So now we'll review 2 quick cases just
to highlight some key points
of some of those other things on our list, and
then do 2 review questions after that.
So, quick case. 36-year-old airforce pilot
with a past medical history of childhood
asthma, presents with, "My eczema is back."
She reports slowly progressive itchy
patches on both of her arms
over the past month. She remembers
having problems with
itchy skin when she was younger, but hasn't
had issues with this in many years.
This is a good example where you could
be susceptible to anchoring bias.
The patient's telling you what
she thinks it is.
And the chart, of course, has atopic
eczema written all over it
when she was a child. We know the patient's
allergic to penicillin, allergic to cats.
This would also be common for someone
with an atopic history to have
medication allergies, food allergies,
allergies to cat dander.
Social family history also atopic.
You're really going to get
sucked into this anchoring bias trap,
if you're not careful.
Review of systems is negative. Initial
vitals, pretty unremarkable.
And on exam, you see erythematous,
lichenified plaques --
sounds like eczema -- on the bilateral
elbows with silvery scale.
Now, that sounds like something else. Let's
take a look at our differential diagnosis.
Seb derm, kind of the wrong.
Age group for seb derm -
not a kid, not an elderly patient and we're
not told that she's HIV positive.
Irritant contact dermatitis and allergic
always worth considering. You have to
take a thorough history,
look for any changes to any shampoos or
clothing or medications or anything
that's new. Psoriasis.
Again, she's got these silvery plaques on a
backdrop of some erythematous plaques.
And then atopic dermatitis, we've talked
about. This case, I think we can safely say
with that silvery scale, again, that's
one of those pathognomonic
clues that you'll see on the boards. It sounds
like this is a case of psoriasis.