There is no warmth over the joints or deformity. He has tenderness with range of motion in all his major joints and in the hands. His heart rate is regular, and his lungs are clear to auscultation. Exam reveals an ill-looking adolescent, salmon-pink rash on the chest, and cervical lymphadenopathy. They also note a new rash developing on his chest. He was complaining of bilateral hip and knee pain for nearly two months but is now developing pain in his wrists, hands, elbows, and shoulders. The patient's mother reports that he has not been feeling well for several weeks, he started to run a fever of 101.3☏ two weeks ago, but it came down with acetaminophen. What is the most likely diagnosis?Ī 15-year-old boy presents to the emergency department with his mother feeling very ill. Electroencephalogram (EEG) demonstrates epileptiform sharp waves in the temporal region. You order magnetic resonance imaging of the brain and find that there is hippocampal atrophy. She has not been sick recently and has not had any head trauma. Exam reveals a generally healthy adolescent, neurologic exam is unremarkable, and cardiovascular and pulmonary exams are unremarkable. She denies any family history of seizures and has not had any episodes where she wets herself or bites her tongue. She is coming to the office now because she wants to start driver's training and is worried this may happen while she is driving. The episodes are becoming more frequent over the past year. Symptoms can happen at any time, and she has not yet identified a pattern. Before these episodes start she gets a strange taste in her mouth. Afterward, she does not recall the event and feels a little bit strange for just a few minutes. She reports her friends and family have noticed her staring and stopping her activity for 30 to 120 seconds. Which of the following is the most likely diagnosis?Ī 15-year-old girl presents to the office with complaint of having staring episodes. He has a normal white blood cell count, a decrease in glomerular filtration rate, and an elevated erythrocyte sedimentation rate. Bloodwork reveals that the patient is positive for hepatitis B. You obtain a punch biopsy of one of the lesions which reveals inflammation and necrotizing of the medium-sized arteries while sparing the small-sized arteries immunofluorescence is negative. Exam reveals tender, erythematous nodules on the lower extremities and 1+ bilateral lower extremity edema. Vitals are BP 170/96 mm Hg, HR 90, and Temperature is 98.3☏. Over the past several months, he has felt weak, tired, and has lost some weight. He reports it started with small painful bumps, and now there are more on his lower extremities. A 63-year-old man presents to the office with a painful rash that developed about a week ago.
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