Practice Management
The patient is a 37-year-old male who presents with a red, round lesion with a fine, scaly plaque on his face which developed over the past month. He also reports seeing similar lesions on his scalp while combing his hair. None of the lesions are painful, though he describes them as “slightly itchy.” No history of injury to the area. View the image and consider what your diagnosis and next steps would be.
Read More
The patient is a 44-years-old previously healthy male who presents with continuous, typical cardiac chest pain of a few hours’ duration, with no associated symptoms. He reports that this is a first-time occurrence. He also relays that he is a nonsmoker, nonalcoholic with no family history of heart disease. On physical examination, you find his vital signs are stable. Cardiac auscultation reveals normal first and second heart sounds with no murmurs. Labs reveal slightly elevated …
Read More
The patient is a 42-year-old male who presents after referral from a diagnostic testing site with an abnormal ECG, obtained during a preoperative evaluation. He reports a history of hypertension and symptomatic inguinal hernia, and acknowledges chronic right groin pain. He is otherwise asymptomatic, including robust exercise tolerance. View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Tom …
Read More
The patient is a 58-year-old male who presents with a painful mass at the lower aspect of his right knee. He denies any impact to his leg, but reports that the pain started “some time ago,” getting progressively worse. Review the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.
Read More
The patient is a 24-year-old male who presents for a pre-employment physical. While undergoing his exam, he mentions being “curious” about tiny papules he noticed recently in his mouth on the inside of his cheek. They seemed to be a group of slightly yellow lesions, present on both sides of his mouth. He reports that they have been there “for a few months,” but they have not caused discomfort so he hasn’t sought care. …
Read More
The patient is a 67-year-old male with no medical history who presents with severe chest pain radiating to his left arm that started 1 hour prior to arrival. The patient also endorses progressive dyspnea on exertion of six months duration. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case contributed by Gregory J Ducach, MD.) Figure 1. ECG upon urgent …
Read More
Urgent message: The urinalysis is a ubiquitous test in urgent care settings, though there is nuance and complexity in its interpretation. An evidence-based approach is essential to assuring correct interpretation and decision-making. Douglas W. Wallace, MD, Blakeley Hudson, MD, and Matthew Delaney, MD Introduction The urinalysis (UA) is one of the most commonly ordered tests across a variety of practice settings. Despite its ubiquity, interpreting a UA can be complicated and nuanced. Given the variable …
Read More
Urgent message: Though it occurs relatively rarely, mushroom toxicity can result in irreversible organ damage and, in certain cases, death if not recognized quickly. Diagnosis can be difficult due to the facts that toxicity may present at different intervals from time of ingestion, depending on the species of mushroom, and initial symptoms are nonspecific and similar to those of benign gastrointestinal illnesses. Timely consultation with a poison control center may be life-saving. Michele L. Stowe, …
Read More
Shelter at home. Wash your hands. Use a tissue and properly dispose it. See your primary care if you are not feeling well. The advice goes on and on. But what if you are homeless? What if you do not have ready access to soap and water, or hand sanitizer, or tissues, or medical care? Universally, efforts to contain and mitigate pandemic diseases such as COVID-19 leave out a vulnerable population: people experiencing homelessness (PEH). …
Read MoreAfter the vivid video of the wrongful death of George Floyd went viral in late May, millions of people of all races in America and abroad took to the streets to demonstrate in the name of solidarity and justice. This was all motivated by one man’s story and, more broadly, was a potent remind of the power of story to capture our attention and provoke action. George Floyd was the most recent widely publicized victim …
Read More