23 yo female p/w one week h/o dyspnea with exertion and increasing lower extremity edema. Pt c/o intermittent episodes of atypical chest tightness and pressure that does not occur necessarily during rest or with exertion. Non-radiating. Does not occur with palpation, shortness of breath, nausea/vomtting or diaphoresis. Dyspnea not present at rest. Pt denies PND, fevers, cough or syncopal episodes. No recent long plane flights or car rides. Denies tobacco, alcohol or drugs. No recent changes in medication. Symptoms have been getting progressively worse over past one week. Pt now unable to climb stairs in apartment without resting mulitple times. Leg swelling is equal bilateral. No redness, warmth or pain. LMP one week ago. Her PE is significant for the following She is in NAD with normal vitals, well appearing, resting comfortably with mild b/l basilar crackles, no wheeze; has an audible murmer III/VI ASB and has b/l +1 pitting edema up to mid calf, no redness, warmth, negative homan’s sign. Below is her ECG. What is your diagnosis?
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Posted on 10/29/2009
A 12 year old female presents to the ED with a rash over her hands, lower extremity, and face and lips. The patient recently had a URI and was treated by her pediatrician with Azithromycin. Her URI symptoms resolved 2 days after starting the medication. She then developed the rash. She has not eaten after getting the rash because of pain in the mouth. The rash is not itchy. There are multiple lesions on lips, none in the vaginal, rectal or ocular areas. No one else has a similar rash in her family and she has not traveled outside of the country. She has no other medical problems. What is your diagnosis?
