Case of the Month

Persistent oral bleeding after toothbrushing

Lauren Neighbors, John L. Abt, DO, FACEP; Joyce Wagner, MCMS, PA-C May 16, 2012

A middle-aged woman experiences persistent gum bleeding after brushing her teeth, accompanied by foul breath.

Dullness to percussion over the right lung base

Monique Beyerle, MPAS, PA-C, AT-C April 27, 2012

This elderly man's phlegm- and blood-producing cough and chest pain were a cause for concern.

An aggressive necrotic skin lesion

Benjamin Kaska, Christopher P. Forest, MSHS, PA-C April 18, 2012

A chemical burn suffered more than 3 decades ago is the underlying cause of a multinodular mass with central erythema.

Right lower quadrant pain in a middle-age woman

Captain James E. Andrews II, DSc, EMPA-C March 21, 2012

A patient with a history of hysterectomy and a family history of ovarian cancer complains of increased abdominal girth, early satiety, periodic postprandial emesis, and bloating.

Increasing hip pain in an elderly woman

Scott Walton, PA-C February 22, 2012

Incapacitating pain and decreased range of motion sideline a previously healthy, active, and independent elderly patient.

Intermittent, longstanding bilateral mastalgia in a 35-year-old woman

Cynthia Bunde, MPAS, PA-C, Bernadette Howlett, PhD, Nicholas Ogami; Rebecca Hall January 25, 2012

This patient's breast pain was severe when she was in cold environments but resolved in warm environments.

Lingering knee pain in a young football player

Carol von Michaelis, PA-C December 23, 2011

The earliest symptoms were mild swelling and minor instability first diagnosed as knee strain, but continuing pain demanded consultation with a pediatric orthopedist.

An unusual presentation in an elderly man

Lara M. West, RPA-C November 23, 2011

Nocturnal abdominal and right-sided shoulder pain signal a life-threatening condition in a patient whose history revealed tell-tale clues.

Spearlike chest pain and vomiting in a morbidly obese patient

Monica Buzzetta, PA-C, MHS October 27, 2011

After taking a laxative in preparation for a colonoscopy, a woman with a number of medical problems experiences troubling symptoms.

Profuse left-sided epistaxis and spiderlike lesions on a 66-year-old male

Jason C. Fowler, MPAS, PA-C, Peter F. White, MD, FRCS September 28, 2011

A man with a history of bleeding experiences has a number of strange lesions on the fingers, cheek, and tongue.

What caused this mucosal diarrhea?

Angie Tsiaras, PA-C August 25, 2011

A patient presents to determine the cause of her abdominal cramping and the mucous and pink-red streaks in her stool.

Vaginal bleeding, suprapubic cramping, and blood clots in a female patient

Kelly K. Devine, PA-C, Michael H. Stella, MD; Ali S. Raja, MD, MBA, MPH July 26, 2011

A patient with a history of two cesarean sections and one therapeutic abortion presented after she passed several small blood clots and experienced cramping over the past hour.

Jaundice, fatigue, and intermittent abdominal pain in a teenager

Heather Trant, MPAS, PA-C June 17, 2011

A teenager experiencing worsening fatigue, jaundice, darkened urine, and vague intermittent abdominal pain presented for evaluation.

Extreme swelling and unusual symptoms in an African woman's finger

Heather Carlson, MSPAP, PA-C May 25, 2011

A 28-year-old female presents with a markedly enlarged finger accompanied by excoriation and yellow discharge.

Intermittent headaches relieved by lying down

Jason C. Fowler, MPAS, PA-C, Mark Casteel, MD; Peter White, MD April 29, 2011

The patient was growing depressed that attempts at pain relief, including therapy for migraine headache and chiropractic care, failed to relieve her month-long symptoms.

Altered mental status and heroin use in a teenage male immigrant

Mandy E. Thompson, PA-C April 15, 2011

A young male is brought in by friends for evaluation of his confused mental state and vomiting, which they claim is due to excessive partying.

What is the cause of this floater in a patient's eye?

Major Shawn T. Buller, APA-C, MPH March 15, 2011

A US Army helicopter pilot deployed in Iraq presents with a troubling loss of peripheral vision and describes seeing a crescent-shaped black spot.

Swelling of the eye and light sensitivity in a patient struck in the face by a wakeboard

Erin Mucker, Michael Suprenant; Barbara Piccirillo, MS, RPA-C, DFAAPA February 25, 2011

The patient brushed off the mishap until friends noted ocular swelling and drooping of the right eyelid.

Progressive paresthesias and pain in the extremities, chest, and abdomen following a seizure

Jason G. Homer, PA-C February 16, 2011

Two weeks after a grand mal seizure, a male patient presents to neurology with numbness, posterior neck pain, and trouble with balance.

A 52-year-old woman reports right upper quadrant pain, weakness, and fever

Kishore Kuppasani, MS, MPA, PA-C, Smita Mahendrakar, MD January 28, 2011

Wide-ranging symptoms were difficult to connect until a leaky basement provided the telltale clue.

A female patient with shortness of breath at rest and fluid retention

Cynthia Cawley, PA-C, MPM, Srinivas Murali, MD January 28, 2011

A patient with a history significant for pulmonary arterial hypertension presents with shortness of breath and jugular venous distention.

Previously healthy man is afflicted with dyspnea, weight gain, and orthopea

Matthew J. Graziano, MPAS December 28, 2010

A man who had frequent contact with animals reported the recent development of respiratory symptoms and signs of heart failure.

A adolescent experiences difficulty focusing, mood swings, and insomnia

Brian T. Maurer, PA-C December 24, 2010

A 15-year-old male's ADHD medications seem to worsen his anxiety and other existing symptoms.

Persistent hiccups prompt closer examination

Natalie R. Nyren, PA-C November 26, 2010

A homeless male patient is brought in by a roommate for evaluation of persistent hiccups and vomiting.

What caused this patient's blurred vision?

Robert Brach, PA-C November 04, 2010

Visual disturbance is the only clue to an uncommon diagnosis that raises patients' risk of other, serious disorders.

Persistent burning pain in the upper middle abdomen

Phillip Todd Smith, MHS, PA-C, MT(ASCP) October 29, 2010

A patient presents with a 3-month history of burning epigastric pain. CT and PET scans help identify the cause.

Left upper-quadrant abdominal pain in a geriatric female

Willard R. Baker, Jr, MS, PA-C October 07, 2010

Sudden onset of left upper-quadrant abdominal pain creates confusion in an elderly woman.

A 71-year-old woman with severe lower back pain and abdominal cramping

Monique Beyerle, MPAS, PA-C, AT-C September 24, 2010

A 71-year-old female presents with complaints of persistent severe back pain, abdominal cramping, and nausea.

Wheezing that is not asthma in a 4-year-old child

Tracey Reeve, MS, PA-C August 27, 2010

The mass seen on the chest film provided the first key to this relatively rare diagnosis.

Heartburn and abdominal pain in a patient with a history of reflux disease

Corri Wolf, PA-C, MS, RD July 30, 2010

Recurring symptoms prompt an important and potentially lifesaving evaluation when a patient runs out of medication.

What is the significance of this patient's pulsatile tinnitus?

Jason C. Fowler, MPAS, PA-C; Barry E. Hirsch, MD; Peter F. White, MD, FRCS June 28, 2010

Symptoms were worse when she tried to sleep, but there was no associated dizziness, vertigo, or otalgia.

Worsening head pain and neurologic symptoms

Heidi Menga, PA-C May 24, 2010

The symptoms were concentrated in the patient's head and scalp, but the diagnosis involved a different and unexpected location.

Vomiting and apparent discomfort in an 11-month-old girl

Michelle Jacobs, RPA-C April 26, 2010

The baby's physical reaction to her symptoms led to the diagnostic imaging that identified the problem.

Disfiguring and disabling growth is seen in an existing mass

Meredith Beaty, MS, RPA-C; Nicholas Martella, MS, RPA-C; Scott Baker, MHA, RPA-C; James O’Connor, MD March 23, 2010

A patient presents with a large cutaneous mass on her buttock. It was first noticed years earlier but had recently grown significantly.

A very abnormal ECG in a relatively healthy person

Rami N. Khouzam, MD, FACC, FACP, FASNC February 23, 2010

An ECG obtained during the routine physical of a healthy, active man indicates serious heart disease.

What could be causing this woman's abdominal pain and constipation?

Corri Wolf, PA-C, MS, RD January 26, 2010

Imaging studies and key laboratory test results help identify the cause of this patient's GI pain and altered bowel habits.

Unexplained hypertension and hypokalemia in a young man

Tom Vascik, MS, PA-C December 22, 2009

The patient's recent behavior and lack of sympathomimetic symptoms hide the cause of his presenting conditions.

A 2-week history of painful urination

Jodi Welt, MA, RD, PA-C; Ellen D. Mandel, DMH, PA-C November 24, 2009

An otherwise healthy 6-year-old boy presents with nonspecific abdominal pain. Recent voiding behaviors were the most definitive clues to this diagnosis.

Persisting shin tenderness and erythema

David M. Alden-St. Pierre, MS, PA-C October 20, 2009

This patient experienced shin pain after a long walk. The next day, an ankle sprain was diagnosed. The clue was in his medical history of thyroid cancer.

Cough steadily increases in severity

Michael D. Jacobson, MSHS, PA-C September 22, 2009

A student reports a progressively worsening cough that comes in spasms and is accompanied by a choking sensation and an inability to catch his breath.

Persistent malodorous breath in a youngster

Rene Frasher, DHSc, PA-C August 21, 2009

A young boy has multiple episodes of foul-smelling breath so severe that he is ridiculed at school. After 5 months and several rounds of antibiotics, the cause emerges.

Episodes of severe dyspnea

Tyson Parker, MPAS, PA-C July 17, 2009

A 73-year-old nonsmoker complains of fatigue and dyspnea so severe that he has to rest when walking from his car to his house and sit up on the edge of the bed to breathe.

Midline lingual lesion

Jason C. Fowler, MPAS, PA-C; Peter White, MD, FRCS June 23, 2009

A middle-aged man presents with a partially flattened, erythematous, painless lesion on the dorsum of his tongue.

Dyspnea, cough, and fever following chemotherapy for Hodgkin lymphoma

Michele Taffaro-Neskey, PA-C May 22, 2009

A patient who was treated for Hodgkin disease develops obstructive/restrictive lung disease and a reduced ejection fraction.

A burning leg pain worsens over a span of years

R. Dennis Rieke Jr, PA-C April 20, 2009

For this older patient with pain radiating from the lower back into the right leg, walking more than 500 feet dramatically increased the pain and triggered severe numbness and tingling in both legs.

Unexplained ptosis of the left eyelid in a 59-year-old woman

Jill Gore, MPAS, PA-C March 11, 2009

A 59-year-old white woman, with a history of small cell lung cancer presented to her oncologist complaining of a drooping left eyelid for two days.

A pregnant woman with persistent headaches and seizures

Hilary D. Sugar; Denise Rizzolo, PA-C, PhD February 20, 2009

A 21-year-old Hispanic woman, 29 weeks pregnant, presents to the emergency department with a persistent headache and subsequent seizures. Her headache began 1 week earlier with pain predominantly on the right temporal side and was associated with blurry vision.

A middle aged woman with shortness of breath

Kate August, PA-C, MMSc January 01, 2009

A 54-year-old woman presented to the emergency department complaining of shortness of breath, fatigue, and nausea. She stated that for the past 4 days, she had noticed progressive shortness of breath, especially on exertion.

Longstanding anterior pelvic pain

Chris A. Webb, MS, PA-C; Matthew L. Jimenez,MD December 01, 2008

The patient is a 74-year-old white woman who presented with complaints of longstanding anterior pelvic pain over the symphysis pubis. She reported a baseline dull and aching pain but experienced sharp, stabbing sensations at the pubic symphysis when performing benign activities such as rising from a seated position or getting in and out of her car.

Falling unconscious at home

Bradley W. Orville, PA-C, PhD November 01, 2008

The patient is a spry, 79-year-old retired dentist who presented to the emergency department (ED) via emergency medical services (EMS) with an unwitnessed episode of passing out at home.

A 28-year-old male with a history of mild psoriasis

Michelle Jacobs, RPA-C October 01, 2008

A 28-year-old male with a history of mild psoriasis (fewer than two flares a year) and tobacco abuse (1 pack of cigarettes per day for 12 years) presented to the orthopedist for evaluation of pain in the left wrist. He reported that he had experienced episodic pain in this wrist since the age of 18 years. He denied any traumatic events.

A sudden onset of chest pain

Irum Ziauddin, PA-C; Artika Patel Loganathan, PA-C September 01, 2008

The patient is a 61-year-old hospitalized male who experienced sudden onset of chest pressure and mild shortness of breath while lying in bed. He described the pain as substernal chest pressure or tightness with radiation to the left arm.

A history of throat pain and fever

Gregory K. Wanner, MS, PA-C August 01, 2008

A 16-year-old female presented to the emergency department (ED) with a 3-day history of sore throat, fever, and malaise. She had discomfort in swallowing solid foods but was able to tolerate fluids

Attention and concentration issues after brain tumor resection

Lloyd A. Taylor, PhD; Reamer L. Bushardt, PharmD, PA-C; Tanya M. Jones, MD July 01, 2008

A 17-year-old white female exhibited difficulties with attention and concentration, low frustration tolerance, and symptoms of depression including anhedonia, tearfulness, and sleep problems.

Increasing lower back pain prevents walking

Jennica E. N. Cornine, PA-C June 01, 2008

The patient is a 51-year-old female who presented to the emergency department with a 1-month history of progressive lower back pain that had worsened. She was now unable to walk. She rated her pain as 10/10.

A 3-month history of menstrual cycle problems

Julie A. Gurwell, PhD, PA-C May 01, 2008

The patient is a 38-year-old woman who presented to clinic with a 3-month history of missed periods. She had been taking oral contraceptives (OCs) for the past 2 years to regulate her menses, which had become consistent at every 28 days. Without consulting a health care provider, she had discontinued the OCs. The patient understood that the return of her periods might be delayed but was now concerned.

Nodule formations on the hands

Marie B. Wiles, MHS, PA-C, Marie B. Wiles April 01, 2008

The patient is a 47-year-old white male who presented to our clinic for medication refills. His medical history was significant for type 2 diabetes, hypertension, hyperlipidemia, and chronic back and joint pain. His medications included rosuvastatin (Crestor), valsartan (Diovan), folic acid, metformin, pentoxifylline (Trental), amitriptyline,carbamazepine (Tegretol), and methotrexate.

Chest pain combined with other symptoms

Marie B. Wiles, MHS, PA-C March 01, 2008

The patient is a 62-year-old white female who presented to our clinic with chest pain, indigestion, and diarrhea. She was not physically active, and she resided in an adult home for the mentally impaired.

A painless but worsening foot rash

Wilton Kennedy, MMSc, PA-C February 01, 2008

A 22-year-old white male presented to his primary care provider with a rash on the bottom of both feet. In the morning, the skin was white and dry, but by the evening the skin had a wet and "crumpled" appearance.

Worsening, intermittent chest tightness in a 74-year-old woman

Denise Rizzolo, PA-C, PhD, Stanley C. Parman, MD, FACEP January 01, 2008

A 74-year-old woman presented with a 5-day history of chills, head congestion, sinus tenderness, sore throat, and a productive cough with yellow-colored sputum.

An 8-day history of severe dysphagia

Amelia Mohabir, RPA-C December 01, 2007

The patient, a 66-year-old female, presented to the emergency department with an 8-day history of severe dysphagia. She reported that the dysphagia was intermittent but worsened after she administered ciprofloxacin (Ciloxin) eye drops, prescribed for bacterial conjunctivitis 2 days ago.

A troubling radiograph follows a history of respiratory infection and long-term cough

Nancy Stasik PA-C, MPAS November 01, 2007

A 56-year-old white male was referred to our clinic for further evaluation of right-sided lymphadenopathy and a suspicious finding on a chest radiograph. Previously the patient had an upper respiratory infection and a resultant nonproductive cough. The cough became progressively worse and produced green-yellow sputum.

Unexplained extremity weakness and neck pain increase over 2-year span

Frank S. Eisinger, PA-C October 01, 2007

The patient is a 27-year-old female who presented with progressive neck pain and extremity weakness. She described the pain as a constant, dull ache that radiated to her shoulders (the left more than the right). The patient also complained of progressive weakness in her left arm and both legs and of numbness in her left arm.

Episodes of tachycardia with an ironic cause

James F. Cawley, MPH, PA-C, Joel Hill, MS, PA-C September 01, 2007

A 47-year-old woman presented with increased exertional heart rate of a few months' duration. She was a coffee drinker and initially attributed the tachycardia to her caffeine intake. However, avoiding caffeine did not resolve her symptoms. The patient was told that the results of a thyroid panel ordered by another clinician a few days earlier were within normal limits.

Intense abdominal pain follows nausea and vomiting

Daniel L. O’Donoghue, PA-C, PhD, D. Shane Harper, PA-C, MPAS August 01, 2007

A 23-year-old white male presented to a rural emergency department (ED) with a chief complaint of abdominal pain. He was seen in the ED 12 hours earlier with nausea and vomiting.

Blurred vision after a flu-like condition

Amy M. Klingler, MS, PA-C, Amber G. Harper, BS; Melissa D. Lilly, BS, MSPA, PA-C July 01, 2007

A 28-year-old white female presented to her primary-care provider complaining of flashes in her right eye that had started after a flulike illness and a tension headache that had lasted for 2 weeks.

An older man restricts his activities due to new-onset dizziness

Bonnie Nelson Wells, PA-C June 01, 2007

The patient is an 88-year-old white male who presented with a complaint of new-onset dizziness so severe that it caused him to limit his activity. He was spending more and more time in his independent living apartment out of concern that the dizziness would recur and he would fall and injure himself.

Pain and swelling re-occurs at gunshot wound site

Jeffrey L. Spivey, MPAS, PA-C; Maj. John R. Chance, MD; Lt. Col. John J. Faillace, MD, FAAOS May 01, 2007

The patient is a 17-year-old male who sustained an accidental, small-caliber gunshot wound to his left hand 6 weeks ago. Sudden onset 2 days ago of pain, swelling, and warmth in the palm of the injured hand prompted this visit.

A complaint of hourly diarrhea and severe abdominal pain

Lt. Stefan C. Hamelin, PA-C, MPAS April 01, 2007

The patient is a 63-year-old woman who arrived at the emergency department complaining of a 5-day history of diarrhea and increasing abdominal pain.

Increasing knee pain prevents walking

Elana A. Min, MMS, PA-C, Chris Webb, MS, PA-C; Suzanne Okolita, MS, PA-C March 01, 2007

The patient is a 45-year-old Hispanic man with type 2 diabetes who presents to the ED complaining of severe pain, swelling, and erythema in both knees. The pain has become unbearable to the point where he cannot walk.

Fever, diarrhea, and vomiting—a case of the flu or something more?

Denise Rizzolo, PA-C, PhD February 01, 2007

A 56-year-old woman presents to the urgent care clinic believing she has a stomach virus or the flu. She had episodes of diarrhea, vomiting, and headache with fever and chills.

A migrant fieldworker presents with a scaly, painful rash on his trunk

Elana A. Min, MMS, PA-C, Erica B. Lundsten, PA-C; A. Maureen Bundick Morgan, PA-C; Richard Andrews, MD January 01, 2007

The patient is a 23-year-old Hispanic migrant fieldworker who presents with a painful rash on his limbs, trunk, and face.

A routine ECG reveals new-onset bradycardia in an elderly man

Justine Isabel, PA-C; John C. Champion, MD December 01, 2006

A 70-year-old man presents to his primary oncologist to consider new chemotherapy to treat relapsed chronic lymphocytic leukemia. During the assessment, a routine ECG reveals new-onset bradycardia. The patient is sent to our cardiology clinic for further evaluation. In our clinic, he describes a 1-day history of increasing exertional dyspnea, fatigue, bilateral flank pain, and dark tea-colored urine. He denies nausea, vomiting, chest pain, fever, or syncope.

A chemist tests positive for bilirubinuria

Audrey Griffin, MPAS, PA-C November 01, 2006

A 54-year-old man presented to his PCP for an annual physical examination, which showed him to be in good health. However, results of a urine dipstick analysis indicated 3+ bilirubin.

Increasing pain after a child's knee injury

Thomas V. Gocke, MS, ATC, PA-C October 01, 2006

An 11-year-old boy was referred to our orthopedic practice after injuring his left knee at football practice. The patient explained that he was hit from behind and fell on his flexed knees.

Pain and edema in the patient's knee causes some difficulty walking

Steve Saunders, PA-C September 01, 2006

The patient is a 69-year-old man who presented to our office with a 2-week history of pain and swelling in his left knee. These had worsened during the past week, making it difficult to walk, climb stairs, and flex the knee. The patient works on a golf course in southwestern Connecticut and reports no history of trauma. He denies any fever, chills, sweats, or tick bites.

A teenager displays differing pupil sizes

Shane Harper, PA-C, MPAS August 01, 2006

The patient is a 14-year-old girl who presents to the emergency department (ED) complaining of a "problem with her right eye." Her father noticed that her pupils were different sizes prior to coming to the ED.

Radiograph shows a patchy infiltrate in the right perihilar region

Rhonda Rotert, MPAS, PA-C July 01, 2006

The patient is a 19-year-old Indonesian man. He claimed to have a history of a positive purified protein derivative (PPD) test.

Limited right wrist mobility and secondary shoulder pain

Celestino Vega, MD, FAAFP; Angela Austin-Leyva, PA-C June 01, 2006

The patient is a 67-year-old white man presenting with a 3-day history of difficulty moving his right wrist to full extension; he also cannot extend his fingers of the same hand.

A 14-year-old girl presents with persistent head pain

Nicholas J. Feison, MPAS, PA-C May 01, 2006

The patient is a 14-year-old girl who presented to the emergency department (ED) with a complaint of a headache for 2 weeks. A week earlier, the adolescent had seen her family physician, who prescribed cefadroxil (Duricef) for sinusitis. The patient had a scheduled follow-up visit the next morning but came to the ED because she could not take the pain any longer.

Sharp pain and edema in the wrist after a hockey injury

Elana A. Min, MMS, PA-C, Gary Sakryd, MS, ATC, PA-C; Ryan Wolf, MS, CSCS; PA-C April 01, 2006

The patient is a 39-year-old man who presented to the clinic, after evaluation in the emergency department (ED), with pain in the left wrist. He had suffered a blunt injury to the left distal radius while playing hockey; the thumb side of his left wrist had struck the goal post while he was attempting to score. He had instant sharp pain and swelling along his distal lateral radius. Evaluation and radiographs in the ED were consistent with a distal radial styloid fracture. At presentation, one day after the injury, his pain measured 6 out of 10, with moderate swelling at the site of injury.

A night-time episode of syncope in a young man

Alex Shalshin, MD, MS, PA-C; Ronald Lo, MD Erich Fogg, PA-C, MMSc, Department Editor March 01, 2006

The patient is a 21-year-old male who experienced a nonwitnessed episode of syncope that resulted in a chin laceration. He was visiting his girlfriend's parents, and after dinner with the family he retired to his room. He woke up to urinate at 2 AM, approximately 4 hours after falling asleep. The syncope occurred as he was making his way up the stairs; he regained consciousness surrounded by members of the family, who were awakened by the noise. The patient denied using alcohol or drugs, or any other activity that could have precipitated this event.

A change in a thumbnail points to a deeper, more serious cause

Shirley M. Seaman, MSA, PA-C; J. Mark Melhorn, MD February 01, 2006

The patient is an 80-year-old white man who was referred by his primary care physician to the orthopedic surgery clinic at the end of December 2003 for evaluation and treatment of his right thumbnail, which was splitting and discolored. Symptoms began in April 2003 with a split nail.

A hospital visit leads to investiagtion of a chest wall mass

Erin O’Branski, MHS, PA-C January 01, 2006

The patient is a 30-year-old Hispanic woman who presented to our clinic for evaluation of a chest wall mass. The mass was noted when she was hospitalized 1 month earlier for a cesarean section and the patient stated that the mass had been present since she was a child.

Progressively worsening arm pain in a 15-year-old

Damian Cabrera, MPH, PA-C December 01, 2005

The patient is a 15-year-old male who was referred to our clinic for evaluation of a recently discovered humeral lesion. The patient described a 1-month history of right proximal arm pain 2 weeks before.

A PA experiences a nonproductive cough and wheezing, followed by visual disturbance

Christopher Hanifin, MSPA, PA-C; Garikiparthy Jyothirmayi, PhD November 01, 2005

The patient is a middle-aged female PA student who developed a nonproductive cough during her surgical rotation. Her physician noted that she was wheezing and started her on an antibiotic, an antihistamine, and prednisone (10 mg twice daily). While the patient was assisting at surgery 3 days later, she noted sudden, painless blurring of central vision in her left eye.

Pelvic pain and vaginal bleeding early in pregnancy

Barbara Piccirillo, MS, RPA-C; Truman J. Milling, Jr, MD October 01, 2005

The patient is a 36-year-old Hispanic woman who presented to the emergency department (ED) with a complaint of first-trimester vaginal bleeding associated with pelvic pain. She described the pain as cramping and nonradiating. The symptoms had started when she woke up that morning and had necessitated the use of one sanitary pad. The patient admitted to urinary frequency but denied dysuria, vaginal discharge, fever, chills, vomiting, or low back or flank pain.

A soldier experiences foot pain aggravated by running

Cpt. Stephen Seward, SP, PT, OCS September 01, 2005

The patient is a 29-year-old soldier who presented with a self-reported "bunion" on his left foot. He was referred to physical therapy (PT) for evaluation by the screening medic. He had ignored the pain until the previous week, when he ran 3 days in a row.

Laura Eldridge, MMS, PA-C; Andrew S. Zelby, MD, FACS August 01, 2005

The patient is a left-handed, 65-year-old Hispanic man, who was referred for consultation by his occupational health clinic after a slip and fall at work. He was complaining of persistent low back and bilateral leg pain. The pain radiated from the low back into the left buttock and down the posterior aspect of the left thigh and calf into the left foot.

Case of the Month

Shylashree Chikkamuniyappa, MD; Jill Uecker, MD July 01, 2005

The patient is a 17-year-old male with a right neck mass. There were no complaints of fever, night sweats, or weight loss. Physical examination revealed a 2-cm mass that was mobile, tender, and firm. The cardiovascular and respiratory examinations were unremarkable. There was no rash, lymphadenopathy, or hepatosplenomegaly.

A 4-week history of worsening hip pain

Edward T. Schuurman, PA-C June 01, 2005

The patient is a 15-year-old overweight white male with a 4-week history of left hip pain. He described the pain as a dull ache in the front and side of his left hip. The pain had gradually worsened over the 4 weeks and was exacerbated by weight bearing. Climbing stairs was particularly painful. At times, the pain radiated to the left knee.