Clinical Quiz

Clinical Challenge: A Rash on the Back and Chest

A 46-year-old Hispanic man presents for evaluation of a rash on his back and chest; he first noted the rash 2 days ago after returning from the Dominican Republic where he spent time outdoors. The red areas are tender to light palpation. He is most concerned about white “spots” visible in the area. He currently take a thiazide diuretic.

Clinical Challenge: Swollen Lesion on the Lower Lip

A 63-year-old man presents for evaluation of a 5-day history of painful swelling affecting his lip. He denies antecedent trauma to the site. He does not have diabetes. He is a nonsmoker and drinks alcohol in moderation. Examination reveals an erythematous, 1.5cm nodule that is tender to palpation. Cervical and submandibular lymph nodes are not palpable.

Clinical Challenge: Firm Nodule on the Hand

A 25-year-old white woman presents for evaluation of a growth on the dorsal surface of her left hand. The lesion has been present for approximately 5 years. She denies localized pain, paresthesia, or loss of hand coordination. The growth was drained of fluid 2 years ago but has since recurred. Examination reveals a firm nodule fixed to underlying tissue.

Clinical Challenge: Asymptomatic Lesion on the Forehead

A 69-year-old man requests treatment for a slowly enlarging growth proximal to his right eyebrow. The lesion had been present for at least a year and is asymptomatic. Examination reveals a 0.6cm erythematous papule. No other significant skin finding is noted. A shave biopsy is performed.

Clinical Challenge: Skin Rash on the Abdomen, Flank, and Upper Thigh

A 37-year-old man presents with a skin rash affecting his abdomen, flank, and upper thigh that has been present for 5 years. The eruption itches on occasion but is otherwise asymptomatic. He denies family or personal history of psoriasis and eczema. Prior therapies to treat the rash included triamcinolone, miconazole and oral terbinafine. Examination reveals scattered, well-demarcated patches.

Clinical Challenge: Asymptomatic Blisters on a Child’s Upper Leg

A 7-year-old boy presents with 2 blisters that developed acutely on his upper thigh. According to his mother, the lesions began as reddened patches less than 48 hours earlier. The child denied discomfort including itching and pain. He was afebrile and without malaise. Needle puncture of the lesions resulted in drainage of a serosanguineous fluid with slight purulence.

Clinical Challenge: Swelling in the Finger Following a Cat Scratch

A 61-year-old woman presents with swelling in a digit that is of 3 days’ duration. Five days earlier she experienced a cat scratch at the site that resulted in profuse bleeding. She also mentions tending to her garden ~2 weeks prior to the onset of her condition but does not recall localized trauma during this activity. The patient is a nonsmoker and is taking antihypertensive medication. She complains of slight malaise but no fever.

Clinical Challenge: Hyperpigmented Macule on the Abdomen

An 11-year-old is brought to the office for treatment of low-grade acne that affects her face and back. Upon examination, a sizable hyperpigmented macule is identified on her abdomen that has been present for ~2 years. No member of her family has similar lesions, and family history is negative for skin cancer.

Clinical Challenge: Erythematous Rash on the Upper Back

A 32-year-old man is referred for evaluation of an erythematous rash on his upper back that has been present for ~2 months. At 25 he was diagnosed with systemic lupus erythematosus. Treatment with hydroxychloroquine 200mg/d was restarted approximately 1 month ago. Examination reveals annular, indurated erythematous plaques, as well as faint malar erythema.