Clinical Challenge: October, 2007

The patient is a 52-year-old tourist who presents with a four-day day history of abdominal pain, constipation, not passing gas, and nausea. The patient was not comfortable but was hemodynamically stable. Temperature was normal, pulse was 94, BP was 195/99. The abdomen was markedly distended. WBC was 11. View the x-rays taken (Figure 1 and Figure 2) and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

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Clinical Challenge: September, 2007

The patient is a 10-monthold child who presents, with the parents upon referral by the pediatrician, with a history of three days of pain, but no history of trauma. The child refuses to stand, presumably due to pain, and resists crawling. 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.

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Clinical Challenge: May, 2007

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 …

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Clinical 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.

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Clinical 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 …

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Insight in Images – Clinical Challenge: Case 2

A 53-year-old female presents after experiencing a fall with a blow to the knee several hours earlier. Upon examination, you find: No fluid in the knee The knee is stable Patient is able to put weight on the affected knee Mildly decreased range of motion due to generalized pain in the area (though not over the patella) View Figure 1, take these findings into account, and consider what your next steps would be. Resolution of …

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