Practice Management
A 70-year-old man presents to an urgent care center after becoming concerned about brown hyperpigmented patches on his legs and arms. He says that he thinks some of his teeth are turning gray, but it has been happening so slowly that he is not sure. He reports that he has been in good health recently, especially after starting to take antibiotics last year to treat his rheumatoid arthritis. View the image taken (Figure 1) and …
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A 57-year-old man climbs a tree in his yard to trim branches, and then falls to the ground and onto his shoulder. In presenting to his local urgent care center, he reports that he has pain over his right shoulder and scapula area that is sharp and worsens when he moves through the range of motion. He says that he took 600 mg of ibuprofen after he was injured but that his pain did not …
Read MoreCase A 78-year-old man presents to an urgent care center with bilateral knee pain that he has had for 1 week. The pain is worse in his right knee and is worse with ambulation. He says that he has not experienced any recent trauma, but he does note that he has been helping his son move into an apartment. He reports no fever, dizziness, chest pain, or shortness of breath. He has hypertension, for which …
Read MoreCase A 20-year-old previously healthy man presents with sudden onset of substernal chest pressure after completing football practice. His chest pain is nonradiating, nonreproducible, and nonpositional. He does not have associated palpitations, dyspnea, or diaphoresis. He reports that he has not had recent upper respiratory tract infections or contact with ill people. He does not have a history of using alcohol, tobacco, or illicit drugs. He has no family history of sudden cardiac death or …
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Urgent message: Common nasal infections can have serious health consequences if not quickly diagnosed and treated. Introduction Both children and adults present to urgent care centers with nasal pain. Infectious causes of such pain include impetigo, furuncles, and nasal vestibulitis (NV). Noninfectious causes include squamous cell cancer and lupus vulgaris. A careful physical examination and a thorough medical history can allow the health-care provider to rule out more serious conditions or to transfer the patient …
Read MoreSean M. McNeely, MD
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Urgent message: Being able to recognize the distinct oral lesions of common illnesses in children is essential, but it can be difficult to conduct an oral examination in frightened young children. Introduction Inspecting intraoral lesions in children will often confirm a diagnosis, but getting uncooperative patients to let the clinician visualize such lesions is challenging. Here we provide helpful examination tips and review common pediatric infectious and allergic oral lesions and their treatment. Techniques for …
Read MoreThese are by far the most frequent questions I am asked by urgent care physicians: “My primary board certification is expiring. Do I have to recertify? Which of the urgent care boards should I take?” If you have been in urgent care practice long enough, you’ll come to a painful moment of truth: Our primary board certification is in a specialty we no longer practice, covering competencies we no longer use. To make matters worse, …
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A 35-year-old woman presents to an urgent care center with severe right wrist pain after a fall onto her outstretched hand after tripping on the sidewalk. She has significant pain throughout the range of motion as well as at rest. She has minimal numbness of the fingers. She has no other visible injuries, and on questioning, she reports that she has no elbow, shoulder, head, or neck pain. View the image taken (Figure 1) and …
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Case An 18-year-old man presents to an urgent care center with pain at the distal aspect of the metacarpal bone of the little finger. The pain began 2 hours earlier, after he punched a wall. He has pain with range of motion and a minimal amount of numbness in the finger. He reports that he has no other injuries. View the image taken (Figure 1) and consider what your diagnosis would be.
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