A 45 yo F with a PMH of TTP presented with a rash on her for | Figure 1

slambert56

Family Medicine Resident

A 45 yo F with a PMH of TTP presented with a rash on her forehead that has been present for over a month that has slowly progressed into a larger rash. She denies pain, pruritus, or new lotions on this area. When asked about hair products, soaps, dyes, and any new creams she is using she does not identify any new ones but she is unsure if her hairdresser changed products on her. She uses dove and another non scented soap which are not new. She did try some triamcinolone cream by another provider and she reports “it made it drier” and thus she stopped this. No other rashes including flexural areas. She denies fever, joint pain, Malay rash, mouth ulcers, rash behind the ears.

No other rashes observed on exam.

I prescribed lotrisone cream.

Thoughts?

59 y/o Latino female with a pmhx of asthma, hyperlipidemia, A1C 5.8 % presents to the clinic with a new onset "rash" that started approximately 8 months ago. She states it started on her abdomen bilaterally in the left lower quadrant bilaterally and then extended to her brachium and antecubital fossa on both arms. She has some pruritus and a "tickling sensation" occasionally in the affected areas. Denies any burning, stinging or any other sensations. The areas of pigmentation change occurred over the last few months. ROS: negative. Family history: non-contributory. Any help appreciated. TY

22-year-old female with hx of rwith 4 month Hx of pruritic vesicular lesions on the dorsal of her hands as well as new lesions just lateral to her left eye. She also has a large vesicular lesions on the back of her left foot. She denies any additional constitutional symptoms And no problems with bowels. She has no new soaps or shampoos or lotions.

A 43 year old female presents to the clinic with the following examination finding. The patient states that for the past few years she notices this rash that occurs on the dorsum of her hands and can extend up to her elbows. She describes the rash as pruritic at times and also states that the rash burns most of the time. She has noticed that the rash occurs mainly during the spring, will last for one week then regress. She states some association of the rash with humidity. Patient denies allergies, denies joint or muscle pains and does not take any daily medicine. She has tried steroid cream in the past but reports it did not work and she stopped using it after one application. Patient denies any new lotion, gardening, new laundry detergent, new soaps or shampoo. FDLMP was 2 weeks ago. On physical exam, a vesicular rash that is concentrated on the hands with sparse vesicles noted on the antebrachium is seen. Past medical history includes inactive hepatitis C.

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.

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.

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.

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?

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