FM # 16 - 68-year-old male with skin lesion - Mr.

Fitzgerald

This case begins with Mr. Fitzgerald, a 68-year-old, with a PMHx of seizure disorder
now presents with an itchy skin lesion that has been present for a few years but he
did not feel necessary to get help but now its itchy. The lesion is erythematous, oval-
shaped, 18 x 16 mm on the forearm. After punch biopsy, the lesion is determined to
be squamous cell carcinoma in-situ. Surgical excision is chosen as treatment.
He also complained of urinary symptoms for the last few months, and he is
suspected to have BPH and the taught about behavior patterns to reduce symptoms
and alpha-antagonists to relieve urinary symptoms. I reviewed the basic
terminology of skin lesions such as macule, papule, etc. because they are used
commonly. I also learned that ABCDE rule for screening and monitoring for
cancerous lesion can help patients note any changes and therefore cause any alarm.
I learned about Mohs microscopic surgery and its benefit in cosmetically sensitive
areas. Overall a good case that reviews basic principles of dermatology.

FM # 7 - 53-year-old male with leg swelling - Mr. Smith

This case begins with Mr. Smith, a 53-year old obese male, with a PMHx of type 2
diabetes, hypertension, and hyperlipidemia now presents with unilateral left lower
leg swelling and there is also erythema present. The swelling when measured is 3.5
cm more than his right leg. There is also an ulcer on his foot and bad hygiene is
noted due to toenail appearance. Doppler ultrasound confirms a deep venous
thrombosis (DVT) in his femoral vein and also D-dimer testing was discussed and in
which scenarios it may be used. He is given IV antibiotics in the hospital due to his
history of non-compliance and then warfarin therapy is discussed and therapeutic
INR range is also addressed. I learned the impact of pretest probability on post-test
predictive value when it comes to DVT testing and the Wells criteria. I also learned
about the wagner ulcer grading system. I also reviewed the risk criteria in Wells
criteria and now know that greater than 3 puts a patient at high risk for DVT and at
that point, Doppler ultrasound is usually the test of choice. Venous thrombosis also
is a good indication for testing for inherited thrombophilia. Overall a good case
reviewing DVTs which is a very common differential diagnosis.