A 35-year-old woman in her third trimester of her first pregnancy presents with a rash that initially appeared on her abdomen and has now spread to her upper thighs and buttocks. Upon examination, you observe an erythematous rash with small papules that have merged into patches in some areas. The rash is most prominent around her stretch marks on her abdomen, with the area around her umbilicus appearing unaffected. There are no blisters present. What is the probable diagnosis?
A 41-year-old man presents to the emergency department with ankle pain and a rash on his lower limbs. He has a history of childhood asthma and untreated hepatitis C. He admits to not taking his prescribed inhalers.
Upon examination, there is a raised, non-blanching rash on his lower limbs, but no swelling in the ankles.
The following blood tests were conducted:
– Hb: 138 g/L (Male: 135-180, Female: 115-160)
– Platelets: 189 * 109/L (150-400)
– WBC: 8.2 * 109/L (4.0-11.0)
– Neuts: 4.2 * 109/L (2.0-7.0)
– Lymphs: 3.0 * 109/L (1.0-3.5)
– Eosin: 0.8 * 109/L (0.0-0.4)
– Urea: 5.3 mmol/L (2.0-7.0)
– Creatinine: 89 µmol/L (55-120)
– CRP: 45 mg/L (<5)
– C3: 0.92 g/L (0.88-2.01)
– C4: 0.06 g/L (0.15-0.45)
Additionally, his urinalysis showed blood and protein.
What is the most likely diagnosis?
A 25-year-old woman presents with new skin lesions.
She underwent a renal transplant a year ago due to IgA nephropathy and has since had her immunosuppressive therapy adjusted multiple times. Her graft function is stable with an eGFR of 80 ml/min/1.73m². She also has a history of hypothyroidism and takes levothyroxine.
The patient first noticed the lesions 3 months ago, although she had seen them a few years prior and they disappeared on their own. The lesions are not itchy and are well demarcated depigmented patches on her arm, shoulders, and upper back. Under Woods lamp, the lesions shine a yellow-green color.
What is the most likely diagnosis?
A 72-year-old male presents to the acute medical take with left sided chest pain, worse on inspiration. On examination, you note his nails are yellow and clubbed with bilateral non-pitting oedema. Examination of his chest reveals reduced air entry of his left lung to mid zone, dull to percussion, with no wheeze.
He has a known past medical history of bronchiectasis diagnosed 3 years ago, for which he has been admitted 4 times in the past 6 months. He reports weight loss of about 7kg in the past 8 months. He last underwent an echocardiogram 3 years ago, during which a left ventricular ejection fraction of 55% was demonstrated.
A chest radiograph demonstrates a large left pleural effusion and a mark has been made by ultrasound for a pleural tap.
Pleural fluid analysis results are as follows:
pH 7.42
Protein 40 g/L (serum 58)
LDH 130 IU/L (serum 181)
Glucose 3.5 mmol/l (serum 6.2)
Amylase 22 u/l (serum 32)
Triglycerides 1.90 mmol/L (serum 2.2)
Cytology awaited
AFB awaited
What is the underlying diagnosis?
A 68-year-old woman comes to the clinic with a newly noticed skin marking. She is confident that it was not present six months ago and has not caused any discomfort or itching. Upon examination, there is a 7mm raised lesion with slight ulceration on her chest. What clinical feature would suggest a higher likelihood of squamous cell carcinoma rather than basal cell carcinoma?
A 56-year-old female came to the dermatology clinic complaining of an aggravating itchy rash. She had a history of psoriasis which had been well managed but had recently worsened. Upon examination, there were several distinct oval-shaped, red/pink raised lesions with silvery scales on her elbows, knees, legs, and scalp. She disclosed that her doctor had prescribed a new medication for her two weeks ago. Which of the following drugs is most likely responsible for her current condition?
A 28-year-old man arrives at the emergency department complaining of a fever and a painful rash. He had recently been prescribed oral amoxicillin by his GP to treat a chest infection. Although his cough had improved, he noticed the rash shortly after. He then experienced joint pain and a general feeling of being unwell. Upon examination, he has a maculopapular rash with target lesions, blistering lesions, and mucosal erosions, including in his oral cavity. His chest appears normal. What timing of exposure is most indicative of Stevens-Johnson syndrome?
What is a recognized medical use for botulinum toxin type A?
A 28-year-old man presented to the dermatology clinic with an itchy, vesicular rash on his buttocks and proximal forearms. He had no other health concerns. After a skin biopsy and direct immunofluorescence, granular IgA was found at the dermal-epidermal junction, leading to a likely diagnosis and treatment with dapsone and dietary recommendations. However, six weeks later, he reports increased fatigue. What investigation is most crucial at this point?
A 75-year-old woman presented to dermatology clinic for evaluation of a skin lesion on her left cheek. The patient had recently returned to the United Kingdom after residing in southern Spain for the past 25 years. She reported the development of a lump just below her left eye over the last six months. She also recalled having an area of slightly dry and sore skin in a similar location before the emergence of the lesion, but did not seek medical attention for it. The patient denied experiencing any symptoms from the lesion, but was distressed about its unsightly appearance.
The patient’s medical history included rheumatoid arthritis, type 2 diabetes mellitus, hypertension, and intermittent episodes of gout. She had no prior dermatological conditions. Her regular medications were methotrexate 15 mg weekly, metformin 1000 mg twice daily, ramipril 2.5 mg daily, and naproxen 500 mg as needed. She denied any previous cancer treatments.
During examination, an approximately spherical nodule measuring 11 mm in diameter was observed on the patient’s cheek, 15 mm inferior to her eyelid. Crusting was noted on the surface of the nodule, but there was no hyperkeratosis, induration, or ulceration.
What is the appropriate treatment technique for the patient’s lesion?