By Rachael Morris-Jones
A 23-year-old African Caribbean lady provides within the emergency division with an acute onset facial rash. in the course of preliminary review she complains of a week historical past of common malaise, fatigue, fever, and weight-loss. you've been assigned her examination...
100 instances in Dermatology provides a hundred situations with a dermatological manifestation in most cases noticeable through clinical scholars and junior medical professionals. A succinct precis of the patient's historical past, exam and preliminary investigations, together with complete color pictures displaying presentation, is via questions about the prognosis and administration of every case. the reply encompasses a targeted dialogue on each one subject, with additional representation the place acceptable, offering a vital revision reduction in addition to a realistic advisor for college students and junior doctors.
Making scientific judgements and selecting the easiest plan of action is without doubt one of the such a lot not easy and hard elements of teaching to turn into a physician. those circumstances will train scholars and junior medical professionals to acknowledge vital dermatological indicators and symptoms and, the place acceptable, their dating to different health conditions, and to boost their diagnostic and administration skills.
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Additional resources for 100 Cases in Dermatology
G. g. physical stimuli, drugs) • Bradykinin mediated: • Hereditary C1-INH deficiency • Acquired C1-INH deficiency (associated with lymphoproliferative or connective tissue disorders). • ACE inhibitors KEY POINTS • Angioedema in the absence of urticaria is unusual and points towards a bradykinin-mediated mechanism, most commonly C1–INH deficiency, either hereditary or acquired. • Symptoms may include angioedema of the face, extremities and genitalia, abdominal pain and bloating, hypotension and potentially laryngeal oedema leading to asphyxiation.
1 47 ANSWER 22 This patient has developed Stevens–Johnson syndrome (SJS) secondary to carbamazepine. SJS is a severe, immune-complex mediated, drug hypersensitivity eruption that affects the skin and mucous membranes. Patients feel unwell and should be admitted to hospital for high-dependency care. SJS usually develops within two months of commencing a new medication. Patients characteristically develop a sore throat, eyes, lips and genitals as the mucosae become inflamed and eroded. Skin lesions affect 10–30 per cent of the skin surface with a variable morphology: erythematous macules, atypical target lesions with central blisters, dusky purpuric lesions, erosions and necrosis.
He has anaemia and thrombocytopenia. The low complement levels should trigger testing of C-1 esterase inhibitor (C1-INH) levels (suggesting acquired C1-esterase inhibitor deficiency). This patient needs thorough haematological assessment looking for an underlying lymphoproliferative disorder. Further investigations include tests for serum lactate dehydrogenase and ␤2-microglobulin, immunoglobulins and protein electrophoresis, CT of the chest, abdomen and pelvis as well as lymph node and bone marrow biopsy.