November 2014

A 28 year-old commercial realtor comes to your office on Monday morning after spraining his right ankle in a basketball game with friends the preceding Saturday afternoon. He has a swollen right ankle with tenderness inferior and anterior to the lateral malleolus. He is limping but able to apply weight to the injured extremity.

This newborn was found to have these fragile white lesions on the scrotum and extremities along with dark macules on the face. The child was otherwise asymptomatic and the pregnancy was uncomplicated, with no significant medication exposures and no family history of similar lesions.

A 35 year-old man with a history of hypertension, obstructive sleep apnea and obesity presents to clinic with complaints of non-cardiac chest discomfort. He is requesting refills of his blood pressure medications. His insurance changed 6 months ago and he has not had them since. The nurse performs the intake vital signs and reports that the patient has a blood pressure of 280/150 mmHg.