Surprise Abscess Afoot

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Surprise Abscess Afoot - Page #1

Author: Kelsey Chmielewski, DO Senior Editor: Marc Hilgers, MD, PhD, FAMSSM Editor: Marissa Vasquez Machuca, MD, MBA Patient Presentation: A 17-year-old female with no past medical history presents to the emergency department with acute right foot pain and erythema. The pain and erythema are located around the right lateral malleolus. Five days before presentation, the pain started acutely and woke her from sleep. Over the past five days the pain is worsening. There is no clear triggering event, trauma, or injury. History: No past medical history. No home medications. The patient denies any bug or animal bites. She also denies any sexual activity. She has been taking acetaminophen for the pain without much relief. Physical Exam: Temperature: 36.7 C, Heart rate 89, Respiratory rate 16, Blood pressure 122/74, Oxygen saturation 100% on room air General: well-appearing, non-toxic, the patient will not move any of her toes or bear weight on the foot due to pain. She is unable to weight-bear secondary to pain. Musculoskeletal: Inspection: erythema and swelling present around the right lateral malleolus. Palpation: tenderness to palpation of the right lateral malleolus, tenderness while squeezing the toes together, tenderness when squeezing the heel, and hypersensitivity with light touch over the skin of the right foot. Range of motion: Limited flexion of the toes due to pain, full range of motion of the ankle Sensation was intact and there were no lesions or abrasions noted in the area. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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