You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

 

CME/CE

A 30-Year-Old Woman With Fever and a Rash

  • Authors: Andrea Bianchin, MD; Moreno Agostini, MD
  • THIS ACTIVITY HAS EXPIRED
Start Activity


Target Audience and Goal Statement

This activity is intended for clinicians in primary care, emergency care, and infectious diseases.

The goal of this activity is to reinforce and highlight common concepts, situations, and presentations that clinicians will encounter on a regular basis in order to provide supportive continuing education that illustrates real-world conditions and situations.

Upon completion of this activity, participants will be able to:

  1. Describe the typical presentation and management of a commonly encountered medical condition in clinical practice.


Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Andrea Bianchin, MD

    Andrea Bianchin, MD, Intensive Care Unit (Anestesia e Rianimazione), Presidio Ospedaliero di Montebelluna, Azienda U.LSS. n.8 di Asolo, Montebelluna (TV), Italy

    Disclosures

    Disclosure: Andrea Bianchin, MD, has disclosed no relevant financial relationships.

  • Moreno Agostini, MD

    Moreno Agostini, MD, Director, Intensive Care Unit (Anestesia e Rianimazione), Presidio Ospedaliero di Montebelluna, Azienda U.LSS. n.8 di Asolo, Montebelluna (TV), Italy

    Disclosures

    Disclosure: Moreno Agostini, MD, has disclosed no relevant financial relationships.

Reviewer(s)

  • Laurie E. Scudder, MS, NP-C

    Nurse Planner, Medscape; Adjunct Assistant Professor, School of Health Sciences, George Washington University, Washington, DC;  Curriculum Coordinator, Nurse Practitioner Alternatives, Inc., Ellicott City; Nurse Practitioner,  Baltimore City School-Based Health Centers, Baltimore, Maryland

    Disclosures

    Disclosure: Laurie E. Scudder, MS, NP-C, has disclosed that she has no relevant financial relationships.

Editor(s)

  • Rick G. Kulkarni, MD, FACEP

    Rick G. Kulkarni, MD, FACEP, Assistant Professor, Yale School of Medicine, Section of Emergency Medicine, Department of Surgery, Attending Physician, Medical Director, Department of Emergency Services, Yale-New Haven Hospital, CT

    Disclosures

    Disclosure: Rick G. Kulkarni, MD, FACEP, has disclosed no relevant financial relationships.

  • Erik D. Schraga, MD

    Erik D. Schraga, MD, Clinical Instructor of Emergency Medicine, Stanford/Kaiser Emergency Medicine Residency Program, Department of Emergency Medicine, Kaiser Permanente, Santa Clara Medical Center, Santa Clara, CA

    Disclosures

    Disclosure: Erik D. Schraga, MD, has disclosed no relevant financial relationships.

  • Michael S. Bronze, MD

    Michael S. Bronze, MD, Stewart Wolf Professor, Chairman of the Department of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK

    Disclosures

    Disclosure: Michael S. Bronze, MD, has disclosed no financial relationships.

  • Luis M. Soler, BA

    Luis M. Soler, BA, Associate Editor, eMedicine/WebMD, New York, NY

    Disclosures

    Disclosure: Luis M. Soler, BA, has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.

    Contact This Provider

    For Nurses

  • Medscape is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

    Awarded 0.25 contact hour(s) of continuing nursing education for RNs and APNs; none of these credits is in the area of pharmacology.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

CME/CE

A 30-Year-Old Woman With Fever and a Rash

Authors: Andrea Bianchin, MD; Moreno Agostini, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

processing....

A 30-Year-Old Woman With Fever and a Rash

Background


Figure 1.
(Click to enlarge)

Figure 2.
(Click to enlarge)

A 30-year-old woman presents to the emergency department (ED) with malaise, diffuse myalgia, and a rash that has spread all over her body (see Figures 1 and 2). Her symptoms began the day before presentation and initially improved with ibuprofen. Her boyfriend, who has accompanied her to the ED, adds that she has been vomiting, has appeared to be in pain with movement, and has even had intermittent confusion during the night. She has developed a headache of moderate intensity that is diffuse, radiating to her neck, and worsens with movement. She does not have any photophobia or dizziness, and she has not experienced any seizures. She denies having any subjective fevers, abdominal pain, hematemesis, or diarrhea. She has not had any urinary complaints or low back pain. She denies having cough or shortness of breath. The patient's past medical history is only remarkable for trauma that occurred 3 months ago and resulted in rib fractures and blunt abdominal trauma. At that time, she underwent an exploratory laparotomy, with suture repair of liver lacerations and a right kidney laceration; she has been doing well since then. The patient does not have any chronic medical conditions and does not take any regular medications. She smokes cigarettes but denies heavy alcohol use or illicit drug use.

On physical examination, she appears drowsy and uncomfortable. Her oral temperature is 100.9°F (38.3°C). She is tachycardic and hypotensive, with a heart rate of 120 bpm and a blood pressure of 80/60 mm Hg. Her respiratory rate and oxygen saturation are normal (at 16 breaths/min and 99% while breathing room air, respectively). She grimaces in pain with movement of the joints, particularly with movement of her neck, which is limited. Her pupils are 3 mm and equally reactive. Her neurologic examination, including a cranial nerve inspection, is normal (except for her drowsy mental status). She has a nonpainful purpuric rash on her arms, trunk, and face consisting of patchy macules approximately 1-4 cm in diameter (see Figures 1 and 2). There is no cervical, axillary, or inguinal lymphadenopathy. Her lungs are clear and her heart sounds are normal, without any murmurs or gallops. She has a soft and nontender abdomen, with no splenomegaly. There is no midline spinal tenderness or costovertebral angle tenderness. There is no evidence of joint involvement, and no tenderness or swelling are noted. The remainder of the examination is unremarkable.

Laboratory studies show an elevated white blood cell (WBC) count of 17.6 × 103/µL (17.6 × 109/L), a hemoglobin of 13.6 g/dL (136 g/L), and a platelet count of 54 × 103/µL (54 × 109/L). Her creatinine is 3.3 mg/dL (291.7 µmol/L) and her blood urea nitrogen (BUN) is 57 mg/dL (20.4 mmol/L). The electrolyte concentrations and hepatic studies are normal. The patient's myoglobin and creatine kinase concentrations are elevated at 332 µg/L and 149 U/L (149 units/L), respectively. The C-reactive protein (CRP) is high at 22 mg/dL. Her partial thromboplastin time (PTT) is elevated at >120 seconds, with an international normalized ratio (INR) of 2.14. The d-dimer is markedly elevated at >10 µg/mL (10 mg/L). Her serum pregnancy test is negative. An arterial blood gas shows a pH of 7.3, a lactate of 64.9 mg/dL (7.2 mmol/L), a partial pressure of carbon dioxide (pCO2) of 35.4 mm Hg, a partial pressure of oxygen (pO2) of 318 mm Hg, and an oxygen saturation of 99.3% while using an oxygen mask at 10 L/min. Blood cultures are drawn and sent to the laboratory.