Practice Management
A 45-year-old woman presents to urgent care with a persistent productive cough for the past few months. Over the past week, she has noticed more sputum production, which is thick and dark in color, as well as fatigue and dyspnea on exertion. She denies fevers, pharyngitis, abdominal pain, or gastrointestinal upset. She denies tobacco use or occupational exposures to any inhaled chemicals. Physical exam reveals that the patient is afebrile with vital signs within normal …
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A 49-year-old male presents to urgent care with 3 days of progressively worsening fever and a widespread painful rash. He also reports dry mouth and painful lesions on his gums. The patient has a history of acute myeloid leukemia, and he received an allogeneic bone marrow transplant 2 weeks prior to onset of symptoms. Physical examination reveals a fever of 101.3°F (38.5°C), several ulcerated lesions on the buccal mucosa, and a violaceous papular rash to …
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A 51-year-old male presents to urgent care after falling while skiing. He reports catching an edge in a patch of slushy snow, causing him to pitch forward and land forcefully onto his left anterior chest. He immediately experienced localized pain over the left chest, worsened by deep inspiration and coughing. He denies shortness of breath, syncope, and neck or head trauma. On exam, vital signs are normal. There is focal tenderness over the left anterior …
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A 64-year-old female presents to urgent care complaining of right thumb pain. The patient states she removed a wooden splinter from her thumb herself about 2 weeks prior, she denies any other trauma or systemic symptoms. The patient has a history of Type II diabetes and her last A1C 2 months prior was 9.3. Physical examination reveals the patient is afebrile with normal vital signs. There is a small, scabbed wound on the palmar surface …
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A 42-year-old male presents to urgent care with complaints of cough, throat pain, and vomiting that developed earlier that morning. He returned from a family vacation to the US Virgin Islands 7 days ago and two days later, he began feeling ill with initial symptoms of high fever, myalgia, and severe headache. Over the past 3 days, he has noticed the development of a widespread rash on his trunk. The rash initially appears faint and …
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A 61-year-old male with a history of hypertension, diabetes, and chronic kidney disease presents to urgent care on a Tuesday afternoon with 1 week of increased weakness. He says he’s “feeling off balance.” He denies chest pain, shortness of breath, or recent illness. An ECG is ordered. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 4-year-old male presents to urgent care with a swollen, painful right elbow. The mother reports that the child had a witnessed fall from the monkey bars 1 hour prior to arrival. He fell onto his outstretched right hand, was in immediate pain that has not subsided, and has refused to let anyone touch his arm. On initial examination, vital signs are stable, and patient is afebrile. Swelling is noted over the right elbow, and …
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A 53-year-old woman visits urgent care for dark patchy spots on her neck and face that have been spreading over the past 3 months. The lesions are not painful or itchy, she denies exposure to allergens or irritants, and has no systemic symptoms. The patient states that sun exposure darkens the spots further and she has not tried any treatments to date. On examination she appears well with normal signs; hyperpigmented gray macular patches are …
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A 60-year-old male with a past medical history of prior myocardial infarction (MI) is presenting with left-sided chest pain for 1 day. He reports nonadherence to his clopidogrel for 2 weeks after running out of his medications. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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An 11-year-old male presents to urgent care complaining of bilateral heel pain, right worse than left. The patient denies recent trauma and reports experiencing increased pain when running. He has not tried any treatment and denies any history of similar episodes in the past. Physical examination reveals bilateral pes planus and decreased dorsiflexion of the feet with weightbearing lunge against the wall. Pain is elicited with calcaneal compression test. The patient is noted to be …
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