Category: Derm

Red All Over

8/23/2013

A 9-month-old baby boy is brought in for fussiness and a pruritic rash he has had for the past week.  The child was born full-term without complications, and his vaccines are up-to-date. He has no personal or family history of atopy and has not been ill
recently.

He was recently visiting relatives out of the area, and when asked, his mother remembers some contacts there with a rash. The boy has been afebrile and eating
well; he is not sleeping through the night lately.  His vital signs and general examination are normal, except for his skin examination:

Which of the following is the MOST likely diagnosis?

    A. Urticaria
    B. Eczema
    C. Drug eruption
    D. Scabies

In the meantime, a quote –

“The defects and faults of the mind are like wounds in the body; after all imaginable
care has been taken to heal them up, still there will be a scar left behind, and they are in continual danger of breaking the skin and bursting out again.”

François de La Rochefoucauld (1613 – 1680) French author of maxims

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Bump in the Night

5/12/2013

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A two-week-old baby boy is brought in by his mother for a “bump” on his head that
has recently become more apparent. The child was born full term via normal spontaneous delivery without complication. There has been no history of trauma, fever, or change in intake, output, or behavior. The boy’s first well-child appointment is tomorrow morning, but an alarmed family member convinced the family to seek help tonight.

On examination, the child is well appearing with normal vital signs and an otherwise normal total body check. The area of concern is shown below:

Which of the following is the BEST course of action?

    A. CBC, blood cultures, incision and drainage, admission to the hospital
    B. Tie base of lesion with silk suture, observe briefly, outpatient follow-up
    C. Watchful waiting and referral to primary medical doctor
    D. Obtain stat MRI

In the meantime, a quote –

Festina lente.

[Make haste slowly.]

– Classical adage

Answer

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Just Inked

4/21/2013

1 Comment

A 23-year-old man with no past medical history comes to the ED for pain and swelling around his forearm tattoo, which he received three days prior during a weekend-long celebration with his friends. To help with the pain, he continued drinking when he arrived home. His review of systems is unclear, and he may have had chills with some nausea over the past day. He is a smoker and denies illicit drug use.

On arrival, T 99.9 HR 92 136/90 RR 20 SpO2 98% RA

In general, he is anxious but in no acute distress. His general exam is reassuring; the extremity shows no streaking, crepitus, or lymphadenopathy. His tattoo is shown below:

Which is the most likely diagnosis?

    A.    Aseptic inflammatory reaction
    B.    Subcutaneous ink diffusion
    C.    Contact dermatitis
    D.    Pyogenic infection

In the meantime, a quote –

“The physician can do all he has to do with speed and precision, but he must never appear to be in a hurry, and never absent-minded.”

Theodor Billroth 1829-1894

Prussian-born Professor of Surgery, Vienna

Answer

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Red All Over

Bump in the Night

Just Inked

Timothy Horeczko, MD, MSCR, FACEP, FAAP

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