Practice Management
A 7‑year‑old male presents to the urgent‑care clinic with left‑knee pain that began after gym class and has gradually worsened over the past several weeks. The mother reports no significant trauma and notes that the pain improves with rest. Physical examination reveals a slightly overweight child with a visible bowing deformity just distal to the knee. The patient demonstrates a full range of motion and normal knee strength, and no bony tenderness, effusion, or laxity …
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A 21-year-old male with no significant past medical history presents to urgent care with a 3-week history of progressive cough, night sweats, dyspnea, and chest discomfort. He denies sore throat, rhinorrhea, sinus congestion, hemoptysis, weight loss, wheezing, tobacco use, or illicit drug use. On examination, vital signs are within normal limits. The patient appears well and not in acute distress. Lung auscultation was clear bilaterally, and the remainder of the initial physical exam is unremarkable. …
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A 42-year-old man presents to urgent care on a Sunday afternoon. He explains that he was playing a game of pick-up football in his neighborhood and suffered a rough kick to the face from another player. His nose is swollen, and he’s clearly in pain. An x-ray is ordered to capture a lateral view of the nasal bones. Review the image and consider what your diagnosis and next steps would be. Resolution of the case …
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A 13-year-old boy presents to urgent care after “rolling” his left foot. He explains that he tripped on a cement curb while riding his skateboard. He has foot and ankle pain that is worse with weight. An x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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Urgent Message: Rapid identification of Lisfranc injuries in urgent care is critical, as delays in diagnosis can lead to chronic disability. Most patients with Lisfranc fractures or dislocations should be referred directly to the emergency department. Cross-sectional imaging (ie, computed tomography) and orthopedic consultation are time-sensitive, and urgent operative repair is often indicated. Alexandra Eby, BS; Nicole Meschbach, MD Questions for the Urgent Care Clinician at the Bedside Abstract A Lisfranc injury is a tarsometatarsal …
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A 51-year-old man presents to urgent care complaining of night sweats and a productive cough with visible blood for the past 2 weeks. He says he’s been feeling rather tired lately. A chest x-ray is ordered. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.
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