Leg Pain in a 34-Year-Old Man

Leg Pain in a 34-Year-Old Man

Urgent message: The ability to differentiate deep vein thrombosis from other diagnoses such as cellulitis is important in choosing the correct treatment option.   Jeff Heimiller, MD    Case Presentation A 34-year-old male presented with a 1-week of right calf pain that was exacerbated by palpation and walking. He was unable to see his primary care physician that day, so he went to urgent care for evaluation. The patient also reported a sensation of shortness …

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Cervical Fasciitis—An Unusual Cause of Neck Pain

Cervical Fasciitis—An Unusual Cause of Neck Pain

Urgent message: Though neck pain is a common complaint among patients presenting to urgent care centers, cervical fasciitis is a relatively uncommon cause. Nonetheless, urgent care providers should consider it in the differential diagnosis for patients presenting with neck pain, even those who are afebrile.   Mark Richman, MD, MPH; Brendan Appold, MS; and Jennie Soniega-Sherwood, MPH   Case Presentation The patient is a 62-year-old-female with no significant past medical history who presented to a …

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An Uncommon Clinical Presentation of Ovarian Torsion

An Uncommon Clinical Presentation of Ovarian Torsion

Urgent message: Abdominal pain is an extremely common complaint in the urgent care setting. The differential diagnosis of abdominal pain is often a challenge, however, because many symptoms and signs are nonspecific. Ovarian torsion usually presents with sudden onset of severe, unilateral lower abdominal pain, associated with nausea and vomiting; however, in a small percentage of cases, the clinical course is prolonged, as the torsion can be intermittent. While failure to consider ovarian torsion in …

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Cardiopulmonary Emergency Masquerading as Gastrointestinal Symptoms

Cardiopulmonary Emergency Masquerading as Gastrointestinal Symptoms

Nihar B. Gala, MD   Urgent message: The ability to distinguish between urgent and truly emergent conditions is an essential skill for all urgent care providers. That distinction is especially challenging when symptoms could indicate either a relatively benign diagnosis that is well within the purview of the urgent care setting or a more dire diagnosis better suited for a higher-acuity setting.   Introduction “Familiar” symptoms such as vomiting, diarrhea, and abdominal pain could be …

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A 38-Year-Old Man with Chest Pain

A 38-Year-Old Man with Chest Pain

Urgent message: When a relatively young patient presents to urgent care with chest pain, there may or may not be a “typical” cause. Prompt evaluation and accurate assessment of risk factors are essential to efficient care and, often, the patient’s survival.   Max Palatnik, MD   Case Presentation A 35-year-old male presented at 21:59 with a chief complaint of chest pain; at 22:03, we noted the following: Temp: 98.9 Pulse: 103 Resp: 16 Syst: 122 …

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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 …

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A 5-Month-Old with Symptoms Beyond the Presenting Complaint

A 5-Month-Old with Symptoms Beyond the Presenting Complaint

Urgent message: Treating preverbal children can be challenging under every-day circumstances for pediatricians who know the child and the family. Urgent care providers who may not have the benefit of that history must be especially vigilant for all available signs and symptoms to make diagnoses based on the full scope of the presentation.   Michael Weinstock, MD   Case Presentation (Please note: The Case Presentation is drawn directly from the treating physician’s notes, without editing …

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Boerhaave Syndrome in a 41-Year-Old Female

Boerhaave Syndrome in a 41-Year-Old Female

Urgent message: While Boerhaave syndrome is a rare finding, a relatively high number of cases may present in the urgent care setting. As such, awareness of and vigilance for related symptoms are essential to taking a proper history and, ultimately, early diagnosis of acute, subacute, or chronic Boerhaave syndrome.    John Shufeldt, MD, MBA, JD, FACEP, Amber Hawkins, and Carli Nichta, MS4     Introduction Boerhaave syndrome is a spontaneous esophageal rupture indicated in some …

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Lumbar Hernia: An Unusual Cause of Back Pain

Lumbar Hernia: An Unusual Cause of Back Pain

Urgent message: Back pain is a common complaint in the urgent care setting. Common causes of musculoskeletal back pain include overuse and work-related injury. Other causes can include disc herniation, metastasis, osteoporosis, arthritis, spinal stenosis, and nephrolithiasis. Crystal N. Bharat MD, Ronald Dvorkin, MD, and Glenn G. Gray MD Case Presentation A 65-year-old female complained of 1 day of low back pain radiating to her left flank, which was aggravated with movement. Symptoms began while …

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Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation

Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation

Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients.  Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …

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