Neck Rash on a 21-year-old Male

Neck Rash on a 21-year-old Male

Urgent message: Acanthosis nigricans has a strong association with obesity and insulin resistance. Assessment involves a thorough physical exam to differentiate from other dermatosis, as well as full workup for insulin resistance. Early diagnosis in the urgent care setting, and treatment, will improve the appearance of acanthosis nigricans, but also the patient’s overall morbidity. Shailendra Saxena, MD, PhD and Bao Chau Nguyen, BS Introduction A 21-year-old Caucasian male presented for a circumferential hyperpigmented rash around …

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Palatine Mass: Physiologic or Pathologic?

Palatine Mass: Physiologic or Pathologic?

Urgent message: Urgent care physicians often encounter patients with masses in the mouth. If they are aware of the existence of toripalatinus and know how to treat them, they can reassure patients who may mistake this benign, congenital bony growth for cancer. JOSHUA WILSON, MS3, and SHAILENDRA SAXENA, MD, PhD Introduction Urgent care and primary-care physicians often must evaluate masses within the mouth. These masses commonly originate from the submandibular or sublingual gland, but a …

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Fracture of the Penis with Urethral Rupture

Fracture of the Penis with Urethral Rupture

Urgent message: Failure to diagnose and, if necessary, repair penile fracture can result in devastating consequences such as stricture, fistula, and long-term voiding difficulty. TAYT ELLISON, MS-3, SHAILENDRA SAXENA, MD, PhD, LAURA KLUG, PharmD, and SANJEEV SHARMA, MD Although penile trauma is not a common presentation in the urgent care setting, it is under-reported because of embarrassment, as are other injuries related to sexual activity. The urgent care clinician should be prepared to evaluate these …

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Erythema Infectiosum

Erythema Infectiosum

Urgent message: Rashes are common in urgent care and taking a careful patient history is important for proper diagnosis of the underlying cause. ICHHA SETHI, MB,BS, JASKARAN S. SETHI, MB,BS, MIKAYLA SPANGLER, Pharm D, BCPS, and SHAILENDRA SAXENA, MD, PhD Introduction Physicians in both primary care and urgent care clinics encounter facial rash quite frequently. Given the high prevalence and variable number of etiologies, it is important to diagnose these patients appropriately so that they …

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Schamberg’s Disease

Schamberg’s Disease

Urgent message: No definitive treatment is available for this condition but diagnosis is important to reassure patients and avoid unnecessary care. SHAILENDRA K. SAXENA, MD, PHD, MIKAYLA SPANGLER, PHARMD, BCPS, and ARCHANA MIKKILINENI, MD Rashes are a common reason for patients to present to the urgent care clinic. Many require treatment but some do not. Schamberg’s disease is one such rash. Case Presentation A 42-year-old male presented to our clinic with a chief complaint of …

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Perichondritis

Perichondritis

Urgent message: With the popularity of piercing of the ear cartilage, urgent care providers need to be on the alert for perichondritis and to treat it promptly. SHAILENDRA K. SAXENA, MD, PHD, and MIKAYLA SPANGLER, PHARM D, BCPS Case Presentation A 26-year-old female presented with complaints of a swollen right pinna for 2 weeks. The swelling progressively worsened over time. In addition, she also complained of severe pain of the right pinna, with an intensity …

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An Urgent Care Approach to Low Back Pain

An Urgent Care Approach to Low Back Pain

Urgent message: To better evaluate and treat patients with low back pain, urgent care providers need a good understanding of the anatomy of the back and they must be vigilant for “red flags” that signal a potentially serious condition. SHAILENDRA K. SAXENA, MD, PHD, MIKAYLA SPANGLER, PHARM D, BCPS, and SANJEEV K. SHARMA, MD, MBA Introduction Acute low back pain is a common condition often seen by urgent care providers. An episode of acute low …

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Case Report: Stye or Chalazion?

Urgent message: Patient discomfort, inconvenience, and concerns—warranted or not—over possible vision loss make it essential for the urgent care clinician to quickly distinguish between benign conditions and those requiring referral, and to be able communicate clearly with the patient. By Eric Langerman, medical student, Colleen Czerniak, pharmacy student, Mikayla Spangler PharmD, Shailendra Saxena, MD, PhD Any ocular pathology can be distressing to the patient, as such conditions can often disrupt activity and even provoke concern …

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Promethazine-induced Tissue Necrosis: A Case Presentation

Promethazine-induced Tissue Necrosis: A Case Presentation

Urgent message: Due to versatility, the urgent care clinician will find promethazine an appropriate choice in many situations. Awareness of potentially serious side effects maximizes the chance of good outcomes while minimizing risk. Shailendra Saxena, MD, PhD, Naureen Rafiq, MD, Liji George, MD, Cara Olsen, PharmD, and Mikayla Spangler, PharmD Introduction Promethazine (Phenergan) is a drug commonly prescribed in emergency departments and urgent care clinics for treatment of a variety of conditions (Table 1). Because …

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Case Report: Upper Extremity Deep Venous Thrombosis – Paget-Schroetter Syndrome

Urgent message: Vigilance for risk factors and diagnostic methods related to Paget-Schroetter syndrome in patients presenting to urgent care with relevant risk factors is essential to initiating therapy on site and timely referral to a hospital and/or vascular surgeon. Darshan Shah, MD, Shikhar Saxena, MD and Shailendra Saxena, MD, PhD Introduction Upper extremity deep venous thrombosis (UEDVT) is estimated to constitute 1% to 4% of all cases of deep venous thrombosis (DVT).1 The incidence may …

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