A 10-Year-Old Boy with Multiple Lesions on His Ear

A 10-Year-Old Boy with Multiple Lesions on His Ear

Figure 1. Case A 10-year-old boy visited urgent care complaining of multiple skin lesions on the rim of his ear. They had begun as vesicles and some were beginning to crust. He also had enlarged cervical lymph nodes. His mother was concerned because the symptoms developed after an early spring camping trip with his scout troop and two other boys had similar symptoms. View the photo taken, and consider what your diagnosis and next steps …

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A 70-Year-Old Female with ‘Bony’ Pain in Her Chest

A 70-Year-Old Female with ‘Bony’ Pain in Her Chest

Case The patient is a 70-year-old female who presents with gradual onset of constant pain in her left lower chest and back. She is unsure when she first noticed the pain, but reports that it has worsened since she experienced a fall several days ago. She denies shortness of breath, diaphoresis, or an exertional component. View the images taken and consider what the diagnosis and next steps would be. Resolution of the case is described …

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A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

A 28-Year-Old Man with Fever, Diaphoresis, and Nausea

The patient is a 28-year-old man who presents to urgent care with a single annular ecchymosis lesion on his leg the morning after returning home from a trip to visit his family’s cabin in the mountains of North Carolina. He “thought” he noticed a small insect bite in the vicinity. The lesion has become increasingly painful. View the photo taken and consider what your diagnosis and next steps would be. Resolution of the case is …

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An 18-Year-Old Female with Sudden Sharp Chest Pain

An 18-Year-Old Female with Sudden Sharp Chest Pain

Figure 1.   Case The patient is an 18-year-old female who presents to urgent care with 1–2 hours of “sharp” chest pain that worsens with range of motion. She reports it began suddenly while lifting boxes at work. Pain is not improved with acetaminophen. She denies exertional discomfort, pleuritic pain, and use of hormone therapy. There is no leg swelling, shortness of breath, or sweating. Physical exam reveals: General: Sitting comfortably on the cart, breathing …

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An 11-Year-Old Girl with Back Pain and Chronic Poor Appetite

An 11-Year-Old Girl with Back Pain and Chronic Poor Appetite

Urgent message: Patients with recurrent symptoms should have an expanded history—including a genitourinary history in premenarchal girls. Lavanya Boddu, MD, MBA PRESENTATION The patient is an 11-year-old female brought by her mother to urgent care, with a chief complaint of back pain. The patient was pushed down at school about 2 weeks ago playing ball, landed on her buttocks, and is complaining of back pain radiating to BL hips. She is still able to walk …

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Top 5 Common Causes—and Controversial Conducts—of Heel Pain in Urgent Care

Top 5 Common Causes—and Controversial Conducts—of Heel Pain in Urgent Care

Urgent message: Nontraumatic heel pain is a common presenting complaint in urgent care. Knowing how to accurately diagnose and develop a treatment plan is important, as the course is typically prolonged. Katty Grand-Pierre, MD, CMSS, Frank Ida, BS, EMT-B, and Vincent D’Amore, MD, FACEP INTRODUCTION The heel can absorb 110% of body weight while a person is walking and 200% of body weight during running.1 While the most common cause is plantar fasciitis (PF), accounting …

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Suspected Pertussis in Infants and Adolescents—What to do?

Suspected Pertussis in Infants and Adolescents—What to do?

Urgent message: Familiarity with the schedule for immunization against pertussis, as well as expertise in diagnosing and prescribing treatment, should be within the urgent care provider’s capabilities—as should the ability to distinguish which patients require transfer to a higher-acuity setting.   Ellen Laves, MD Microbiology and Immunity Pertussis is a toxin-mediated disease caused by the gram-negative coccobacillus Bordetella pertussis. Toxins produced by B pertussis impair ciliary clearance of pulmonary secretions through the paralysis of normally …

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A 44-Year-Old Man with Cough of Several Weeks’ Duration

A 44-Year-Old Man with Cough of Several Weeks’ Duration

Urgent message: Lung cancer—the leading causes of cancer-related deaths in the United States—may first present with relatively benign symptoms and findings, such as those seen in urgent care. A pulmonary nodule may be the first manifestation of lung cancer in tobacco users. Early diagnosis and intervention, as well as ensuring a patient has appropriate and timely access to follow-up, is a critical measure in decreasing mortality.   Introduction Lung cancer is the second most common …

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A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

Case The patients is a 57-year-old man with a complaint of syncope 3 hours before arrival. He states he was sitting on the couch and the next thing he knew he was waking up. No preceding dizziness. No seizure activity, biting of the tongue, blood in the mouth, or post ictal symptoms. No cp, sob, leg pain, head pain, or back pain. He drank 2 glasses of water and felt better, but was encouraged to …

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