pruritic rash<p><span style="font-family:arial,helvetica,sans-serif; font-size:12px">A 16-year-old boy joined the soccer team about 1 month earlier. Shortly thereafter, a persistent, pruritic rash developed on the dorsa of his feet. </span></p>
red rash resisted topical antifungalsA topical antifungal cream has not cleared the red, bumpy rash on a 6-year-old girl’s chin and paranasal area.
stubborn lesion<p style="margin-top: 0px; margin-right: 0px; margin-bottom: 16px; margin-left: 0px;"><img src="/sites/default/files/Untitled-2.jpg" style="display: block; float: left; margin-left: 8px; margin-right: 8px;" width="150" height="114"></p><p>A 42-year-old woman complains of a “callus” of 6 months’ duration on the thumb of her dominant hand. The persistent lesion responds to the use of a pumice stone and moisturizers but quickly returns.<br><em><strong></strong></em></p><p><em><strong>What do you suspect?</strong></em></p>
versicolor<p><img src="/sites/default/files/Untitled-1_0.jpg" width="250" height="163" style="border-style: none; display: block; border-width: 0px; margin-left: 8px; margin-right: 8px; float: left;" class="image" /></p><p><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 16px;">A slightly pruritic, pigmented rash of several weeks’ duration on the right side of the abdomen prompts a 27-year-old man to seek medical evaluation.</span></p><p><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 16px;"><br /><strong><em>Which of the following would you include in the differential diagnosis?</em></strong></span></p>
What's the Take Home?, Ankle Pain, PainA 57-year-old man presents with pain in his left ankle. He denies trauma to the ankle or foot.
Elfin Face<p><img src="/sites/default/files/Untitled-18.jpg" style="float: left; margin-left: 4px; margin-right: 4px;" width="100" height="168"></p><p>A Four-year-old boy born at 35 weeks’ gestation to a gravida 2, para 1, 23-year-old mother via emergency cesarean delivery because of fetal distress. Birth weight, 1670 g (3 lb 11 oz). Apgar scores, 8 and 9 at 1 minute and 5 minutes, respectively. At birth, child found to have supravalvular aortic stenosis, peripheral pulmonary stenosis, and ventricular septal defect. Gastroesophageal reflux, laryngomalacia, bilateral inguinal hernias, hypothyroidism, hypercalcemia, growth retardation, and developmental delays noted at various times during the first 4 years of life. Family history, unremarkable.</p>
ACE Inhibitor and ARB Combination TherapyARBs were initially developed because ACE inhibitors were associated with “escape.” That is, after initial blockade of the RAAS with ACE inhibitors (at the step of angiotensin I to II conversion), renin levels rebounded, and as a result, so did angiotensin II and aldosterone levels (the latter called aldosterone synthesis escape).
Crepitus<p><img src="/sites/default/files/Untitled-4.jpg" width="200" height="183" style="float: left; margin-left: 8px; margin-right: 8px;"></p><p>A 72-year-old man presents to the emergency department (ED) after a violent assault. He complains of facial, neck, and chest pain with odynophagia and hoarseness. He did not lose consciousness, and he denies dyspnea, epistaxis, cough, and hemoptysis. His past medical history includes gastroesophageal reflux disease and previous right shoulder and right knee surgery.</p><p> </p>
Port-Wine Stain and Leg Hypertrophy<p><img src="/sites/default/files/Untitled-19.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="200" height="101">This newborn was noted to have an impressive nevus flammeus on the trunk and left lower extremity (<strong>A</strong>). He was also noted to have subtle hypertrophy of the left lower extremity: his left foot was about 0.5 cm wider and longer than the right (<strong>B</strong>), and his left leg was 0.75 cm longer than the right.</p>
Child With Leg Pain, Swelling, and Varicosities<p><img src="/sites/default/files/Untitled-9_0.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="142" height="271">A 7-year-old girl presented with pain and discomfort in the left leg that was exacerbated by physical activity. She had been born with a port-wine stain on the left knee. As her mobility increased, she occasionally complained of discomfort in the left leg.</p><p>Klippel-Trenaunay syndrome (KTS) was diagnosed at age 3 years after an evaluation for swelling, discoloration, and pain of the left leg. Magnetic resonance angiography and venography had revealed abnormally dilated, tortuous veins in the subcutaneous tissues from the distal thigh to the posterolateral calf with involvement of the proximal anterior tibial muscle. The parents had elected for conservative management with observation.</p><p>At the patient’s current visit, she was noted to have 2 erythematous to bluish vascular plaques on the superior and inferior aspects of the patellar surface with subcutaneous nodular swellings and varicosities predominantly on the lateral aspect of the lower leg.</p>
Kaposi Varicelliform Eruption<p><img src="/sites/default/files/Untitled-10.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="200" height="108">A 46-year-old man with HIV infection was hospitalized for evaluation of a nonhealing, tender wound on the right lower extremity. The lesion had been present for 2 months following a minor injury to the leg, but it flared the week before admission. A month before hospitalization, the patient was given trimethoprim/sulfamethoxazole and minocycline for treatment of the wound, with no improvement.</p>
Cerebral Venous Sinus Thrombosis<p><img src="/sites/default/files/images/May_figA%26B_CTscan.jpg" style="margin-left: 8px; margin-right: 8px; float: left;" width="250" height="149">A 73-year-old woman was found on the ground by her husband. She was unable to move her left arm or leg, and she was confused and disoriented.</p><p>In the emergency department, the patient was drowsy and unable to follow commands. She withdrew from painful stimulation to her right side but not to her left. She did not open her eyes to verbal or painful stimuli. </p>
Peripheral Artery Disease<P><IMG style="FLOAT: left; MARGIN-LEFT: 8px; MARGIN-RIGHT: 8px" src="/sites/default/files/images/Gregory%20W%20Rutecki%2C%20MD.jpg" width=150 height=176>Recently published evidence- based guidelines for peripheral artery disease (PAD) highlight some disturbing facts about the prevalence and complications resulting from this disease.<SUP>1</SUP> For instance, the rate of myocardial infarcts, strokes, and heart disease is higher among patients with PAD than among those with coronary artery disease.<SUP>2</SUP> As a result, patients with PAD have a 6 times greater risk of dying from associated heart disease compared with agematched controls.</P>
Lambl Excrescences<p><img src="/sites/default/files/images/May_MRI_Scan_2011.jpg" style="float: left; margin-left: 8px; margin-right: 8px;" height="135" width="100">A 47-year-old woman presented with altered mental status and slurred speech. Past medical history included hypertension, multiple strokes, and alcohol- induced pancreatitis. The patient frequently used cocaine. Initial blood pressure was 198/116 mm Hg. A urine drug screen was positive for cocaine. The neurological findings evolved over 12 hours to include further slurring of speech, leftward tongue deviation, left facial droop, and left-sided hemiparesis.</p>
Chronic Fatigue<p><img alt="" height="112" src="/sites/default/files/images/adrenal_insufficiency_2011.jpg" style="float:left" width="100" />Among the symptoms of acute adrenal insufficiency are dehydration, hypotension, hypoglycemia and, at times, delirium with altered mental status. Acute adrenal insufficiency is usually a complication of an acute medical illness, such as sepsis associated with tuberculosis or chronic fungal infection or disseminated intravascular coagulation.</p>