A 38-Year-Old Man with Chest Pain

A 38-Year-Old Man with Chest Pain

Urgent message: When a relatively young patient presents to urgent care with chest pain, there may or may not be a “typical” cause. Prompt evaluation and accurate assessment of risk factors are essential to efficient care and, often, the patient’s survival. Max Palatnik, MD Case Presentation A 35-year-old male presented at 21:59 with a chief complaint of chest pain; at 22:03, we noted the following: Temp: 98.9 Pulse: 103 Resp: 16 Syst: 122 Diast: 69 …

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Lumbar Hernia: An Unusual Cause of Back Pain

Lumbar Hernia: An Unusual Cause of Back Pain

Urgent message: Back pain is a common complaint in the urgent care setting. Common causes of musculoskeletal back pain include overuse and work-related injury. Other causes can include disc herniation, metastasis, osteoporosis, arthritis, spinal stenosis, and nephrolithiasis. Crystal N. Bharat MD, Ronald Dvorkin, MD, and Glenn G. Gray MD Case Presentation A 65-year-old female complained of 1 day of low back pain radiating to her left flank, which was aggravated with movement. Symptoms began while …

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Intermittent Abdominal Pain and Vomiting in a Teenager: One More Urgent Cause to Consider

Intermittent Abdominal Pain and Vomiting in a Teenager: One More Urgent Cause to Consider

Urgent message: Superior mesenteric artery syndrome should be included in the differential diagnosis in children with abdominal pain and weight loss with rapid increase in linear growth. Ralph Mohty, MS3, and Michael Esmay, MD Introduction Abdominal pain is one of the most common complaints in childhood. A minor self-limited condition such as constipation or viral gastroenteritis is usually the cause, but more serious conditions need further evaluation and management.1 Chronic abdominal pain is a term …

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An Unexpected Cause of Amenorrhea

An Unexpected Cause of Amenorrhea

Urgent message: The simplest explanation for a mundane symptom may not always reflect the correct diagnosis. Urgent care providers should consider all the possibilities in order to reach the correct conclusion as early as possible, or risk missing a more serious underlying diagnosis. Introduction Sometimes a simple complaint results in a common diagnosis, but other times a rare diagnosis will be discovered. The following case illustrates the importance of considering a wide differential and obtaining …

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An Uncommon Mechanism for Work-Related Total Achilles Tendon Rupture

An Uncommon Mechanism for Work-Related Total Achilles Tendon Rupture

Urgent message: This is a really big deal to urgent care clinicians and operators. Introduction Achilles tendon (AT) ruptures account for approximately 40% of all operative tendon repairs.1,2 With 18 ruptures per 100,000 people, it is the most frequently ruptured tendon—and the incidence of AT ruptures has been steadily increasing over the past few decades.1–4 Typical patients include athletic males between the ages of 30 and 50.3 Because the AT is the strongest, yet most …

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A Rare but Insidious Cause of Abdominal Pain

A Rare but Insidious Cause of Abdominal Pain

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 …

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Initially Missed Diagnosis of Quadriceps Partial Tendon Tear

Initially Missed Diagnosis of Quadriceps Partial Tendon Tear

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, …

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Midline Neck Mass

Midline Neck Mass

Urgent message: Swelling of the neck is a common problem seen in the urgent care setting. Etiologies range from infectious to lymphatic to malignant. If serious conditions are not diagnosed and treated in a timely manner, complications may lead to airway compromise, sepsis, or even death. How this article helps you: alerts you to uncommon presentations of neck masses. Introdution Swelling in various areas of the neck is frequently seen in urgent care centers. Most …

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Rocky Mountain Spotted Fever: Dermatologic Manifestation of a Life- Threatening, Systemic Disease

Rocky Mountain Spotted Fever: Dermatologic Manifestation of a Life- Threatening, Systemic Disease

Urgent message: Obtaining a detailed medical history is paramount for the early detection and treatment of Rocky Mountain spotted fever. Failure to acquire adequate patient information can lead to misdiagnosis and delayed treatment of this potentially life-threatening disease. WHITNEY CRAMER, PA-C Many dermatologic conditions such as rashes and eczema are encountered by urgent care providers on a daily basis. Often these conditions are diagnosed as contact dermatitis or are misdiagnosed, or the patient is referred …

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