حالات طبية متجددة ..

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أعتذر عن التأخر بالمتابعة :
الجواب الصحيح هو :

اقتباس: histoplasmosis 3

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الحالة جدا جدا سهلة ....
A Pustular Rash and Fever in a 45-Year-Old Woman

A 45-year-old woman presents to the emergency department (ED) with a 2-day history of an acute-onset, mildly pruritic rash. The rash started in her axillae and groin and has since progressed to the rest of her body. She then developed a fever this morning. She was diagnosed with pneumonia 4 days ago and has been taking azithromycin since that time. She was previously in good health, and her past medical history and family history are negative for psoriasis, arthritis, and other significant medical conditions. She has no known history of drug allergies. She does not smoke and drinks an average of 2 glasses of wine each week. She is a teacher, and she has 2 young children at home.

On physical examination, the patient appears to be in no acute distress. Her vital signs include a temperature of 102.0°F (38.9°C), a pulse rate of 88 bpm, a blood pressure of 124/76 mm Hg, and a respiratory rate of 16 breaths/min. Fine crackles are auscultated in the left lower lung field. A complete skin examination reveals hundreds of nonfollicular pustules on erythematous bases diffusely spread over her face, trunk, axillae, groin, arms, and legs. The lesions are without any crust or scale. No lesions are observed on her palms, soles, or mucous membranes. The remainder of the physical examination is unremarkable.

Laboratory tests are obtained. The white blood cell count is elevated at 16 × 109 cells/L (normal range, 4.3-10.8 × 109 cells/L), with a moderately elevated total neutrophil count of 14 × 109 cells/L (normal range, 1.3-6.7 × 109 mg/L) and a slightly elevated eosinophil count of 0.37 × 109 cells/L (normal range, 0.0-0.3 × 109 cells/L). The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are also elevated, at 84 mg/L (normal range, <10 mg/L) and 34 mm/hr (normal range, 0-19 mm/hr), respectively. Blood cultures are positive for Mycoplasma pneumoniae but negative for additional bacteria or fungi. Culture and Gram stain of several pustules are obtained and are negative. A punch biopsy of a pustule on her leg is performed. The histology shows spongiform subcorneal pustules, edema of the papillary dermis, marked perivascular infiltration of neutrophils, and exocytosis of a few eosinophils.


السؤال هو :
What is the diagnosis?

Hint: She has tolerated azithromycin once in the past, with no adverse effects.
Acute generalized exanthematous pustulosis- 1
Leukocytoclastic vasculitis -2
Pustular psoriasis -3
Subcorneal pustular dermatosis- 4
Toxic epidermal necrolysis -5

تقييم متواضع لكل مشترك , وثلاثة تقاييم لأول إجابة صحيحة .
وفق الله الجميع لكل خير

[آلاء ربها]

Subcorneal pustular dermatosis- 4

و الله أعلم .....
جزاكَ الله خيرا

[GoLdEn Fox]

ربما
Toxic epidermal necrolysis -5
بس مالي متأكد

[العزيز بذله لله]

فرسان هذا الموضوع .. الأخت آلاء ربها .. والأخ nary man
شكرا جزيلا لمروركم ومتابعتكم ومشاركتكم

الإجابة الصحيحة هي الأولى :
Acute generalized exanthematous pustulosis- 1

وصورة من الإجابة :


ونبذة بسيطة عن المرض - مع تلوين الكلمات الهامة باللون الأحمر - :
Acute generalized exanthematous pustulosis (AGEP) is a cutaneous eruption in which dozens to hundreds of sterile nonfollicular pustules on edematous and erythematous bases appear acutely on the skin. Dermatologic symptoms are almost always accompanied by fever and neutrophilic leukocytosis. Usually linked to drug intake, most reactions resolve rapidly and spontaneously after discontinuation of the responsible drug.

The pathogenesis of AGEP is unknown; however, there may be a link with type III and IV hypersensitivity reactions. The association with type IV hypersensitivity may explain the delayed reaction in some cases, whereby patients have either used the offending drug in the past with no problems, or they have used the drug for 1-3 weeks before symptoms appear.

Clinically, there is an acute onset of reaction (average time to reaction, 2.5 days; range, 3 hours to over 3 weeks) after drug ingestion, first manifesting as an edematous erythema, which may cause burning or pruritus. Shortly after, dozens to hundreds of sterile nonfollicular pustules arise in the folds of the skin, later generalizing to the rest of the body. A fever above 100.4°F (38.0°C) develops soon after the appearance of the pustules.

AGEP is a benign disease following a self-limited course. Pustules resolve spontaneously within 4-10 days and are often followed by a characteristic postpustular pinpoint desquamation. The prognosis of AGEP is excellent, although the uncommon superinfection is a potentially serious complication.

Drug-induced AGEP responds well to discontinuation of the offending drug, and skin changes will diminish and eventually resolve completely, often within 14 days. Management includes topical corticosteroids, antihistamines, and antipyretics to relieve symptoms. Less commonly, systemic steroids may be employed if the symptoms are severe.

دمتم بحفظ الله ورعايته

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السلام عليكم ورحمة الله

A 43-Year-Old Woman with Painful and Discolored Toes

A 43-year-old woman presents to the rheumatology clinic with a 1-month history of painful, discolored toes. She first noted an onset of redness and itching at the tips of her toes about 2 months before presentation. The itching progressed to tenderness, followed by the formation of "sores" over the affected areas. She notes that the toes have been sensitive to cold, particularly when she leaves the house and is exposed to winter weather. She denies any trauma to her feet, recent illnesses, or surgical interventions. She has never suffered similar symptoms in the past and has received no specific therapy. She feels otherwise well and denies any fevers, joint pains, gastrointestinal complaints, or weight changes. Her current medications include over-the-counter fish-oil tablets and a daily multivitamin. She does not smoke tobacco and drinks 3 glasses of wine weekly.
On physical examination, her oral temperature is 98.8&ordm;F (37.1&ordm;C). Her pulse has a regular rhythm, with a rate of 79 bpm. Her blood pressure is 112/66 mm Hg. The examination of her head and neck, including auscultation of the carotid arteries and funduscopic visualization, is normal. Her lungs are clear to auscultation. The cardiac examination reveals normal S1 and S2 heart sounds, without murmurs, rubs, or gallops. Her abdomen is soft and nontender, with normal active bowel sounds on auscultation. No abdominal masses or organomegaly are noted. Her vascular examination reveals 2+ pulses at the axillary, brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial regions, without bruits. The neurologic examination is nonfocal. Nonblanching purpuric lesions overlying the pulp area of the right 1st, 3rd, and 5th toes, as well as the left 2nd and 3rd toes, with superficial ulceration of the right 3rd toe, are noted on the dermatologic examination. The lesions are surrounded by poorly demarcated blanching erythema (see Figures 1-3.) The remainder of the dermatologic examination is normal, with normal upper extremity nailfold capillaroscopy.
The laboratory analysis, including a complete blood count (CBC) and comprehensive metabolic panel, are normal. The prothrombin time (PT) and partial thromboplastin time (PTT) are each normal. The findings of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), both inflammatory markers, are normal. Testing for antinuclear antibodies (ANA), antineutrophil cytosplasmic antibodies (ANCA), rheumatoid factor (RF), lupus anticoagulant, anticardiolipin antibodies, antihistone antibodies, anticentromere antibodies, and cryoglobulins, all have negative results. Testing for acute and chronic viral hepatitis is negative. A lower extremity arteriogram reveals patent vasculature with normal-appearing flow. A punch biopsy of the left 2nd toe reveals both superficial and deep perivascular predominantly lymphocytic inflammatory infiltrate and superficial dermal hemorrhage, in addition to an interface/lichenoid dermatitis (see Figures 4-6).
و الصور :




السؤال هو :
What is the most likely diagnosis?

Hint: The lesions occur during the winter and are exacerbated by cold exposure
1 - Trench foot
2 - Purple toe syndrome
3 - Raynaud phenomenon
4 - Chilblains

ولكم خالص التحية والتقدير

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الإجابة الصحيحة هي :

اقتباس: المشاركة الأصلية كتبت بواسطة العزيز بذله لله [عزيزي الزائر يتوجب عليك التسجيل للمشاهدة الرابطللتسجيل اضغط هنا]    3 - raynaud phenomenon

دمتم بخير

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السلام عليكم ورحمة الله وبركاته

نعود لطرح بعض الحالات المرضية :
الحالة اليوم جدا جدا سهلة ويمكن لطالب درس الفسيولوجي جيدا أن يجيب :

A 41-year-old man presents to the emergency department (ED) complaining of a severe frontal headache that began suddenly and awakened him from sleep. The headache is associated with nausea, vomiting, and subjective fevers. He also complains of new-onset diplopia and photophobia, but denies any decrease in visual acuity. He denies experiencing any associated seizures, focal weaknesses, previous similar episodes, frequent headaches, or previous visual disturbances. He does not have any prior significant medical problems, and his only medication is occasional sildenafil. He drinks socially, does not smoke, and denies recreational drug use.

On physical examination, the patient is ill-appearing but alert and in no apparent distress. His vital signs reveal a temperature of 103.1°F (39.5°C), a blood pressure of 155/95 mm Hg, and a pulse of 110 bpm. The ocular examination demonstrates ptosis of the right eye (see Figure 1), which is deviated inferolaterally and has a dilated and unreactive pupil (see Figure 2). The visual field examination demonstrates bitemporal hemianopsia. Funduscopic examination shows normal venous pulsation and mild bilateral temporal disc pallor. The cranial nerves are otherwise without deficit. The neck is supple and without meningismus. Examination of the chest reveals mild bilateral gynecomastia, without nipple discharge. The lungs are clear to auscultation. Cardiac auscultation reveals a normal S1 and S2 and no murmurs, rubs, or gallops. The abdomen is soft and nontender, and no organomegaly is detected. Bilateral upper and lower extremity strength is 5/5, with normal deep tendon and plantar reflexes. The patient's sensation is intact to light touch and pinprick throughout, and the gait is normal.

Laboratory investigations reveal a hemoglobin concentration of 13 g/dL (130 g/L); a white blood cell (WBC) count of 16.0 × 103/µL (16.0 × 109/L), with 75% neutrophils; and a platelet count of 340 × 103/µL (340 × 109/L). The electrolyte, blood urea nitrogen (BUN), creatinine, and glucose examinations are all within normal limits. Cerebrospinal fluid (CSF) specimens show 420,000 red blood ceels (RBC)/μL, 20,000 WBC/μL, a normal glucose of 85 mg/dL (4.72 mmol/L), and an elevated protein concentration of 230 mg/dL (2.3 g/L). The CSF Gram stain is negative for bacteria. A computed tomography (CT) scan of the brain is performed, followed immediately by magnetic resonance imaging (MRI; see Figure 3).

Questions answered incorrectly will be highlighted
الصور :


.

What is the diagnosis?

Hint: The neurologic findings on this patient's physical examination aid in establishing the etiology of his headache.
1- Subarachnoid hemorrhage
2- Cerebellar infarction
3- Pituitary tumor apoplexy
4- Cavernous sinus thrombosis

أول مجيب إجابة صحيحة , يستحق 3 تقاييم متواضعة

دمتم بحفظ الرحمن ورعايته