Answer and Explanation 22

22.  B is the correct answer.  Urticaria produces lesions like seen in the photo.  You commonly see them in the trunk and axilla, but you can see them anywhere.  A diagnosis of angioedema cannot be made because it affects the lips and mouth but urticaria can be associated with it.  Erythema multiforme lesions are target shaped.  Vasculitis is seen more on the dependent areas of the body like the extremities and is is usually a deeper color.  It can be seen anywhere though.

Question 22

22.  Your patient is a 34 year old male who present to the ER with the rash below.

Based upon the information above, what is the most likely diagnosis?

A.  Angioedema

B.  Urticaria

C.  Vasculitis

D.  Erythema Multiforme

Answer and Explanation 21

21.  A is the correct answer.  This clinical presentation is textbook for Kawasaki's Disease.  The major symptom is a fever greater than 5 days in this age group.  It usually does not respond to anti-pyretics.    It gives the deep red color to the mucus membranes and can have an associated conjunctivitis.  Fifth's disease would give you a rash on the cheeks like this but not have a fever for 8 days.  You also would not have that deep color red on the lips.  Eczema of course would not give you a fever or conjunctivitis.  Scarletina would not have a fever lasting for 8 days, and give you pink eye or deep red color to the lips.

Question 21

21.  Your patient is a 4 year old male that present with fever that has been persistent for 8 days.  He has been complaining of a sore throat, and erythematous conjunctiva, and peeling in his hands and feet.  He does have some lymphadenopathy.  On physical exam you had noted reddened mucus membranes in the mouth with cracked lips.  There is a photograph below of the patient.  

Based upon the above information, what is the most likely diagnosis?

A.  Kawasaki's Disease

B.  Fifth's Disease.

C.  Eczema

D.  Scarletina   

Answer and Explanation 20

20.   The correct answer is C.  Drug eruption usually gives that deep pink color and macules seen in patches.  Vasculitis is about the same color but typically effects gravity dependent areas more and not the trunk.  These lesions are not vesicular or ulcerated and do not look tike varicella.  This rash is not discoid or malar and is not consistent with SLE.

Question 20

20.  What is the diagnosis of the rash listed below in this 74 year old male?

A.  Vasculitis

B.  Systemic Lupus Erythematous

C.  Drug Eruption

D.  Disseminated Varicella

Answer and Explanation 19

19.  B is the correct answer.  Angioedema is a common adverse reaction seen in patients who take ACE inhibitors.  These patients often lack C1 esterase which we treat with fresh frozen plasma.  Patients who take ACE inhibitors will have elevated bradykinnin levels but that is often what causes the dry cough.  Prostaglandins is helps lower blood pressure in patients who take ACE inhibitors.  Phosphodiesterase has nothing to do with this mechanism.