Journal of Urgent Care Medicine

Neck Rash on a 21-year-old Male

Urgent message: Acanthosis nigricans has a strong association with obesity and insulin resistance. Assessment involves a thorough physical exam to differentiate from other dermatosis, as well as full workup for insulin resistance. Early diagnosis in the urgent care setting, and treatment, will improve the appearance of acanthosis nigricans, but also the patient’s overall morbidity. Shailendra Saxena, MD, PhD and Bao Chau Nguyen, BS Introduction A 21-year-old Caucasian male presented for a circumferential hyperpigmented rash around …

A 5-Month-Old with Symptoms Beyond the Presenting Complaint

Urgent message: Treating preverbal children can be challenging under every-day circumstances for pediatricians who know the child and the family. Urgent care providers who may not have the benefit of that history must be especially vigilant for all available signs and symptoms to make diagnoses based on the full scope of the presentation. Michael Weinstock, MD Case Presentation (Please note: The Case Presentation is drawn directly from the treating physician’s notes, without editing or correction, …

Boerhaave Syndrome in a 41-Year-Old Female

Urgent message: While Boerhaave syndrome is a rare finding, a relatively high number of cases may present in the urgent care setting. As such, awareness of and vigilance for related symptoms are essential to taking a proper history and, ultimately, early diagnosis of acute, subacute, or chronic Boerhaave syndrome. John Shufeldt, MD, MBA, JD, FACEP, Amber Hawkins, and Carli Nichta, MS4 Introduction Boerhaave syndrome is a spontaneous esophageal rupture indicated in some cases by …

Lumbar Hernia: An Unusual Cause of Back Pain

Urgent message: Back pain is a common complaint in the urgent care setting. Common causes of musculoskeletal back pain include overuse and work-related injury. Other causes can include disc herniation, metastasis, osteoporosis, arthritis, spinal stenosis, and nephrolithiasis. Crystal N. Bharat MD, Ronald Dvorkin, MD, and Glenn G. Gray MD Case Presentation A 65-year-old female complained of 1 day of low back pain radiating to her left flank, which was aggravated with movement. Symptoms began while …

Acute Occlusion of the Abdominal Aorta in a Patient with Severe Peripheral Vascular Disease and Untreated Atrial Fibrillation

Urgent message: Acute aortic obstruction should be suspected in all patients with back pain and a history of peripheral vascular disease and atrial fibrillation, as over 50% of these cases are misdiagnosed, resulting in high mortality rates in affected patients. Kristopher Palmer, DO and JM Alderson, DO Introduction Aortic occlusion is a rare but potentially fatal vascular phenomenon that must be considered in all patients with peripheral vascular disease (PVD) complaining of severe pain. Here, …

Intermittent Abdominal Pain and Vomiting in a Teenager: One More Urgent Cause to Consider

Urgent message: Superior mesenteric artery syndrome should be included in the differential diagnosis in children with abdominal pain and weight loss with rapid increase in linear growth. Ralph Mohty, MS3, and Michael Esmay, MD Introduction Abdominal pain is one of the most common complaints in childhood. A minor self-limited condition such as constipation or viral gastroenteritis is usually the cause, but more serious conditions need further evaluation and management.1 Chronic abdominal pain is a term …

An Unexpected Cause of Amenorrhea

Urgent message: The simplest explanation for a mundane symptom may not always reflect the correct diagnosis. Urgent care providers should consider all the possibilities in order to reach the correct conclusion as early as possible, or risk missing a more serious underlying diagnosis. Introduction Sometimes a simple complaint results in a common diagnosis, but other times a rare diagnosis will be discovered. The following case illustrates the importance of considering a wide differential and obtaining …

Altered Mental Status in an Elderly Patient Due to Chronic Salicylate Toxicity

Urgent message: Urgent care providers must maintain a high index of suspicion for life-threatening conditions when assessing patients whose self-reporting of symptoms can be vague and nonspecific. Introduction Elderly patients often present for medical evaluation with vague complaints, oftentimes requiring the provider to obtain additional history from family and caregivers. Urgent care providers must maintain a high index of suspicion for life-threatening conditions based on non-specific symptoms. This case demonstrates the importance of recognizing a …

An Uncommon Mechanism for Work-Related Total Achilles Tendon Rupture

Urgent message: This is a really big deal to urgent care clinicians and operators. Introduction Achilles tendon (AT) ruptures account for approximately 40% of all operative tendon repairs.1,2 With 18 ruptures per 100,000 people, it is the most frequently ruptured tendon—and the incidence of AT ruptures has been steadily increasing over the past few decades.1–4 Typical patients include athletic males between the ages of 30 and 50.3 Because the AT is the strongest, yet most …

An Uncommon Mechanism of Work-Related Partial-Thickness Triceps Tear

Urgent message: Triceps tears are an uncommon acute injury that can occur from multiple mechanisms, including direct trauma. Assessment of these injuries requires obtaining a medical history and exam and a knowledge of characteristic diagnostic imaging findings. Early diagnosis and identification in patients presenting to an urgent care center is critical to ensure that appropriate treatment is initiated in a timely fashion. Introduction Triceps tendon (TT) tear is the least common of all tendon injuries …