old man who presents to urgent care with low back pain of two weeks duration. He is hemodynamically stable and has a normal neurological exam. His personal medical history reveals hypertension, for which he is being treated. Blood pressure is 140/80, pulse 63. 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.

This male patient presents to urgent care after, he claims, falling from a ladder. He refuses to give further details, except to say that the distance he fell was “not high.” 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.

The patient is an 82-year-old man who presented after having fallen backwards and landing on his back. He did not lose consciousness; nor did he vomit. The patient entered the clinic using a walk- er, which he reported using on a regular basis. Examination revealed an abrasion over his forehead and over the anterior right tibia. The neurological exam showed no acute changes. The patient was specifically tender over the shoulder, but there was no …

The patient is a 15-year-old boy who presented two days after experiencing a blow to both ankles and the right knee. He could bear weight minimally, with tenderness over the lateral and medial malleolus, as well as over the knee. There was marked swelling View the x-rays taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

The patient is a 9-year-old girl who fell and received a blow to her right chest. A few hours later, she presented to urgent care complaining of pain on deep breathing. On exam, you find a pulse of 103, and SAT of 96. She is not in respiratory distress; her chest exam was clear and she has an abrasion over her right chest. She is generally healthy, is on no medica- tions, and has no …

The patient is a 26-year-old male who slipped and twisted his left ankle. He is unable to bear weight on the ankle and there is marked local swelling circumferentially around the ankle. Oth erwise, he is generally healthy. View the x-ray taken (Figure 1) and consider what your diag- nosis and next steps would be. Resolution of the case is described on the next page.

The patient is a 14-year-old who took a fall two hours prior to presenting to the urgent care clinic. The left ankle is swollen and unable to bear weight, but the patient is otherwise  healthy. 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.