A 27-year-old male with a history of epilepsy presents with a fever and rash. He has been experiencing difficulty controlling his seizures and has recently started taking carbamazepine and valproate. Over the past week, he has developed a painful, diffuse erythematous rash that appears to slide laterally upon palpation. In addition, he has blistering and inflammation in his oral cavity. What is the probable diagnosis?
A 32-year-old man visits her GP with a complaint of a rash in his groin area. He recently returned from a beach vacation and had used a cream recommended by a local pharmacist to treat the rash. However, the rash has only worsened since then. The patient reports that the rash is itchy and painful.
Upon examination, the rash appears as a scaly and raised border with a sharp red outline. It spreads asymmetrically in the area but does not involve the scrotum. The rash is slightly raised and has a clearer center.
What would be the most appropriate clinical investigation, if any, to aid in the diagnosis?
A 32-year-old male patient arrives at the Emergency Department (ED) with a complaint of painful genital sores that have been present for three days. He reports experiencing discomfort while urinating and flu-like symptoms, including myalgia and a low-grade fever.
During the examination, multiple small, white painful ulcers are observed throughout the genital area. The patient also has tender lymph nodes in the inguinal region.
A swab is taken of the ulcers, but while waiting for the results, what is the most appropriate next step?
A 32-year-old woman from Brazil, who has been studying abroad in the United States, presents to the Dermatology Clinic with multiple hypopigmented lesions on her arms and legs. She reports decreased sensation within these areas and tenderness upon palpation of the superficial nerves. Additionally, she has a non-painful ulcer on her foot. Laboratory results show:
– Hemoglobin (Hb): 130 g/L (normal range: 120-160 g/L)
– White blood cell count (WBC): 7.2 x 10^9/L (normal range: 4.0-11.0 x 10^9/L)
– Platelets: 220 x 10^9/L (normal range: 150-400 x 10^9/L)
– Sodium (Na+): 142 mmol/L (normal range: 135-145 mmol/L)
– Potassium (K+): 4.2 mmol/L (normal range: 3.5-5.0 mmol/L)
– Creatinine (Cr): 90 umol/L (normal range: 50-120 umol/L)
What is the most useful test to confirm the diagnosis?
A 28-year-old man presents to the emergency department with sudden onset of severe left-sided chest pain. His vital signs are as follows: temperature 37.2ºC, blood pressure 165/92 mmHg, pulse 129/min and regular, and respiratory rate 20/min. Upon examination, he appears anxious, diaphoretic, and agitated. His nasal mucosa is atrophic, and both pupils are dilated. Heart sounds are regular without murmurs or rubs, and the lungs are clear. An initial ECG shows ST-segment elevation in leads V4-V6, and a chest x-ray is normal. Laboratory studies reveal elevated troponin T levels.
Which of the following treatment options should be avoided in this patient?
A 36-year-old man presents to the emergency department with chest pain. He has no significant medical history and is not taking any regular medications. He has been awake for twenty-four hours after consuming a large amount of cocaine.
During examination, he appears anxious and is sweating profusely. His vital signs are as follows: heart rate 111 beats per minute, respiratory rate 21/minute, blood pressure 180/100 mmHg, oxygen saturation 97% on room air, and temperature 37ºC. Chest auscultation is normal, and there are no added sounds or murmurs in the heart. The jugular venous pulse is not raised, and there is no peripheral edema. Abdominal and neurological examinations are unremarkable.
The ECG shows sinus tachycardia with T wave inversion in leads V5-V6, I, and AVL. In this situation, what medication should be avoided?
A 35-year-old man is brought to the Emergency Department after ingesting a large amount of his dad’s amlodipine tablets due to financial stress. On arrival, his blood pressure is 90/60 mmHg, and his heart rate is 110 bpm and regular. The paramedics have initiated IV normal saline.
What is the next best course of action in managing this patient’s overdose?
A 35-year-old woman presents to the doctor with a maculopapular rash 4 weeks after returning from a trip to Brazil. She denies any sexual activity during her trip. While in Brazil, she went on a hike through the rainforest and recalls a strange lesion on her leg that looked like a large, wart-like lump that eventually healed.
The following test results were obtained: Hb 130 g/l (normal range 120-160 g/l), WCC 6.2 × 109/l (normal range 4.0-11.0 × 109/l), PLT 180 × 109/l (normal range 150-400 × 109/l), Na+ 142 mmol/l (normal range 135-145 mmol/l), K+ 4.2 mmol/l (normal range 3.5-5.0 mmol/l), Cr 80 μmol/l (normal range 50-120 µmol/l), P24 negative, TPHA positive.
What is the most likely diagnosis?
A 56-year-old man presents to the dermatology clinic with a hyperpigmented rash on his neck, axillae, and groin that has worsened over the past few weeks. He reports increased shortness of breath and decreased exercise tolerance over the past 3 months. He is a smoker and has COPD, which is treated with a high dose salmeterol/fluticasone inhaler. On examination, he has a blood pressure of 132/82 mmHg, a pulse of 65 beats per minute, and a BMI of 22 kg/m². There is a quiet wheeze on chest auscultation and mild tenderness in the epigastrium.
Investigations reveal a hemoglobin level of 90 g/l, platelets of 191 * 109/l, WBC of 7.0 * 109/l, and elevated CRP and ESR levels. His electrolyte and renal function tests are within normal limits.
What is the most appropriate next investigation to perform?
A 20-year-old man presents with tear-drop papules on his trunk and limbs. He is asymptomatic otherwise. The clinician suspects guttate psoriasis. What is the best course of action for management?