Practice Management
The patient is a 68-year-old woman who presents with a rash she says developed on her trunk over a span of several weeks. On examination, there were multiple confluent, orange-red plaques on the trunk and arms with “islands of sparing” within them. The rash had a primarily truncal distribution and was pruritic. She was feeling well otherwise. View the image and consider what your next steps and diagnosis would be. Resolution of the case is …
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The patient is a 15-year-old boy who presents to urgent care with a painful medial right elbow he and his parents attribute to pitching in a baseball game earlier in the day. View the images 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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Joshua Russell, MD, MSc, FCUCM, FACEP A colleague, Dr. Mitchell we’ll call him, told me about a PA that he was supervising recently who made a great catch in a patient with a swollen, blue finger: Achenbach syndrome. When the PA presented the presumptive diagnosis, Dr. Mitchell, unfamiliar with the condition, had to Google it before seeing the patient. Our PA was right, though. The patient walked out of clinic, happy to have a benign …
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Urgent message: It is common for transgender patients to have a history of poor experiences with healthcare providers. As such, they may be less likely to have an ongoing clinical relationship with a primary care provider, making urgent care a likely destination when a need arises. Familiarity with issues facing adolescent transgender patients, in particular, can benefit both the provider and the patient. Timothy McGinnis and Emily Montgomery, MD THE CASE A 15-year-old transgender male …
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The patient is a 36-year-old male with a history of tobacco and alcohol use who presents to urgent care with sudden-onset substernal chest pain and shortness of breath that began 1 hour prior to arrival. View the ECG 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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The patient is a 43-year-old male who presents with a painful collection of pus near his fingernail. He reported that it had developed over the past day. On examination, a large, yellow-green superficial pus collection was seen at the proximal nail fold with surrounding erythema and edema. The patient mentioned that he had a home renovation business and that it was common for him to experience mild injuries such as splinters on his hands. The …
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The patient is a 47-year-old male who presents with a primary complaint of right ankle pain after a pick-up game of basketball. He reports he twisted his ankle when he landed on another player’s foot. View the images 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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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 …
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Urgent message: Though not considered as at “at risk” for severe disease with COVID-19, children have suffered significant disruptions to educational and personal activities throughout the pandemic. Recognizing urgent care’s role in testing for the virus could show benefit for families and urgent care centers alike. Rita P. Nunag, MD; Francesca M. Darquea, MD; Claire Loiselle; and Magdy W. Attia, MD Citation: Nunag RP, Darquea FM, Loiselle C, Attia MW. COVID-19 testing pattern in a …
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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 …
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