What’s the most common cause of infective endocarditis in IV drug users?
a. Viridans streptococci
b. Enterococcus faecium
c. Staphylococcus aureus
d. Candida parapsilosis
This nail finding is most consistent with lichen planus.
The image demonstrates characteristic nail changes including longitudinal ridging, thinning of the nail plate, distal V-shaped splitting, and early dorsal pterygium formation.
Lichen planus is an inflammatory T-cell–mediated disorder that affects the skin, mucous membranes, hair, and nails. While nail involvement occurs in only about 10% of patients, it can be the sole manifestation of the disease.
Remember the classic "6 Ps" of lichen planus:
Purple
Polygonal
Planar
Pruritic
Papules
Plaques
Other hallmark findings include Wickham striae, a lace-like network of white lines seen on skin and oral lesions.
Answer: B. Lichen Planus
Source: StatPearls (2024).
Answer:
a) Clinical sign:
Urschel's sign: prominent dilated superficial venous collaterals over the shoulder, upper chest, and upper arm.
b) Commonly associated condition:
Paget–Schroetter syndrome (effort thrombosis), a form of upper-extremity deep vein thrombosis caused by thrombosis of the axillary-subclavian vein, often due to repetitive strenuous overhead arm activity and frequently associated with venous thoracic outlet syndrome.
Explanation:
When the subclavian vein becomes chronically obstructed, collateral superficial veins enlarge to bypass the blockage, producing the characteristic appearance known as Urschel's sign. It is classically seen in young, otherwise healthy individuals involved in repetitive upper-extremity activities such as athletes, laborers, or workers performing frequent overhead motions.
Case Reference:
Lawless SM, Samson R. Urschel's Sign in Paget Schroetter Syndrome. American Journal of Medicine Blog. February 26, 2018
This peri-orbital edema developed suddenly during general anesthesia and was followed by severe hypotension, bronchospasm, and cardiovascular collapse.
What is the most likely diagnosis?