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?
An 83-year-old man visits the dermatology clinic with scalp changes. He is bald and has noticed thickened and abnormal skin. He has a history of sun exposure from living in Spain for five years but has now returned to the UK permanently. He also has a history of smoking, but quit 15 years ago, and has quit drinking. He has been diagnosed with COPD, fractured NOF, gout, and hypertension. He regularly uses ipratropium, seretide, allopurinol, ramipril, amlodipine, and alendronic acid.
During the examination, the scalp appears erythematous with thickened plaques. It is mildly tender and slightly irritated. What is the most suitable treatment?
The following patient is undergoing treatment for epilepsy:
What is the probable underlying diagnosis for this case?
A 32-year-old man comes to the clinic complaining of a rash on his foot. He reports that he first noticed it four weeks after returning from Thailand. The rash is extremely itchy and has been causing him sleepless nights. He has no medical history and does not take any medications regularly. During the examination, a serpiginous track with erythema and oedema is observed on the superior aspect of his right foot.
What is the preferred treatment for this ailment?
A 78-year-old female presents to the hospital after experiencing a seizure where she lost consciousness and had twitching in all four limbs. She has a history of a previous stroke resulting in mild right-sided weakness and is also a type 2 diabetic. The patient is diagnosed with her first generalized seizure and is prescribed lamotrigine. During her hospital stay, she develops a sore throat and the following day, the healthcare provider notices peeling skin on her lower lip and a new well-defined red rash on her trunk. What is the most likely diagnosis?
A 42-year-old woman presents to the Rheumatology Clinic for evaluation. She has been diagnosed with rheumatoid arthritis and has been on various treatments, including methotrexate and biologic agents, but has not experienced significant improvement in her symptoms. She reports joint pain and stiffness, particularly in her hands and feet, which is affecting her ability to work as a hairdresser.
On examination, there is evidence of synovitis in multiple joints, including the wrists, metacarpophalangeal joints, and ankles. Laboratory investigations reveal the following:
Investigations Results Normal Values
Haemoglobin (Hb) 129 g/l 120–160 g/l
White cell count (WCC) 7.8 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 240 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 90 µmol/l 50–120 µmol/l
Alanine aminotransferase (ALT) 42 IU/l 5–30 IU/l
Alkaline phosphatase (ALP) 80 IU/l 30–130 IU/l
Bilirubin 10 µmol/l 2–17 µmol/l
Erythrocyte sedimentation rate (ESR) 45 mm/hour 1–20 mm/hour
What is the most appropriate next step in management for this patient?
A 67-year-old woman presents to the cardiology clinic after being admitted for a NSTEMI. During her hospital stay, an echocardiogram revealed mild-moderate LV systolic dysfunction with an ejection fraction of 40%. She reports feeling well since discharge, but experiences mild breathlessness when climbing two flights of stairs. During the examination, the physician notices a rash on her lower legs consisting of tense blisters and minimal underlying edema. Which medication is most likely responsible for the rash?