Brain Abscess in an Immunocompetent Patient: Complex Pathology and Communication

Brain Abscess in an Immunocompetent Patient: Complex Pathology and Communication

Urgent message: Remain diligent in the evaluation of headache; though often a benign condition, the possibility for severe morbidity and mortality warrants careful evaluation of subtle aspects within the history and/or physical exam. INTRODUCTION Headache is one of the most common complaints in the urgent care setting, yet also one that can be daunting for a provider. While there are many benign causes, such as a migraine or tension headache, the potential for an emergent …

Read More
Bullous Pemphigoid Reaction After Second Dose of COVID-19 Vaccine

Bullous Pemphigoid Reaction After Second Dose of COVID-19 Vaccine

Urgent message: Throughout the COVID-19 pandemic, unvaccinated people have shown higher rates of morbidity and mortality in comparison with those who are fully immunized. While most vaccination adverse reactions are mild and self-resolving, it is important to consider the timeline of vaccinations to correlate possible adverse reactions. Amanda dos Santos, MD and Michael Pallaci, DO, FACEP, FACOEP INTRODUCTION The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic continues to affect all aspects of our society and …

Read More
How Useful Is Ultrasound in Diagnosing Ovarian Torsion?

How Useful Is Ultrasound in Diagnosing Ovarian Torsion?

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of abdominal pain, aiding in the diagnosis of intestinal abnormalities, urinary tract infection, and obstetrical and gynecological problems such as suspected ovarian torsion. Andrew Alaya, MD, MSc Introduction Abdominal pain is one of the most common complaints among women of childbearing age who visit urgent centers. Urinary tract infection, diarrhea, constipation, acute viral gastroenteritis (AGE), pelvic inflammatory disease (PID), and dysmenorrhea are the …

Read More
A Case of Late-Onset Diabetes

A Case of Late-Onset Diabetes

Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …

Read More
A 20-year-Old Female with Chest Pain and SOB

A 20-year-Old Female with Chest Pain and SOB

Urgent message: Urgent care providers need to be vigilant for more than acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection when patients present with chest pain—such as this 20-year-old who developed pneumomediastinum while smoking marijuana. Xiangyang Jiao, MD Case Presentation A 20-year-old female presented to urgent care for pleuritic chest pain and shortness of breath for about 2 hours. The chest pain was located in the upper and mid chest, was dull, pressure like, …

Read More
Testicular Torsion: The Case of the Dancing Testicle

Testicular Torsion: The Case of the Dancing Testicle

Urgent message: The differential diagnosis for unilateral testicular pain includes testicular torsion; this is a ”must not miss” diagnosis, as delayed diagnosis can cause significant morbidity both physically and psychologically. Jeannette Vaughn-Dotterer, PA-C CASE PRESENTATION ML is a 47-year-old male who developed left-sided testicular pain after getting out of bed 2 hours prior. He states that his left testicle appears to be “dancing” and seems to be riding higher than his right testicle. ML states …

Read More
Posterior Shoulder Pain—Not Always a Muscle Spasm

Posterior Shoulder Pain—Not Always a Muscle Spasm

Urgent message: Patients present to urgent care with a variety of complaints, many of which are common—even if they are the result of an uncommon condition. It is important that the provider develop a broad differential diagnosis as they approach these problems. Richard A Ginnetti, MD, MBA, CPE and Justin Holschbach, MD CASE PRESENTATION History A 52-year-old male presents to urgent care with the chief complaint of new lower posterior neck and right shoulder pain …

Read More
How Useful Is Ultrasound in Diagnosing Extrauterine Gravidities?

How Useful Is Ultrasound in Diagnosing Extrauterine Gravidities?

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of gynecological and obstetrical problems, such as suspected ectopic pregnancy (and is the test of choice for first-trimester pregnant women with abdominal pain or vaginal bleeding). Andrew Alaya, MD, MSc  and Harold Pelikan, MD INTRODUCTION An ectopic pregnancy or extrauterine gravidity (EUG) is a pregnancy that implants outside of the uterus. In 90% to 95% of EUGs, the pregnancy lies in the fallopian …

Read More
Reoccurring Metatarsophalangeal Joint Pain

Reoccurring Metatarsophalangeal Joint Pain

Urgent message: Acute or chronic hallux pain is a common complaint in urgent care. Due to the structure, several diagnoses can have similar presentation on history and exam. With this discussion, we examine a sesamoid stress injury. Sergio P. Ramoa, MD, MS INTRODUCTION The tibial (medial) and fibular (lateral) sesamoids are contained within the flexor hallucis brevis tendons along the metatarsal head.1 They have several roles such as absorbing weight, helping glide and reducing friction …

Read More
Atypical Skin Abscess Caused by Nontuberculous Mycobacterium

Atypical Skin Abscess Caused by Nontuberculous Mycobacterium

Urgent message: Cutaneous abscesses are common presentations in urgent care. While either methicillin-sensitive or methicillin-resistant Staphylococcus aureus accounts for up to 75% of skin abscesses, atypical organisms such as nontuberculous mycobacteria (NTMB) can also lead to abscess formation. Urgent care providers should be aware that the clinical presentation may be atypical and require specialized treatment. Rachel Hughes, MD and Erik Butler, DO CASE PRESENTATION A 26-year-old female with no known past medical history other than …

Read More