Practice Management
The patient is a 57-year-old female who presents to urgent care with progressive shortness of breath and chest pain of “several weeks” duration. On exam, she is nonobese, normotensive, slightly tachycardic, and tachypneic with clear lungs and distant heart sounds. View the initial ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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A 6-year-old girl presents to urgent care for vaccinations at the start of the school year. Her father asks the pediatric provider to look at bumps that developed on her abdomen about 4 weeks ago. They consist of tiny papules, some scattered and some in linear configurations. The patient is asymptomatic without pain or itching. Her father is concerned because they have not resolved. View the image in this context and consider what your diagnosis …
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The patient is a 36-year-old male who presents with left hip pain for “years.” The pain is motion- or position-related and over time there has been occasional pain in his buttock, back, and thigh. Additionally, he has stiffness, clicking, locking, and catching. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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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.
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The patient is a 60-year-old woman who presents to urgent care after developing dark areas over both legs over the course of the past few days. They are extremely painful. On examination, there were violaceous and dark brown, retiform plaques, some depressed and some crusted, over the legs. The patient has a history of diabetes, hypertension, and chronic renal insufficiency for which she required hemodialysis. View the image and consider what your diagnosis and next …
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The patient is a 31-year-old male who presents with lateral ankle pain after an inversion injury during a game of basketball. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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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 …
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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 …
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The patient is a 30-year-old male who presents with 2 days of difficulty swallowing and what he calls a painful “bump” on the right side of his neck. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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The patient is a 36-year-old male with a history of tobacco and alcohol use who presents to urgent care with sudden-onset substernal chest pain and shortness of breath that began 1 hour prior to arrival. View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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