Discoid Eczema (Nummular Dermatitis)

Eczema or Dermatitis is a term used to describe conditions in where there is inflammation of skin. There are several types of eczema and Discoid eczema is one type which causes round or oval red patches of inflamed skin. It is also known as Nummular dermatititis which means coin shaped lesions. 

Discoid eczema is usually seen in adults with dry skin although it can affect teenagers and young children, but this is rare.

Clinical Features

• typically present as round or oval plaques on the extremities
• the lesions are extremely itchy
• central clearing may occur giving a similar appearance to tinea corporis

Some other symptoms might include:

A 25 Year old Pregnant woman presents with Palpitations...

This ECG was recorded from a 25-year-old pregnant woman who complained of an irregular heart beat. Auscultation revealed a soft systolic murmur but her heart was otherwise normal.

What does the ECG show and what would you do?

The ECG shows:
• Sinus rhythm
• Ventricular extrasystoles
• Normal axis
• Normal QRS complexes and T waves

A 29-year-old man presents to his doctor with a rash ...

A 29-year-old man presents to his doctor with a rash (shown in picture below). The rash does not itch and has been present over the last week. A large, red area developed first, followed by a more generalized rash that is now present.
Physical examination shows that the rash appears in a Christmas-tree pattern on his chest and back.

The most likely diagnosis is
A) Pityriasis rosea
B) Tinea versicolor
C) Herpes zoster
D) Varicella
E) Lyme disease

The answer is

QT Interval Prolongation On ECG

QT Interval Prolongation On ECG 

•Normal QTc interval is less than 440 ms.

• QTc interval greater than 440 ms is considered prolonged.

• QTc interval greater than 550 ms is markedly prolonged.

                                        (Click on Image to enlarge)

Learning Points: 
1. The QT interval is measured form the beginning of the QRS complex to the termination of the T wave (or U wave if present) and should be measured in the EKG lead with the longest-appearing QT interval that has a distinct T wave with a clear termination point.
2. The QT interval will increase with bradycardia and decrease with tachycardia, thus it is important to use the corrected QT interval (QTc = QT/μR-R interval) for heart rates other than 60 (in which the QTc = QT).

Developing Aspergilloma - As Seen On Chest X ray

A 43 years old male presented with a history of cough, fever and weight loss with loss of appetite since two months. His Chest X ray is shown below:

X-ray chest shows a right mid zone cavity with thick irregular wall with non-homogeneous shadowing due to an irregular sponge work filling the cavity with intervening air spaces.

Comments And Explanation:
Superinfection with Aspergillus generally occurs in a pre-existing cavity (tuberculous or bronchiectasis) in immune-compromised patient.
Initially, the aspergilloma appears as an irregular spongework filling the cavity with intervening air spaces (as seen in the above X ray). Presumably this appearance reflects the presence of irregular fonds of fungal mycelia mixed with residual intracavity air. Furthermore, thickening of the wall of the cavity can be a finding of superimposed fungal infection well prior to development of a fungal ball as has been demonstrated in this case.

Hyphema - a pooling or collection of blood inside the anterior chamber of the eye .

Introduction
Injury to the anterior chamber that disrupts the vasculature supporting the iris or ciliary body results in a hyphema.
The blood tends to layer with time, and if left undisturbed, gravity will form a visible meniscus.

Definition: A hyphema is a pooling or collection of blood inside the anterior chamber of the eye (the space between the cornea and the iris).

                    Hyphema. This hyphema has completely layered out in the anterior chamber.

Clinical Symptoms can include

• pain, 
• photophobia, and possibly blurred vision secondary to obstructing blood cells. 
• Nausea and vomiting may signal a rise in intraocular pressure (glaucoma) caused by blood cells
• clogging the trabecular meshwork.