32-year-old male with burning sensation in chest

32-year-old male with burning sensation in chest

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 EKG taken and consider what your diagnosis and next …

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2-year-old boy with Williams syndrome suffers fever and cough

2-year-old boy with Williams syndrome suffers fever and cough

The patient is 2-year-old boy with Williams syndrome who presents two days after a trip to the emergency room for a three-day history of fever, cough, and wheezing. In the ED, the parents report, he received three doses of nebulized albuterol and was diagnosed with reactive airway disease and bilateral otitis media. He was discharged on oral amoxicillin and albuterol MDI. Today, you find he has similar symptoms, plus vomiting. His parents say he vomited …

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2-year-old boy with sudden pain in left leg

2-year-old boy with sudden pain in left leg

The patient is a boy, age 2 years 8 months, who presents with the complaint of pain in the left leg that started five hours ago. There is no history of trauma. On exam, the child looks well and has a temp of 98.96 degrees (axillary) and a pulse of 114. In addition, he has a WBC of 17.7, with 73.7 percent granulocytes. The child\’s leg has no external findings. There is clear pain on …

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35-year-old female catches finger in banister

35-year-old female catches finger in banister

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 right fifth PIP hyperextension and DIP hyperflexion (swan neck deformity). The patient\’s PIP flexion appears to be limited to about 20 degrees, while her contralateral PIP joint shows about 100 degrees of flexion. No sensory or motor deficits are noted. View the x-ray taken and consider what your diagnosis …

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23-year-old male complains of heel pain since slipping down steps

23-year-old male complains of heel pain since slipping down steps

The patient is a 23-year-old male who presents with a complaint of pain in the heel area after slipping down four steps. He is limping but able to bear weight. On exam, you note local tenderness and swelling over the area of the Achilles tendon. Other findings are unremarkable. View the x-ray taken and consider what your diagnosis and next steps would be.

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