Practice Management
A 64-year-old woman with a history of chronic obstructive pulmonary disease, diabetes mellitus, osteoarthritis, and obesity presents to urgent care with acute right posterior ankle pain after stumbling on a curb earlier that day. She says she felt a sudden sharp pain in the back of her ankle and experienced immediate difficulty walking and climbing stairs. She reports 10 days of mild posterior ankle discomfort before this event, which she treated with ice, an elastic …
Read More
An 83-year-old female with a past medical history of hypertension, diabetes mellitus, and hyperlipidemia presents to urgent care with palpitations and dizziness for the past 2 weeks. She does not have any family members present. An ECG is obtained. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
A 28-year-old female presents to urgent care complaining of right ankle pain after awkwardly stepping off a high curb, subsequently rolling her ankle while running outside earlier today. She is unable to bear weight on her ankle. She has no past medical history, takes no medications regularly, and has not tried any treatments since the injury. Physical exam reveals she is afebrile with normal vital signs, and she has marked tender edema to the lateral …
Read More
A 63-year-old woman visits urgent care with the chief complaint of an asymptomatic scabby growth on her scalp that developed 10 months prior and is gradually getting larger. The patient has no systemic symptoms and is otherwise well. She has a history of working as a welder in a metal fabrication plant for the past 35 years. On dermatological examination, an eroded and crusted plaque is seen on the frontal scalp. A punch biopsy reveals …
Read More
An 86-year-old male presents to urgent care with intermittent palpitations for the past several days. He says he has a history of Wolff-Parkinson-White syndrome.An ECG is obtained. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
A 28-year-old male with history of left shoulder dislocations presents to urgent care with severe left shoulder pain. He reports an inability to move the arm after injuring his shoulder while taking off his shirt. He reports feeling the shoulder “shift out of place” during the movement. On examination, the patient is in significant discomfort. He is holding the left arm in slight abduction with left shoulder external rotation. His elbow is flexed and his …
Read More
A 26-year-old female presents to urgent care with a persistent productive cough for 1 week. Over the past 3 days, she reports progressive shortness of breath and fatigue. She has a history of recurrent pneumonia. Vital signs show the patient is afebrile with normal blood pressure, heart rate, respiratory rate, and oxygen saturation. Physical examination revealed clear lung sounds with diminished air movement in the bilateral bases. Jugular venous distension (JVD) at 4 cm above …
Read More
A 67-year-old man visits urgent care for a lesion on his right ankle that was first noticed 25 years ago. He reports that it has progressively grown larger over the past 6 months. The lesion is painless but is intermittently mildly pruritic. The patient denies any recent injury or past medical history besides chronic venous insufficiency. On dermatologic examination, a discrete dark brown plaque is noted posterior to the lateral malleolus with numerous surrounding spider …
Read More
An 84-year-old woman presents to urgent care with palpitations that have lasted for several hours. The patient is afebrile, slightly tachypneic on exam, with a blood pressure of 148/97 mm Hg. An ECG is obtained. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
A 53-year-old male butcher visits urgent care for a painful red rash that developed on his hand 3 days prior. There is no history of recent travel, but he accidentally cut himself when processing meat 1 week ago. Exam reveals that the patient is febrile at 100.2° F. Otherwise, his vital signs are within normal limits, and he is well appearing. On dermatologic examination, erythematous vesiculated papules, plaques, and associated edema are visible on the …
Read More