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PDATES
Aa16-year-
oldamaleapresentsatoayouraoffice.aHeawasasentabyaanaorthopedist.aHeahasarecentlyahadasurg
icalafixationaofaaahumerusafracture.aTheapatientahasabeenagoingatoaphysicalatherapyaandaha
sabeenadevelopingaaarashaonahisaarmaafteratherapyathatadisappearsashortlyaafterareturningah
ome.aHeadoesanotahaveathearashaprioratoatherapy.aTheapatientadeniesafeversaandachills,aand
hisaincisionaisawellahealed,awithanoasignsaofainfection.aOfanote,atheapatientahasabeenaexperi
a
encingamoreahandaedemaathanatheaaverageapatientaandahasahadaedemaawrapsausedaatath
eaendaofatherapyatoahelpawithahisaswelling.aTheawrapsaareamadeaofaaasyntheticaplasticamate
rial.aThearashatheapatientagetsaisaerythematousaandablotchy,anotaraised;aitaisaonatheaoperativ
eaupperaextremity.aWhataisatheamostalikelyadiagnosis?
1.Contactadermatitis.
2.Atopicadermatitis.
3.Seborrheicadermatitis.
4.Psoriasis.a-aANSWER-aContactadermatitis.
,rationale:aTheapatient'sahistoryaandarashaareaconsistentawithaaalatexaoraplasticasensitivityadu
eatoatheaedemaawrapsausedainatherapy.
Elizabeth,aagea83,apresentsawithaaa2-
dayahistoryaofapainaandaburningainathealeftaforehead.aThisamorningasheanoticedaaarashawitha
erythematousapapulesaatathatasite.aWhatadoayouasuspect?
1.Varicella.
2.Herpesazoster.
3.Syphilis.
4.Rubellaa-aANSWER-aherpesazoster
rationale:aThearashaofaherpesazosteraisadistinctive,ainathataitaappearsaonaonlyaoneasideaofathe
body.aHerpesazosterabeginsainaaadermatomaladistribution,amostacommonlyainatheathoracic,a
a
cervical,aandalumbosacralaareas,aalthoughaitaalsoaoccursaonatheaface.aTheaclassicapresenta
tionaisawhenathereaisapainafora1-2adaysaprecedingatheaeruption.
Aabiopsyaofaaasmall,ayellow-orangeapapulonoduleaonatheaeyelidawillaprobablyashow:
1.Fragmented,acalcifiedaelasticatissue.
2.Matureasebaceousaglands.
3.Lipid-ladenacells.
4.Endothelialaswellingaandaanainfiltratearichainaplasmaacellsa-aANSWER-alipid-ladenacells
,rationale:aAabiopsyaofaaasmall,ayellow-
orangeapapulonoduleaonatheaeyelidawillaprobablyashowalipid-
ladenacells.aThisaisaaadescriptionaofaaanoneruptiveaxanthomaaofatheaeyelida(xanthelasma).
SandyaasksawhatasheacanadoaforaDolores,ahera90-year-
oldamother,awhoatakesaaabathaeveryadayaandawhoahasaextremelyadryaskin.aYouarespond:
1."Afterabathingaeveryaday,auseaaagenerousaamountaofamoisturizer."
2."Useaaaspecialamoisturizingasoapaeveryaday."
3."Youramotheradoesanotaneedaaabathaeveryaday."
4."Increaseayouramother'saintakeaofafluids."a-aANSWER-
"Youramotheradoesanotaneedaaabathaeveryaday."
a
rationale:aDoloresadoesanotaneedaaabathaeveryadayabecauseathatawillaexacerbateatheadryne
ssaofaheraskin
Helen,aagea39,acomesatoayouraclinicaforageneralizedajointapain,aespeciallyainatheakneesaanda
hands.aSheatellsayouathatatheapainaisamoderate,aspreading,aandasymmetrical.aSheareportsah
avingahadaaasoreathroataandalow-
gradeafeveraforaaafewadaysaandathenadevelopingaaarash,adescribedaasawarmaerythemaaofath
eacheeks,awhichalastedaabouta4adaysabeforeadisappearing.aYouaaskaheraifathearashaonatheac
heeksaincludedatheanasolabialafoldsaoracircumoralaskin,aandasheatellsayouathataitadidanotacov
eratheseaareas.aTwoadaysalater,asheadevelopedaaanonspecificamacularaeruptionathataprece
dedatheajointapain.aHerarashafadedawithina2aweeks,abutasheatellsayouathataitacomesaandagoes
, ifasheabathesainahotawateraoraspendsatimeainatheasunlight.aYourapatient'sasymptomsaareamo
a
staconsistentawithaaadiagnosisaof:
1.Rubella.
2.Erythemaainfectiosum.
3.Rheumatoidaarthritis.
4.Scarletafevera-aANSWER-aErythemaainfectiosum.
rationale:aErythemaainfectiosuma(fifthadisease)aisadistinguishedabyaitsaerythematous,awarm
rash,awhichagivesatheaappearanceaofa"slappedacheeks,"aandaitadoesanotainvolveatheanasola
a
bialafoldsaoratheacircumoralaregion.aWomenaareamorealikelyatoahaveajointapainaasaaasympto
maofaerythemaainfectiosum.
Whichapresentationaisamostaconcerningaforaskinacancer?
1.Darkapigmentationaofa1asolitaryanailathatahasadevelopedaquicklyaandawithoutatrauma.
2.Aa1-
mmablue,around,anonpalpableadiscolorationaofatheaskinathatahasabeenapresentasinceabirthaw
ithoutachange.
3.Aa5-mmablackamoleawitharound,aregularaboarders.
4.Aa2-mmabrownamoleathataisaraiseda1ammabutaroundaandaregulara-aANSWER-
Darkapigmentationaofa1asolitaryanailathatahasadevelopedaquicklyaandawithoutatrauma
a
.
rationale:aThisaisaconcerningaforaacralamelanoma.