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

Necrotic Skin Lesions in a 61-Year-Old Woman

  • Authors: Marc Hare, MD
  • CME/CE Released: 5/20/2009
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 5/20/2010
Start Activity


Target Audience and Goal Statement

This activity is intended for clinicians in primary care, emergency care, dermatology, and hematology.

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, MedscapeCME 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.

MedscapeCME 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)

  • Marc Hare, MD

    Marc Hare, MD, Medical Director, Center for Wound Healing and Hyperbaric Medicine, Paradise Valley Hospital, National City; Assistant Clinical Professor of Medicine, Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, CA

    Disclosures

    Disclosure: Marc Hare, MD, has disclosed no relevant financial relationships.

Nurse Planner

  • Laurie E. Scudder, MS, NP

    Laurie E. Scudder, MS, NP, Accreditation Coordinator, Continuing Professional Education Department, MedscapeCME; Clinical Assistant Professor, School of Nursing and Allied Health, George Washington University, Washington, DC; Nurse Practitioner, School-Based Health Centers, Baltimore City Public Schools, Baltimore, Maryland

    Disclosures

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

Editor(s)

  • Rick G. Kulkarni, MD, FACEP

    Rick G. Kulkarni, MD, Vice President/Medical Director, WebMD; Editor-in-Chief, eMedicine; Assistant Professor of Surgery, Yale University School of Medicine, New Haven, CT

    Disclosures

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

  • Jules Harris, MD

    Jules Harris, MD, Visiting Professor of Medicine, Arizona Cancer Center, University of Arizona, Tucson, AZ

    Disclosures

    Disclosure: Jules Harris, MD, has disclosed no relevant financial relationships.

  • Erik D. Schraga, MD

    Erik D. Schraga, MD, Director, eMedicine Case of the Week; 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.

  • Luis M. Soler, BA

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

    Disclosures

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


Accreditation Statements

    For Physicians

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

    MedscapeCME 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, LLC 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. MedscapeCME 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

Necrotic Skin Lesions in a 61-Year-Old Woman

Authors: Marc Hare, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME/CE Released: 5/20/2009

Valid for credit through: 5/20/2010

processing....

Necrotic Skin Lesions in a 61-Year-Old Woman

Background

Figure 1.

A 61-year-old woman presents to the wound center for continued treatment of venous leg ulcers complicated by diabetes mellitus. Her past medical history is remarkable for essential hypertension and obesity. The patient also has a history of angioimmunoblastic lymphadenopathy, which occurred over 15 years ago. The patient can not remember any details of this diagnosis; consultation with her primary care clinician reveals that this was a benign/peripheral presentation. No records are available for review. According to the primary care clinician, the condition went into complete remission following a course of prednisone. The patient notes that she has developed new wounds on both of her thighs. The lesions are black, with surrounding redness and tenderness. There is no itching. She states that the lesions have been enlarging slowly over the past several days, and many are now several centimeters in diameter. She denies having any fever or chills. Her fasting serum glucose readings have been stable in the 100-200 mg/dL (5.55-11.1 mmol/L) range. She denies experiencing any easy bruising or bleeding. She has not had any recent trauma or procedures in the area of the lesions, and she has not had any recent changes in her medications. She has no history of smoking, alcohol or illicit drug use.

On physical examination, her oral temperature is 97.8°F (36.6°C). Her pulse is 86 bpm and regular, and her blood pressure is 128/81 mm Hg. Her respiratory rate is 14 breaths/min. She is in no acute distress, but she does note that the wounds are causing her discomfort. The examination of her head, neck, lungs, heart and abdomen is unremarkable. The skin of the upper extremities and torso is also unremarkable. She has a nonhealing venous ulcer on each of her medial malleolar areas, which are unchanged from previous examination. She has multiple black eschars on her thighs, each surrounded by a centimeter of erythema with a slightly reticular pattern, as well as induration. She has trace edema to her ankles, but no edema in her legs or thighs. The lesions are tender. There are no vesicles or pustules. No confluent or ascending erythema is noted. The largest lesion measures 4.4 × 2.6 cm (see Figure 1).

Laboratory testing shows a white blood cell (WBC) count of 10.1 × 103/µL (10.1 × 109/L; normal range, 4.1- 10.9 × 103/µL), a hemoglobin of 10 g/dL (100 g/L; normal range, 12.0-15.2 g/dL), platelets of 492 × 103/µL (492 × 109/L; normal range, 140-450 × 103/µL), and a normal WBC differential. The basic metabolic panel is normal. The hemoglobin A1c finding is 6.6% (0.066; normal range, 3.8-6.4%). The albumin is normal at 3.5 g/dL (35 g/L), and the erythrocyte sedimentation rate (ESR) is elevated at 80 mm/hr (normal range, 1-25 mm/hr).

Biopsies are obtained of representative lesions at their edges. They demonstrate acute and chronic inflammation in the dermis and subcutaneous fat. No viral cytopathic changes are seen. Small vessel microthrombi are limited to the base of the ulcer and are not identified in vessels away from the ulcer, which suggests a secondary thrombotic reaction. No specific changes of vasculitis or malignancy are identified.