A 42-Year-Old Male with a New Symmetrical Rash on His Legs

A 42-Year-Old Male with a New Symmetrical Rash on His Legs

The patient is a 42-year-old man who presents with a symmetrical rash of palpable purpura on his legs. He also complains of a fever and arthralgia, but denies any headache or neck pain. He also discloses current infection with the hepatitis C virus. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.    

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A 6-Year-Old Boy with Foot Pain After Tripping a Day Earlier

A 6-Year-Old Boy with Foot Pain After Tripping a Day Earlier

The patient is a 6-year-old boy who cried out in pain after jumping off the fourth step of the stairs in his house yesterday, landing hard on his feet. His mother reports that he has been limping ever since. She applied ice at home, hoping the pain would resolve overnight. It did not. On exam, you note the pain is located at the base of the first/second metatarsal. View the images taken and consider what …

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A 70-Year-Old Man with Hand Numbness and Pain

A 70-Year-Old Man with Hand Numbness and Pain

The patient is a 70-year-old male who presents to urgent care with numbness, pain, and difficulty opening his hands. His son, who drove his father to the appointment, notes that the skin also looks “bunched up in places.” The physician also observes what look like raised scars. The thumb and index finger seem unaffected. Upon questioning, the patient says he started noticing smooth nodules “a couple years ago.” He attributed that to his many years …

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Urgent Identification and Management of Postsplenectomy Sepsis

Urgent Identification and Management of Postsplenectomy Sepsis

Urgent message: Asplenic individuals have a rate of severe infections 2-3 times higher than the general population. Postsplenectomy sepsis should be considered in patients with impaired splenic function who present with a fever. Megan L. Lawson, PA-C and Christina Gardner, DHSc, MBA, PA-C CASE PRESENTATION A 45-year-old male presented to the urgent care with 18 days of sinus pain and congestion unresponsive to two courses of antibiotics, cefdinir and levofloxacin. Past surgical history revealed a …

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A Blistering Rash in an Otherwise Healthy 9-Year-Old Boy

A Blistering Rash in an Otherwise Healthy 9-Year-Old Boy

Urgent message: Impetigo is one of the most common skin infections in children, and can have a variable presentation. As such, it is essential that the urgent care provider be able to recognize this common skin infection, and to know the treatment options. Aimy T. Patel, MD, FAAP, Allison Burris, MD FAAP, and Nirav Shastri, MD, FAAP, FAMIA, ABMS-CI CASE PRESENTATION History A 9-year-old otherwise healthy boy presents with a 1-week history of an itchy …

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Keep Your Differential Broad, Especially During Flu Season

I’m phenomenally bad at gambling for a multitude of reasons. I bet small when I should bet large. I bet large when I shouldn’t even be playing the game. I’m especially terrible at roulette because when I pick a number, usually 22, I stick with it—much longer than I should. Each time the wheel stops, on any other number, I’m disappointed, sure. But that disappointment is quickly replaced with hope that the odds of lucky …

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Evaluation and Diagnosis of Trigger Finger with Current Management Strategies

Urgent message: Appropriate treatment of “trigger finger” in the urgent care setting starts with differentiating that diagnoses from other disorders of the hand. This is relatively straightforward if one finger is involved, but can become more complex with multiple digits. Shailendra K. Saxena, MD, PhD and Alexander M. Stock, BS INTRODUCTION Trigger finger, also known as stenosing flexor tenosynovitis, is a common hand disorder that affects approximately 2.6% of the general population during their lifetime.1 …

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A 69-Year-Old Man with a 2-Month History of Shortness of Breath and Mild Chest Pain

A 69-Year-Old Man with a 2-Month History of Shortness of Breath and Mild Chest Pain

The patients is a 69-year-old man with shortness of breath and mild chest pain of 2 months duration. He has felt it unnecessary to see his “regular doctor” because his complaints haven’t gotten worse, but conceded to visit urgent care today at the insistence of his family. When asked, he acknowledges a history of congestive heart failure and hypertension. View the ECG and consider what your diagnosis and next steps would be. Resolution of the …

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