UMEM Clinical Pearls

Awesome visual pearls, perils and pitfalls from the University of Maryland Emergency Medicine gurus especially + Haney Mallemat (@criticalcarenow). See also…

ScenarioUMEM LinkKeywords
19 year-old male presents with L ankle pain and obvious deformity after jumping out of a window and landing on his inverted foot. What's the diagnosis?UMEM Pearl 001ankle, subtalar, dislocation, limp
An alcoholic patient presents with a cough, fever, and very foul smelling breath (worse than usual)UMEM Pearl 002Lung abcess, respiratory, CXR
68 yo man presents with new-onset seizures. What is your differential diagnosis?UMEM Pearl 003CT, head, ring enhancing, lesion
67 yo male presents with burning substernal chest pain; worse with meals and when supine. What's the diagnosis?UMEM Pearl 004hernia, GERD, GORD, HH, hiatus
26 year old male with pain when he extends his 4th finger as well as swelling of that digit.UMEM Pearl 005hand, finger, infection, tenosynovitis
14 year-old male presents with right-sided testicular pain. What's the diagnosis?UMEM Pearl 006testicle, pain, torsion, ultrasound
24 year-old male presents following fall from a scaffolding and complains of wrist pain. Diagnosis?UMEM Pearl 007hand, wrist, scaphoid, lunate, dislocation
35 year old male with sudden onset of abdominal pain. Diagnosis?UMEM Pearl 008pneumonperitoneum, x-ray
28 y.o. male felt his left knee "pop" after landing from a jump while playing basketball. Knee exam revealed limited knee extension. X-ray is shown. Diagnosis?UMEM Pearl 009Patella Alta secondary to Patellar tendon rupture, knee, x-ray
20 year old female complains of ‰ÛÏitchy‰Û rash to her foot x 1 week and recently the rash has spread to her other other foot and both hands (shown below). No past medical history, no fever or chills, no mucus membranes involvement, no new medications, no tick bites, no travel. She is also 16 weeks pregnant. What‰Ûªs the diagnosis?UMEM Pearl 010STD, infectious disease, dermatology, syphilis
23 year-old male fell off porch while intoxicated. The head CT is shown below. Diagnosis?UMEM Pearl 011pneumocephalus, CT head, fracture, skull
64 year old male with emphysema and stage 4 lung cancer presents in respiratory distress. What's the diagnosis?UMEM Pearl 012Pneumothorax, bullae, CXR, chest, lung ca
60 year old male with 6 months of weight loss and recent epistaxis. Diagnosis?UMEM Pearl 013SVC, obstruction, vascular, obstruction
9 year-old boy with sudden onset of unilateral facial swelling. What‰Ûªs the diagnosis?UMEM Pearl 014Parotitis, mumps, bacterial, viral
72 year-old man, one-week post right fem-pop bypass presents with painful blue and black toe. Diagnosis?UMEM Pearl 015Blue-Toe Syndrome, Emboli, Vascular, infective
5 year-old male with developmental delay presents with intractable non-bloody and non-bilious vomiting over 10 days; bowel movements are normal. Four weeks ago he was placed in a hip-spica cast following a motor vehicle crash. Abdominal x-ray is below. Diagnosis?UMEM Pearl 016CAST syndrome, x-ray, Superior Mesenteric Artery Syndrome
50-year-old diabetic female s/p foot burn several weeks ago, now presenting with pain and discharge from a poorly healing wound. Diagnosis?UMEM Pearl 017Osteomyelitis, diabetic foot, x-ray
19 year-old male s/p high-speed MVC with hypotension and diminished breath sounds on left. Diagnosis?UMEM Pearl 018diaphram rupture, trauma, chest x-ray
A 50 year-old patient presents after a self-inflicted eye injury. The patient had taken some type of needle and inserted it into their eye. What is the diagnosis and what complications might result?UMEM Pearl 019eye, penetrating trauma, needle, ocular, endophalmitis
26 year old male presents s/p basketball dunk. Diagnosis?UMEM Pearl 020talar dislocation, ankle, x-ray, trauma
Patient presents with right-sided chest and shoulder pain.... What's the diagnosis?UMEM Pearl 021Herpes Zoster, rash, vesicles, shingles
79 y.o. male lung cancer patient with tachypnea, tachycardia, and normal blood pressure.UMEM Pearl 022Right ventricular (RV) dysfunction, ultrasound, submassive pulmonary embolism
13 year-old right-hand dominant male following assault with blunt object. Diagnosis?UMEM Pearl 023Monteggia fracture, x-ray, trauma
34 y.o. male with history of IVDA (intravenous drug abuse) complains of fever, chills and cough. Diagnosis?UMEM Pearl 024IV drug use, lung abscess, CXR, chest x-ray, CT
48 year old male following 15 foot fall onto both feet. What is the diagnosis? ‰Û_and why is it called the ‰ÛÏLover‰Ûªs Fracture‰Û?UMEM Pearl 025Calcaneus fracture, trauma, lover's fracture, x-ray, Bohler's angle
49 y.o. female on Trimethoprim/sulfamethoxazole presents with rash and oral mucus membrane lesions. Diagnosis?UMEM Pearl 026Steven-Johnson Syndrome, rash, drug
13 y.o. with shoulder trauma (during basketball game). Arm held in adduction and exquisite scapular tenderness. Diagnosis?UMEM Pearl 027Scapular fracture, x-ray, shoulder, trauma
A 20 year-old female presents with bilateral neck pain that occurred at rest. No other complaints. See if you can find the subtle clue on the x-ray...UMEM Pearl 028Pneumomediastinum, subcutaneous emphysema, x-ray, chest
13 y.o. female with ankle pain following fall down escalator. What's the diagnosis? (Hint: Look very closely)UMEM Pearl 029Tri-plane ankle fracture, x-ray, trauma
50 yo female s/p motor vehicle crash. Diagnosis?UMEM Pearl 030PneumomediastinumåÊfrom pneumothorax, chest x-ray
70 yo female from nursing home with fever. RUQ ultrasound is shown below. Diagnosis?UMEM Pearl 031Acalculous Cholecystitis, ultrasound
Patient presents with the following X ray after yawning. Diagnosis?UMEM Pearl 032mandibular dislocation, x-ray
60 y/o male transferred from local rehab facility c/o abdominal pain.UMEM Pearl 033Ogilvie's syndrome, x-ray, Acute colonic pseudo-obstruction (ACPO)
25 year old male presents after falling from 10 feet and landing on right shoulder. Diagnosis?UMEM Pearl 034Glenoid Fossa Fracture, shoulder dislocation, scapula, x-ray
65 yo female with breast cancer presents with dyspnea and CXR shown below. Diagnosis? Can anything help clarify the diagnosis?UMEM Pearl 035ung, ultrasound, pneumonia, hepatization, sonogram, air bronchograms
24 yo woman presents with syncope, abdominal pain, and normal menses 4 days prior. Urine HCG(+) and quantitative beta-HCG is 1300 with the transvaginal ultrasound seen below. Diagnosis?UMEM Pearl 036ultrasound, ectopic, free fluid, hypotension, pregnancy
50 year-old s/p fall.....what's the diagnosis?UMEM Pearl 037Luxatio Erecta, shoulder, x-ray, inferior glenohumeral dislocation
What's wrong with this picture? (Don't scroll too far down)UMEM Pearl 038boxer's, fracture, orthopedics, hand, brawler's, radiology, xray

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