Spot the diagnosis, differencial diagnosis and treatment.

### 45 years old Muslim housewife got admitted with the complaints of joint pain for 2 & 1/2 years. Associated with generalised purpuric & non blanching rash for 3 days which is more on both lower limbs & upper limbs. H/o mild fever for last 3 days associated with oral ulcer. Known case of IHD, COPD & Hypothyroidism. What's your D/Dx ??? What's your Dx ??? What are the investigation that you will do ??? How will you treat the patient ???

prurituc rashes 2days on both lower limb. your first visual impression

32 y male with this kind of lession on both leg...no history itching and pain ...disappears after. 2-3 months...become aggressive in long journey...pls help me to know the diagnosis and Treatment pls....?? Psoriasis

May be useful for General practitioners and Medical Students. Common Nail Findings associated with diseases. 1. BEAU'S Lines- These are transverse grooves or depressions parallel to the lunula. Caused by the conditions that cause the nail to grow slowly or even cease to grow for short intervals. The point of arrested growth is seen as a transverse groove. Often associated with - infections (Typhus, Acute Rheumatic Fever, AIDS) -Protein deficiency -Pellagra -Raynauds disease -Diabetes -Hypothyroidism -Hypocalcemia -Chronic Pancreatitis 2. MEES' Bands- White transverse line or band parallel to lunula resulting from poisoning or systemic illness.seen in -Chronic arsenic poisoning -Hodgkins disease -CHF -Leprosy 3. LINDSAY'S Nails- also called half & half nails. Proximal portion of Nail bed is whitish whereas distal part is red or pink. commonly associated with -Chronic Renal Failure -Azotemia 4. TERRY'S Nails - are white nail beds to within 1 to 2 mm of distal border of nail associated with -Hepatic Failure -Cirrhosis -Hypoalbuminemia -Chronic CHF -Hyoerthyroidism 5. SPLINTER HAEMORRHAGE. These are formed by extravasation of blood from longitudinal nail bed blood vessels to adjacent troughs. These are most often related to local, light trauma. Classically associated with -Subacute Bacterial Endocarditis. May be seen in -Leukemia -Vasculitis -Rheumatoid Arthritis -SLE 6. KOILONYCHIA - Spoon Nail is a dystrophic state in which the nail plate thins and a cup like depression. develops. Commonly associated with - Iron deficiency Anemia. 7. CLUBBING - Angle between the normal nail bed and finger is approx 160 degrees and nail bed is firm. This angle is referred to as LOVIBOND'S angle. When clubbing develops, this angle straightens out to be greater than 180 degrees & nail bed becomes spongy and has a bullous shape with exaggerated horizontal and longitudinal curvature. Most commonly associated with -Congenital Cyanotic Heart Disease -Cystic Fibrosis -Mesothelioma of Pleura -Pulmonary Neoplasms -Bronchogenic Carcinoma. 8. PITTING of Nails is seen in Psoriasis. SOURCE. TEXTBOOK OF PHYSICAL DIAGNOSIS. MARK. H. SWARTZ.

40 yrs female patient came with c/o Erythematous rashes over the Both lower limb with swelling last 4 days no history of fever kindly give valuable opinion