The patient pictured presented with two hours of intense pain and redness along the left side of her head and down her left arm. Though this could easily be mistaken for an infectious process, it was actually reflex sympathetic dystrophy (RSD), also referred to as complex regional pain syndrome (CRPS) type I. By any name, however, this is a rare and poorly understood neurological condition. It may manifest by way of sensory, focal autonomic, or …
Read MoreClinical 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 …
Read MoreClinical 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.
Read MoreClinical Challenge: August, 2007
The patient is a 9-year-old boy who received a blow to the shoulder from a height of approximately 6 ½ feet. He has limited elevation of the arm due to pain. 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 2: June 2007
The patient is a young child with three days of constipation with a non-specific history of abdominal pain. On exam, the child was asleep. The abdomen was easily palpable and soft. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described below.
Read MoreClinical Challenge: June, 2007
The patient is a 15-year-old boy who presents with pain in the wrist 40 minutes after stopping a soccer ball with his hand. There is no snuffbox tenderness. 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 2: May 2007
The patient is a 13-year-old male who presented to urgent care after taking a fall while running; he landed on his outstretched left hand. Upon examination, you find tenderness in the snuff box and observe swelling around the 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: 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 …
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.
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