Male, 48 years old, rural worker. The patient requests a med | Figure 1

ReginaldoCastro

Internal Medicine

Male, 48 years old, rural worker. The patient requests a medical check up. He complains of itching in hemiface on the right. He does not use medications and he has duodenal ulcer. Considering the pictures, what advice would you give to this patient?

Case Discussions:

• Case 1: I have had a 70 yo male patient with chronic cough for 20 years. Spirometry, x-ray, and blood test NAD. He has tried medication for GERD without any success. He has also tried cortisone inhalers or nasal spray without any success. He doesn't take any medications. He has never smoked and he doesn't have any allergies. The coughing is kind of associated with his speech and it's always dry. Doesn't matter what time during the day. Any ideas?

• Case 2: 37 yrs old male, chronic smoker- smokes 12 cigarettes per day. X-ray was taken for a migration purpose. He was rejected in a medical round saying he has a granuloma in the lungs. Will the granuloma spread? Any idea?

• Case 3: Male, 57 years old. He is asymptomatic and does not use medications. The patient was a smoker for 23 years but stopped smoking 5 years ago. He is interested in knowing the result of ECG and chest X-ray. What alterations in these exams?

• Case 4: 24 y.o. male presents to the Emergency Department with acute-on-chronic persistent open wound infection to the right neck. Positive past history of MRSA. Patient is homeless and uses IV heroin. He eloped from the Emergency Department after CT scan. Medical records indicate he was being treated for the past two months with vancomycin at a nearby hospital. I will update if I receive any more information.

• Case 5: A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

• Case 6: A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

• Case 7: A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

• Case 8: Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?