Practice Management
A 68-year-old woman presents to urgent care with her husband after tripping on a rug at home the previous day and falling onto her left hand. She has experienced persistent pain and swelling in the hand since the fall. Ibuprofen provided modest pain relief. Physical examination reveals normal vital signs with focal edema and tenderness over the dorsal surface of the 4th and 5th metacarpals. Decreased range of motion and knuckle contour at the 5th …
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A 52-year-old woman visits the urgent care clinic for itchy bumps that have been present on her back for the past 3 months. The lesions are very itchy, and it is difficult for the patient to stop scratching. She has not tried any treatments for her symptoms since onset. On dermatological examination, pink scaly papules with dark exterior rims are seen on her back, some of which appear excoriated. Laboratory results for complete blood count, …
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A 62-year-old female presents to urgent care with acute dyspnea that worsened significantly 2 hours prior to arrival. She has noted progressive shortness of breath over the past week but now feels severely winded. She denies chest pain, cough, fever, leg swelling, or history of deep vein thrombosis. On evaluation, the patient is tachycardic and tachypneic with a heart rate of 110 beats per minute and an oxygen saturation of 91% on room air. She …
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A 79-year-old female presents to urgent care complaining of sharp, severe lower back pain for the past 2 months. The pain began when she was bending over to pick something up from the floor and has not improved. The pain occasionally radiates to her flank area but not down her legs, and she denies any bowel or bladder pattern changes. She tried acetaminophen, cold and warm compresses, and rest without any relief. The pain worsens …
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An 8-year-old male is brought to urgent care by his mother reporting a widespread, itchy facial rash. The patient says that the rash is severely painful and pruritic, and that he feels tingling and pain in his lips. The facial rash presented 3 days prior, and the mother states that her son repeatedly scratches the legions. The patient and is family are from Honduras; they deny any recent travel. The patient is otherwise well and denies …
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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 …
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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.
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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 …
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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 …
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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.
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