Journal of Urgent Care Medicine

Atypical Chest Pain in a Fibromyalgia Patient Presenting to Urgent Care

Tracey Q. Davidoff, MD, FACP, FCUCM Urgent message: Underlying medical and psychiatric conditions can cloud judgment and lead to cognitive errors, which may result in potentially serious medical errors.1 Case Presentation A 31-year-old woman with a medical history significant for fibromyalgia, migraines, bipolar disorder, and anxiety presents with 2 hours of severe bilateral neck spasms, left shoulder and arm pain, and chest pain which began soon after taking a new prescription for olanzapine. She also …

An 11-Year-Old Girl with Red, Itchy Rash

Urgent message: Urticaria from cold exposure should be considered to prevent future anaphylaxis and angioedema with re-exposure. KELSEY REED, MSN, APRN, FNP-C CASE PRESENTATION An 11-year-old girl presents to urgent care with complaints of repetitive episodes of sudden onset of itchy red rash with ill-defined borders which has occurred three times in the past 1.5 weeks following exposure to cold water. Twice, the hives occurred after swimming in a pool and once in a local …

An Unusual Etiology of Chronic Subdural Hematoma: Case Report and Review of the Literature

Urgent message: Absence of an obvious cause of symptoms should not mislead the clinician away from the likely diagnosis based on those symptoms. In this case, for example, the patient was ultimately diagnosed with a symptomatic chronic subdural hematoma associated with repetitive straining secondary to cough and constipation. Joel Kaye, BS, MS4 and Dana Tarina, MD Introduction Chronic subdural hematoma (CSDH) is an encapsulated collection of old blood in the space between the arachnoid membrane …

A 30-Year-Old Female with Headaches of Increasing Frequency

Urgent message: Cerebral venous sinus thrombosis (CVST) occurs when a blood clot forms in the venous sinuses within the brain, preventing drainage of blood. It can cause blood cells to break down and leak into the brain tissues, forming a hemorrhage. This can result in stroke. CVST affects about 5 people in 1 million per year. Aasia Ferdous, DO and Jordan Miller, DO CASE PRESENTATION A 30-year-old female presented to urgent clinic with a headache …

Abdominal Pain in the Younger Adult: Let’s Not Forget Acute Diverticulitis

Urgent message: The differential diagnosis of abdominal pain is challenging because many symptoms and signs are nonspecific and because patients might often have concomitant medical conditions that could cause abdominal pain. Although diverticulitis is more common in older patients, failure to consider diverticulitis in the differential diagnosis of abdominal pain in the younger adult could lead to delayed diagnosis and undesirable complications. Fabrizia Faustinella, MD, PhD, FACP and L. Alexandre Frigini, MD Introduction Diverticular disease …

A 9-Year-Old Girl with Sudden-Onset Sore Throat After a Meal

Urgent message: Sore throat and throat pain are common complaints in the urgent care setting. While infectious causes are the most common and the likely cause of the patient’s complaint, it is important to consider other causes. Linu Samuel, MD Introduction Sore throat and throat pain are common chief complaints across all ages in the urgent care setting. As clinicians who likely see these complaints multiple times a day, our differential diagnosis when walking into …

An 11-Year-Old Girl with Back Pain and Chronic Poor Appetite

Urgent message: Patients with recurrent symptoms should have an expanded history—including a genitourinary history in premenarchal girls. Lavanya Boddu, MD, MBA PRESENTATION The patient is an 11-year-old female brought by her mother to urgent care, with a chief complaint of back pain. The patient was pushed down at school about 2 weeks ago playing ball, landed on her buttocks, and is complaining of back pain radiating to BL hips. She is still able to walk …

A 44-Year-Old Man with Cough of Several Weeks’ Duration

Urgent message: Lung cancer—the leading causes of cancer-related deaths in the United States—may first present with relatively benign symptoms and findings, such as those seen in urgent care. A pulmonary nodule may be the first manifestation of lung cancer in tobacco users. Early diagnosis and intervention, as well as ensuring a patient has appropriate and timely access to follow-up, is a critical measure in decreasing mortality. Introduction Lung cancer is the second most common …

Infection Masquerading as a Fall in the Elderly

Urgent message: Falls in the elderly may be mechanical or due to an underlying etiology, making the urgent care evaluation tricky. The provider will need to evaluate the sequelae of the fall as well as searching for the hidden cause. Introduction Medical complaints from the elderly population will pose more of a challenge when the chief complaint is fall. The source can range from a neurologic etiology, a cardiac abnormality, or a metabolic or …

Shortness of Breath in a Postprocedural Pneumothorax

Urgent message: Patient histories can be helpful in guiding the examination and raising red flags for possible diagnosis. However, it is essential to resist the urge to accept a patient’s self-diagnosis at face value. Katlin F. Mattson, M3 and Shailendra Saxena, MD Case Presentation A 65-year-old female with a history of metastatic endometrial cancer, COPD, and asthma presented with increasing shortness of breath. Four days prior, the patient had undergone a chest wall …