SAEM Derm Exam with Questions and Answers

SAEM Derm Exam with Questions and Answers A 58 year old construction worker who has no primary care doctor comes to the emergency department because of a non-pruritic rash above his ankles (see Figure). Physical examination reveals bilateral erythematous and swollen ankles that are mildly warm but non-tender to touch. His overlying skin of both legs show mild scaling and thickened skin. There is no puncture site or visible opening in the skin, although he has prominent varicose veins bilaterally (see Figure). His temperature is 37C (98.6F). He appears to be in no acute distress. What is the most likely diagnosis? [image] Figure courtesy of eM A. eczema B. cellulitis C. psoriasis D. necrotizing fasciitis E. stasis dermatitis ANSWER e A patient with no medical history presents to the emergency department for a second opinion. Nearly a week ago, there was a rapid onset of malaise, headache, backache, and fever. A rash began to appear on the leg a few days after the initial symptoms and the patient presented to a hospital-affiliated walk-in clinic for assessment. The patient had no respiratory symptoms but was noted to have some lesions on the tongue. At the time of his assessment at the walk-in clinic, the fever had resolved and the patient was diagnosed as having a viral syndrome. At the walk-in clinic, a digital photograph of the rash was taken and inserted into his computer records (see top of Figure). It is now 3 days after the initial walk-in clinic visit. You are working in the emergency department where the patient presents complaining of a recurrence