Practice Management
A 16-year-old presents with an irregular patch of skin on his chest, reporting that it has become increasingly hyperpigmented over the past year. He also says the same area has had in increase in hair growth in recent months View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreClinical practice guidelines have been gaining interest, along with a little ire, over the last decade. Fueled by Medicare reform, the Affordable Care Act, Meaningful Use, and value-based reimbursement models, clinical practice guideline development has been envisioned as a critical way to achieve consistent care quality in a cost-effective and evidence-based way. This is nothing new of course. I remember memorizing the U.S. Preventive Services Task Force Screening Guidelines in residency in preparation for boards. …
Read MoreCase A 14-year-old boy presents to urgent care complaining of lateral right elbow pain that began after a fall on the playground yesterday, in which he landed on his outstretched hand. He has no significant medical or surgical history. The elbow pain is worse with range of motion. He denies any wrist or shoulder pain, and there is no head trauma. There are no paresthesias to the hand or arm. View the images taken (Figures …
Read More
Urgent message: The incidence of community-acquired pneumonia (CAP) is seasonal in nature, with a peak during the winter months and a trough in the summer months. In the urgent care setting, primary concerns are risk factors for CAP, as well as current treatment and testing guidelines. Overview Pneumonia is an acute alveolar lung infection that presents with infiltrates upon chest imaging and is often accompanied by fever, cough, sputum production, shortness of breath, and physical …
Read More
Urgent message: Recognizing the need for workup and referral in patients, even if their symptoms are relatively common, is crucial for optimal outcomes Introduction Abdominal symptoms can be attributed to a wide array of causes. When etiology is not immediately apparent, searching for signs and symptoms the patient may not have reported—or even be aware of—may be the first steps toward timely diagnosis and treatment. In this case, the abdominal symptoms were ultimately due to …
Read MoreEarlier Return to Activities May Benefit Concussed Children Key point: Another (possibly surprising) view on rest after concussion. Citation: Grool AM, Aglipay M, Momoli F. Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. JAMA. 2016;316(23):2504-2514. In this prospective, multicenter cohort study, approximately 2,400 children aged 5-18 years with acute concussion diagnosed at nine emergency departments across Canada were evaluated for persistent postconcussive symptoms (PPCS). Each …
Read More
Parents bring their 2-year-old boy to an urgent care center after noticing that his right pupil looks white, and that the eye is excessively teary and looks bloodshot. They report that they boy has also complained that it hurts on occasion. View the image taken (Figure 1) and consider what your diagnosis would be
Read More
Urgent message: The prevalence of cancer is increasing—and along with it, malignancy-associated complications. Early recognition and management of these conditions is vital to alleviating patient morbidity and maximizing quality of life. Introduction Cancer is a leading cause of morbidity and mortality throughout the world, accounting for over 580,000 deaths in 2013 in the U.S.1 With an aging population and more effective forms of treatment, the overall prevalence of cancer is increasing. Consequently, acute cancer-related complications …
Read MoreCase A 19-year-old man presents to urgent care with a 5-day history of a dry cough. He says he has “felt warm” but didn’t think to check his temperature. He also complains that he has been weak, with a decreased appetite. He notes that his girlfriend had an upper respiratory infection a couple of weeks ago, but other than that he’s had no exposure to anyone who’s been sick. He has not traveled anywhere recently, …
Read More
Urgent message: Quadriceps tendon tears are misdiagnosed frequently, leaving patients at excessive risk for long-term disability. Early identification and immediate referral for further care—often, surgery—is necessary for optimal outcomes. Low-riding patella (patella baja) commonly seen in complete tendon tears. (Photo courtesy of Wikimedia Commons.) Introduction Musculoskeletal injuries are among of the most common problems seen in the urgent care setting. Quadriceps tendon tears are uncommon injuries, with an incidence of approximately 1.4/100,000 per year. Consequently, …
Read More