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Chief Complaint

“I fell while hiking this weekend and now my arm has really a painful blister.”

History of Present Illness

SP is a 36-year-old woman who presents to the emergency room of her local hospital 3 days after falling during a hike and sustaining an injury to her right upper extremity. She has a few scratches on her right lower extremity, but no punctures to the skin, scabs, or blisters. She has been taking acetaminophen 500 mg a few times per day since the fall, but states that it hasn’t helped much. She also states that she washed the wound when she got home with soap and water, but didn’t use hydrogen peroxide or apply any topical antibiotics.

Past Medical History

Seasonal allergies

Surgical History


Family History

Mother with hypertension

Father with diabetes

Maternal grandfather with heart failure

Social History

No illicit drug use

No tobacco use

Occasional alcohol use (2 to 3 times per month)



Home Medications

Ethinyl estradiol and norgestimate (Sprintec), 1 tablet by mouth daily

Fexofenadine (Allegra) 180 mg by mouth daily for allergies

Fluticasone (Flonase) nasal spray, one spray in each nostril twice daily during allergy season

Vitals on Admission

Temp 39.5°C, BP 111/54 mm Hg, P 86, RR 16 breaths per minute, Wt 57.5 kg, Ht 5′5″

Physical Examination


Well-developed, well-nourished appearing Caucasian woman in no acute distress


Right upper arm: red, erythematous, warm, and tender to touch; localized fluid collection that appears fluctuant


PERRLA; EOMI, oropharynx clear

Neck/Lymph Nodes

Supple, no lymphadenopathy


Clear to auscultation, no rales or wheezing


Regular rate/rhythm, no murmurs/rubs/gallops


Soft, NT/ND; (+) Bowel sounds


No observed abnormalities


Upper extremities: erythematous area on RUE with 2 × 3 cm abscess that is painful to touch

Lower extremities: no observed abnormalities


A & O ×3



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