Groin Rash

55y man with h/o questionable recurrent genital herpes, presents with mildly pruritic rash in his groin for the past few weeks. Pelvic exam displays erythematous macular lesions in the groin with some satellite pustular lesion on the medial aspect of the thigh.

What is the most likely diagnosis?

1. Erythrasma
2. Tinea Cruris
3. Genital candidiasis- CORRECT ANSWER
4. Eczema
5. Lichen Planus
6. Recurrence of genital herpes

Psoriasis

61y, white woman, h/o HTN, CAD, severe vasculopathy- s/p coronary stents and renal arterty stents, bilateral moderate carotid stenosis and psoriasis comes in for a routine follow up. She is asymptomatic on her current drug regimen- Diovan-HCT 160/12.5mg qd, Metoprolol XL 100mg qhs, ISMO 60mg qd, Lovastatin 40mg qhs, Calcipotriene topical bid, Lasix 20mg qd, ASA and NTG s.l. prn. Her vital signs are stable. Exam reveals psoriatic plaques on both the elbows, with mildly erythematous base and rim with superficial silvery scales. She has similar smaller plaques on her legs. Which of the following statements is false?

1. She has a 30% likelihood of having psoriatic arthritis
2. Arthritis precedes skin lesions in 15% of patients with psoriasis
3. She is on a medicine that could exacerbate her skin lesions
4. Calcipotriene, although very effective, is extremely expensive as compared to topical steroids.
5. She has guttate variant of psoriasis, commonly linked to Streptococcal infections - CORRECT ANSWER

Old man with hand muscle wasting

68 year old African-American man, with h/o HTN and early prostate cancer, presents with "muscle thinning" in both the hands and progressive weakness, although symptoms seems to be more prominent on the Lt hand. He does not volunteer any symptoms of paraesthesias. He continues to work as a manual laborer with a construction company. He smokes a pack every day and is intermittently compliant with his meds- Verapamil, Enalapril and HCTZ
On exam, his vitals are stable. Hand shake displays a weak grip. Hand exam shows mild clawing of the left hand, wasting of the interossei (prominent guttering of the back of the hand), of the web-space between thumb and index finger and softening and flattening of the hypothenar eminence, more prominent on the left hand. Tinel’s sign was positive. Reflexes were bilaterally symmetrical at 1+. Sensory exam was not done. Forearm and arm muscles did not show signs of atrophy.
Fasting Blood sugar in January 2005 was 120. Prostate biopsy done in 8/03 showed high-grade neoplasia. He has not followed up with his urologist since then.

1. Occupation induced carpal tunnel plus cubital tunnel syndrome- CORRECT ANSWER
2. Inclusion body myositis
3. Syringomyelia
4. Cervical disc disease
5. Unrecognized diabetes