Journal of Urgent Care Medicine

A Case of Late-Onset Diabetes

Urgent message: Previously undiagnosed diabetes in elderly patients is too frequently a precursor to the diagnosis of pancreatic cancer. Incidental and unexpected diagnosis of diabetes in older patients in urgent care, especially in normal or underweight individuals, should prompt a discussion about vigilant monitoring for other symptoms of malignancy and close follow-up with a primary care provider. Joshua Russell, MD, MSc, FCUCM, FACEP CASE PRESENTATION A 72-year-old woman with a history of hypertension presented to …

A 20-year-Old Female with Chest Pain and SOB

Urgent message: Urgent care providers need to be vigilant for more than acute coronary syndrome, pulmonary embolism, and thoracic aortic dissection when patients present with chest pain—such as this 20-year-old who developed pneumomediastinum while smoking marijuana. Xiangyang Jiao, MD Case Presentation A 20-year-old female presented to urgent care for pleuritic chest pain and shortness of breath for about 2 hours. The chest pain was located in the upper and mid chest, was dull, pressure like, …

Testicular Torsion: The Case of the Dancing Testicle

Urgent message: The differential diagnosis for unilateral testicular pain includes testicular torsion; this is a ”must not miss” diagnosis, as delayed diagnosis can cause significant morbidity both physically and psychologically. Jeannette Vaughn-Dotterer, PA-C CASE PRESENTATION ML is a 47-year-old male who developed left-sided testicular pain after getting out of bed 2 hours prior. He states that his left testicle appears to be “dancing” and seems to be riding higher than his right testicle. ML states …

Posterior Shoulder Pain—Not Always a Muscle Spasm

Urgent message: Patients present to urgent care with a variety of complaints, many of which are common—even if they are the result of an uncommon condition. It is important that the provider develop a broad differential diagnosis as they approach these problems. Richard A Ginnetti, MD, MBA, CPE and Justin Holschbach, MD CASE PRESENTATION History A 52-year-old male presents to urgent care with the chief complaint of new lower posterior neck and right shoulder pain …

How Useful Is Ultrasound in Diagnosing Extrauterine Gravidities?

Urgent message: Ultrasound can provide essential data in the urgent care evaluation of gynecological and obstetrical problems, such as suspected ectopic pregnancy (and is the test of choice for first-trimester pregnant women with abdominal pain or vaginal bleeding). Andrew Alaya, MD, MSc and Harold Pelikan, MD INTRODUCTION An ectopic pregnancy or extrauterine gravidity (EUG) is a pregnancy that implants outside of the uterus. In 90% to 95% of EUGs, the pregnancy lies in the fallopian …

Reoccurring Metatarsophalangeal Joint Pain

Urgent message: Acute or chronic hallux pain is a common complaint in urgent care. Due to the structure, several diagnoses can have similar presentation on history and exam. With this discussion, we examine a sesamoid stress injury. Sergio P. Ramoa, MD, MS INTRODUCTION The tibial (medial) and fibular (lateral) sesamoids are contained within the flexor hallucis brevis tendons along the metatarsal head.1 They have several roles such as absorbing weight, helping glide and reducing friction …

Atypical Skin Abscess Caused by Nontuberculous Mycobacterium

Urgent message: Cutaneous abscesses are common presentations in urgent care. While either methicillin-sensitive or methicillin-resistant Staphylococcus aureus accounts for up to 75% of skin abscesses, atypical organisms such as nontuberculous mycobacteria (NTMB) can also lead to abscess formation. Urgent care providers should be aware that the clinical presentation may be atypical and require specialized treatment. Rachel Hughes, MD and Erik Butler, DO CASE PRESENTATION A 26-year-old female with no known past medical history other than …

Weight Loss, Abdominal Pain, and Distension in a 74-Year-Old Woman

Urgent message: Not all GI complaints can be attributed to gastrointestinal pathology; symptoms of dyspepsia, vomiting, early satiety, weight loss, and abdominal pain may also be from a pelvic etiology. Fabrizia Faustinella, MD, PhD and L. Alexandre Frigini, MD INTRODUCTION Gastrointestinal complaints are common in ambulatory centers, urgent care, and in emergency departments. The symptoms of abdominal pain, nausea, and vomiting account for 12% to 15% of ED visits.1 Several non-GI intra-abdominal, endocrine, and pelvic …

An Unresponsive Pupil in the Urgent Care: Can A Diagnosis Be Made from the Bedside History and Exam?

Urgent message: Ocular complaints for which there is no immediate, obvious explanation do not necessarily have to be referred to the emergency room or ophthalmology. Employing the process of elimination to narrow down a broad differential, using the available evidence, can expedite the correct diagnosis while allowing the patient to remain in the urgent care. Kayla Penny, BS; Joseph LaRochelle, PharmD, BCPPS, FCCP; Deirdre Hooper, MD; Haley Caire, BS; and Kelsey Rooney, BS CASE PRESENTATION …

Similar to Past Flare Ups Pulmonary Eosinophilia: Putting the Pieces Together

Urgent message: Pulmonary eosinophilia is a generic term for a heterogeneous group of disorders that result in increased eosinophils within the pulmonary parenchyma. Ultimately, the patient here was treated with an extended course of glucocorticoids to treat his chronic eosinophilic pneumonia until he could follow up with his hematologist/pulmonologist. CASE PRESENTATION The patient is a 29-year-old male with history of pulmonary eosinophilia, degenerative disc disease, and asthma who presents to an urgent care center with …