The patient is a 2 ½-year-old child whose parents report recurrent episodes of abdominal pain without vomiting or diarrhea. On exam, you note fullness of the abdomen. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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73-year-old woman with foreign body lodged in hand after fall
The patient is a 73-year-old woman who presents with a foreign body (a piece of wood, specifically) sticking out of a scratch on her hand. She reports that she fell in her yard. On examination, you discover that she also has local pain and swelling of the left wrist. View the x-ray taken and consider what your diagnosis and next steps would be.
Read MoreClinical Challenge: December, 2009
In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected]. The patient is a 93-year-old female who lost her balance and twisted her ankle. She presents with significant pain in the ankle and swelling over her lateral …
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23-year-old male complains of heel pain since slipping down steps
The patient is a 23-year-old male who presents with a complaint of pain in the heel area after slipping down four steps. He is limping but able to bear weight. On exam, you note local tenderness and swelling over the area of the Achilles tendon. Other findings are unremarkable. View the x-ray taken and consider what your diagnosis and next steps would be.
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55-year-old female experienced blow to back from fall
The patient is a 55-year-old female who experienced a blow to the back when she fell while riding a bus. She complains of pain in her neck, shoulder, and back. On examination, you find that her vitals are stable and she has no significant past medical history. View the x-ray taken and consider what your diagnosis and next steps would be.
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Treatment of Pediatric Community-acquired Pneumonia in an Urgent Care Center
Urgent message: Although diagnosis of pediatric community-acquired pneumonia is not always straightforward, most cases can be diagnosed adequately by non-pediatricians and treated in the urgent care center, thereby reducing hospitalization for this condition. By Deena R. Zimmerman, MD, MPH, IBCLC, Scott Fields, MD, Nahum Kovalski, BSc, MDCM Introduction Pediatric community-acquired pneumonia (CAP) is a common illness. Estimates are that the annual incidence of pneumonia per 1,000 children in North America ranges from 30 to 45 cases …
Read MoreClinical Challenge: November, 2009
In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected] The patient is a 19-year-old male who complains of pain after receiving a blow to the shoulder. Range of motion is limited due to pain. The patient …
Read More82-year-old man slips and takes a blow to his shoulder
The patient is an 82-year-old man who slipped on the street, experiencing a blow to his right shoulder. He has significant local swelling in the injured shoulder (specifically, over the acromioclavicular joint), as well as significantly limited range of motion. His distal pulses are normal. View the x-ray taken and consider what your diagnosis and next steps would be.
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7-year-old boy with persistent fever and cough
The patient is a 7-year-old boy who presents to urgent care at midnight with a four-day history of fever and cough. Two days prior, a throat culture administered elsewhere showed nothing suspicious. The parents brought him to urgent care tonight because of subsequent increasing chest pain. On exam, you find the child is not in respiratory distress, but has decreased air entry on the left side of his chest. His temperature is 101.3 degrees F, …
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80-year-old man suffering lower back pain
The patient is an 80-year-old man who presents with a two-week history of low back pain. He is hemodynamically stable and has a normal neurological exam. His personal medical history reveals hypertension, for which he is being treated. Blood pressure is 140/80, pulse 63. View the x-ray taken and consider what your diagnosis and next steps would be.
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