ebf5296e 09f5 400c bc5a d7f2fe700b38

TheFastDoctor

•Follow

Family Medicine

Some actions are only available when you log in.

Report case

Report this to our moderators

Acne type Skin Rash

Next

You can view up to 4 cases without signing up Sign up for unlimited access

45yom first experienced a scarring skin eruption at the age of about 12 years. It is limited to the back, almost none on the rest of the body, relatively sharp demarcation. This responded to Tretinoin but he stopped due to side effects. He is worried the same would happen if restarted. Zinc did not help.

Current depression and sleep problems, Psychiatrist Rx Vortioxetine 20 mg plus Melatonin for "Delayed Sleep Syndrome". Also Methylphenidate when working (ADHD since childhood).

Smoker and use a lot of caffeine. Thyroid normal, small cyst abome testicle, not enlarging, slighty increased Testosterone and SHBG, Lactate, triglyderides and he has 1+ biliuria in spite of normal liver functions and serum bilirubin.

Any ideas?

35 comments

Sign up to add a comment

More about this case

UnresolvedCommon presentationTrending

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ After initiation of CPAP, the patient’s snoring, gasping, observed apnea, and morning headaches have resolved. Due to his work schedule, he is unable to nap or sleep enough hours. He feels his sleep quality is better with CPAP and he is now able to sleep in on the weekends. He denies a history of driving while drowsy or having motor vehicle accidents.\ However, his repeat Epworth score on CPAP was still 16/24.\ In this patient, besides treating sleep apnea it is important to consider insufficient sleep syndrome in your differential diagnosis.\ The patient had work and family commitments that did not allow him to sleep the recommended 7-8 hours per night and it was likely responsible for his residual sleepiness.\ The patient was counseled on appropriate sleep hygiene and to ensure adequate amount of time dedicated to sleep in any given 24 hour period. We also advised that the patient not drive or operate heavy machinery until his sleepiness is resolved.\ Summary: In evaluating hypersomnia, it is important to consider multiple etiologies including insufficient sleep syndrome, which may not be obvious unless a detailed sleep history is obtained.](https://app.figure1.com/case-detail/0cbd40bf-d4f9-4335-9882-6980204eaa63)

\ \ A 49year old woman with no co-morbidities presented again with sudden difficulty of breathing at night after sleeping for 6 months duration. Cardiology referrals were done during previous presentations (2months back) and all findings were normal including a 48hr holter monitoring. Examination and investigations were all normal and psychiatry referral was done and was being treated as possible depression with antidepressants. But the symptoms paroxysmal nocturnal dyspnoea still persisted and occurs 3-4 times a week usually 2 hrs after falling asleep. patient suddenly wake up feeling her airway is collapsing and lasting for 3-4 minutes, no such symptoms during the day. Examination findings were normal. please kindly advice on how to proceed from here?](https://app.figure1.com/case-detail/5410c897-813a-4fda-8e7b-39a05a4bd695)

\ \ The pt is M 49 yo with hx CVA 2 yrs ago. Now presents with sleep disturbance described as "stomach feels like I'm falling" and wakes him up. He says the sensation is similar to going over a hill in a car or roller coaster. Mild confusion upon waking. Any ideas? Focal seizure maybe?](https://app.figure1.com/case-detail/7ba19c9d-61ac-47cb-a577-8f127446b851)

\ \ nice delta waves (stage N3), polysomnogram of 10 year old. # sleep study PSG](https://app.figure1.com/case-detail/8a476d7d-8f18-4902-a7e4-088c2c3db8dc)

Trending now

\ \ 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.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ 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.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ 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.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ 70 yo WF with 20y hx HTN lost 21 lbs on a semaglutide but still BMI over 30, shows drop in BP when standing, stabilizing at 102-116 systolic, 65-75 diastolic. Discontinued all HTN meds x 30 days and no episodes of HTN. Could a small weight loss like this cause a drop to normal BP? Has anyone heard of a side effect of lowering BP?](https://app.figure1.com/case-detail/636fd008-29e2-47f4-8ba4-fbee9d527051)