Cat Scratch Disease Presenting as Parinaud’s Oculoglandular Syndrome

Urgent message: Cat scratch disease caused by the bacteria Bartonella henselae typically presents as isolated lymphadenopathy in the region draining the inoculation site (cat scratch or saliva), as well as systemic symptoms such as a fever and malaise. In otherwise healthy people, oculoglandular symptoms are occasionally seen as a complicated presentation. CSD should be included in the differential diagnosis of these symptoms. Joseph V.M. Kelly, MD, MBA, Nicholas Baltera OMS I, and Ronald Dvorkin, MD, …

A 57-Year-Old Man with 3 Days of Lightheadedness

The patient is a 57-year-old man who complains of lightheadedness for the last 3 days. He has a history of a heart stent placed 4 years ago and has been asymptomatic since that time. He denies vomiting, diarrhea, chest pain, shortness of breath, abdominal pain, or paresthesias. No recent travel. He takes metoprolol and clopidogrel. There is a family history of hypertension Upon exam, you find: General: Sitting comfortably in a chair, alert, breathing comfortably …

A Pregnant Mother Presenting to Urgent Care with Chickenpox

Urgent message: Failure to correctly diagnose and provide immediate treatment for varicella zoster virus (VZV) infection in pregnant patients can lead to life-threatening complications for the mother, and serious congenital malformations to the fetus. Samrana Arefeen, MD and Khalid Aziz, MD Introduction There are several types of skin lesions and rashes that are common during pregnancy. Some are benign and confer no risk to the expectant mother or the fetus. However, some are symptoms of …

A 50-Year-Old Farmer with Flu-Like Symptoms

The patient, age 50, is a farmer who presents with flu-like symptoms—fever, chills, productive cough, myalgia, and pleuritic chest pain that developed over a few weeks. What worried him most, however, was a crusted lesion on his arm that was a large verrucous scaly plaque. View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Longitudinal Assessment: A Dent in the ABMS Armor?

With the volume of dissent against Maintenance of Certification (MOC) now at a fever pitch, American Board of Medical Specialties (ABMS) boards are finally making changes to their recertification programs with the intent of reducing the burden on physicians. The issue could not be more acute than in urgent care, where many UCA member physicians have been practicing for years. Working outside of their specialties of training and growing more distant from the best practice …

Abstracts In Urgent Care – December 2018

The Year in Abstracts: Top Papers of 2018 for the Urgent Care Clinician Reviewed by Andy S. Barnett, MD This has been an eventful year in the urgent care marketplace. Then again, you could say that at the end of most years in our dynamic, ever-growing industry. That begs the question, what did set 2018 apart from other years? Mergers and acquisitions, evolving technologies, and workplace trends certainly impact what you do every day. But …

A 9-Year-Old Girl Who Choked on a Chicken Nugget

Case The patient is a 9-year-old girl who is brought in by her parents shortly after choking on a chicken nugget. They are concerned because even though she stopped gagging, she complains that it feels “like there’s something stuck in there.” View the images, ordered to rule out a lodged foreign body, and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

Treating Patients Infected with Influenza Virus in the Urgent Care Setting

Urgent message: As patients start to feel the effects of the 2018–2019 influenza season, urgent care centers can expect to see visits by patients with related symptoms increase. Providers must be prepared to identify and treat patients most at risk for complications and poor outcomes—armed with old standbys and a newly approved antiviral agent. Samantha Arnold, DO Introduction Last month, JUCM explored prevention, diagnosis, and testing for influenza. In this issue, we focus on management …

A 73-Year-Old Woman with a 12-Day History of Palpitations

Case The patient is a 73-year-old woman who presents to the urgent care center with palpitations she says she first noticed 12 days ago. There is no associated chest pain, shortness of breath, abdominal pain, or paresthesias. The patient states she takes warfarin, with recent INR of 2.2. Her personal medical history includes atrial fibrillation, and there is a history of heart disease within the family. Upon examination, you find: General: A&O, NAD, WNWD Lungs: …

A 12-Year-Old Football Player with Sudden Hip Pain

Case The patient is a 12-year-old boy who presents with sudden hip pain that started simultaneously with a “popping feeling” in the same hip. He reports that it started in the middle of his football game earlier in the day. View the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.