Decision Support in Medicine

Are You Confident of the Diagnosis? What you should be alert for in the history A variety of causes including systemic illnesses and medications can cause this phenomenon. Characteristic findings on physical examination Beau’s lines are a nonspecific physical finding on the nail plate (Figure 1). They represent a transient arrest of nail matrix production…

Are You Confident of the Diagnosis? What you should be alert for in the history Patients with multiple basal cell carcinomas (BCCs) of early onset in the same family is typical of Basex-Dupré-Christol syndrome Characteristic findings on physical examination Frequent symptoms: -Multiple BCC of early onset -Follicular atrophoderma presenting as grouped pits on the dorsa…

Are You Confident of the Diagnosis? Basal cell carcinomaŠ(BCC) is the most common cancer in humans. There are nearly as many BCCs diagnosed each year as all other cancers combined. Patients often describe a slow-growing or persistent sore that will not heal or a “pimple” that persists for several months. The history frequently includes bleeding…

Are You Confident of the Diagnosis? The primary differential diagnosis is lichen planus, although Candida balanitis, psoriasis, and erythroplasia of Queyrat can also present with genital lesions that could be confused with balanitis xerotica obliterans (BXO). Itch is generally a prominent symptom. The absence of itch should prompt the clinician to question the diagnosis. Characteristic…

Are You Confident of the Diagnosis? The diagnosis of bacillary angiomatosis (BA) can be made by finding the characteristic skin lesions confirmed by histopathologic examination (Figure 1). Biopsy shows angioproliferation and microorganisms stained with Warthin-Starry silver stain (Figure 2). Patients are usually immunocompromised. Although BA is a systemic disease, the cutaneous lesions lead to recognition…

Are You Confident of the Diagnosis? What you should be alert for in the history Patients present with pigmented, moist, pruritic plaques in the folds of skin; most commonly, the axillary creases. Authors have suggested the term “granular parakeratosis” be used because the condition may affect other sites, such as the inguinal folds. Characteristic findings…

Are You Confident of the Diagnosis? Frey syndrome is characterized by unilateral flushing and sweating of the facial skin innervated by the auriculotemporal nerve (neck, parotid region, and frontotemporal scalp), which occurs in response to gustatory or olfactory stimuli. Bilateral involvement has been reported. It is more common in adults. What to be alert for…

Are You Confident of the Diagnosis? Atypical mycobacteria (ATM) are mycobacteria other than Mycobacterium tuberculosis and M leprae. MOTT (mycobacteria other than tuberculosis) is sometimes used to refer to this group. Often, ATM infections are not considered initially. The variable presentations, lack of appropriate culture media, delay in culture growth, or paucity of organisms on…

Are You Confident of the Diagnosis? Considered to be a rare clinical variant of localized scleroderma or morphea, the characteristic lesions in atrophoderma of Pasini and Pierini (APP) consist of atrophic lesions or depressions rather than indurated plaques with lilac border. APP typically affects young adults, women outnumbering men, with no associated antecedent history of…

Are You Confident of the Diagnosis? What you should be alert for in the history Patients generally present with neurologic impairment; ie, ataxia, since the first months of life. Truncal ataxia (oscillations of the trunk) may be evident at the 5th-6th months of life, while gait ataxia appears when the affected child starts to walk,…