Journal of Urgent Care Medicine

A 43-Year-Old Woman with a New Ulcer on One Hand

A 43-year-old woman presents with 2 weeks of a smooth nodule on her right hand. The patient denies recent travel but recalls that she “banged up” her hand while cleaning out a fresh-water fish tank prior to noticing the nodule. Past medical history is significant for renal transplantation. Exam reveals a tender, erythematous plaque with an ulcer on dorsal aspect of her hand. View the image and consider what your diagnosis and next steps …

A 12-Year-Old Boy with Knee Pain After a Baseball Game

The patient is a 12-year-old boy who presents with pain in his left knee. His mother reports that during a baseball game earlier in the day he slid hard into a base and came up limping. Review the x-rays taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

39-year-old Male with Sharp, Nonradiating Chest Pain

History: A 39-year-old male with no known past medical history presents to urgent care for evaluation of several hours of sharp, non-radiating, left-sided chest pain. The pain is non-exertional, non-pleuritic, began after his last meal and resolved without intervention approximately 30 minutes prior to arrival. No history of similar pain in the past. No associated shortness of breath, nausea, vomiting, or diaphoresis. View the ECG taken and consider what your diagnosis and next steps would …

A 55-Year-Old with a Recent History of Rash

A 55-year-old female presents to urgent care with a few weeks of a mildly pruritic rash on her trunk and arms. On examination, there are scattered erythematous, fine, scaly plaques. The coin-like plaques are round or oval in configuration and affect her extremities symmetrically. The patient denies current medications or any personal or family history of dermatologic conditions. She reports no systemic symptoms. However, she shares that she has been taking longer and more frequent …

An 18-Year-Old with Diffuse Abdominal Pain

An 18-year-old male presents to urgent care with widespread abdominal “gas pain” for several days. He denies changes in diet or changes in bowel habits. However, he recalls having a hard collision with another player during a lacrosse game prior to onset of symptoms. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

A 10-Year-Old with Fever, Headache, Muscle Aches, Nausea—and a Suspicious Rash

The patient is a 10-year-old girl who presents to urgent care with 3 days of fever, headache, muscle aches, nausea, and a skin rash. She has a temperature of 102°F. On examination you find numerous erythematous macules and purpura on her palms and the soles of her feet. The patient is immunocompetent with an unremarkable medical history. Her mother recounts no recent travel from their home in North Carolina, but notes that the patient spent …

A 58-Year-Old Male with Chest Pain

The patients is a 58-year-old male who presents with chest pain. He describes it as sharp, lasting seconds, and worsened by lifting objects at work. Review the initial ECG taken and consider what your diagnosis and next steps could be. Resolution of the case is described on the next page. (Case presented by Tom Fadial, MD, Assistant Professor, McGovern Medical School, The University of Texas Health Sciences Center of Houston.)

A 46-Year-Old Male Who Presents Due to His Defibrillator Firing

The patient is a 46-year-old male with a history of hypertension and congestive heart failure who presents complaining of his defibrillator firing—twice yesterday and once today. He denies chest pain, shortness of breath, fever, nausea or vomiting. He ran out of his carvedilol about 1 month ago. View the initial ECG and consider what your diagnosis and next steps would be.

An 81-Year-Old Female with a History of A-Fib and a Recent Syncope Event

The patient is an 81-year-old female with past medical history of atrial fibrillation on apixaban who presents to urgent care after a syncopal episode 30 minutes prior to arrival. The patient felt lightheaded while being pushed in her wheelchair and then lost consciousness. There was no trauma. She returned to baseline approximately 2 minutes after the event. There was no seizure activity. The patient denied associated chest pain, shortness of breath, headache, urinary or fecal …

A 13-Year-Old Girl with Fever, Chills, Dry Cough, and Myalgia

A mother brings her 13-year-old daughter to your urgent care center with a complaint of fever, chills, dry cough, and myalgia for 3 days. On exam, the patient is febrile (101°F). In addition, there is conjunctival injection and blanching erythematous patches on the face and neck. The mother mentions that the family returned from a trip to Brazil 10 days prior. While traveling they ate local food, drank local (unfiltered) water, sustained a few mosquito …