Quiz 23 Context:
A 28-year-old female presents with a complaint of persistent fevers at night for the past 3 weeks. Over the same time period she has experienced 5 pounds of weight loss in spite of little or no change in appetite. Two days prior to the visit she noticed a new painful skin rash.
Past medical history is most signficant for stage 3 chronic kidney disease thought secondary to longstanding intravenous drug abuse.
Physical examination reveals a thin female patient in no distress. Temperature is 37.8. Heart rate is 96 bpm. Blood pressure is 126/80. The cardiac examination reveals a single mid-systolic click best heard medial to the apex, followed by a soft late systolic murmur. The pulmonary examination is normal. The abdominal examination is normal. The skin and extremity examination reveals 1 + edema at the dorsum of the feet. There are several small hematomas in various stages of resolution located along the superficial veins of the upper arms. In addition there is a raised, red, somewhat tender skin lesion located on the left palm.
The new skin lesion is shown above.
Sorry, that is not the most likely answer. Try Again.
This lesion, along with the history and examination, are most consistent with which of the following possibilities:
- Osler's node: bacterial endocarditis
- Gottron's papule: dermatomyositis
- Burrow and vesicle: scabies
- Bone cyst: sarcoidosis
- Erythema migrans: Lyme disease