Psoriasis punctata, an early manifestation of guttate psoriasis

From 'The Sick Rose'

Cardiac tamponade

All I know about this as a 3rd grader is that it causes an Obstructive shock

Most of Infectious Mononucleosis (IM) patients who take amoxicillin (or other beta-lactam antibiotics) will suffer from rash due to drug reaction, even if they previously did not have a penicillin sensitivity.

الفكرة هي أنّ العدوى الفايروسية (خاصةً الـ IM) ممكن تؤثر بالجهاز المناعي بحيث تخليه يفقد الـ tolerance مالته لبعض المواد مثل الـ amoxicillin والـ azythromycin

A 43-year-old man is admitted to hospital with pneumonia. His past medical history includes Addison's disease for which he takes hydrocortisone (20mg in the mornings and 10mg in the afternoon). What is the most appropriate action with respect to his steroid dose?

Cortisol is one of the "stress hormones" of the body. It's released normally in a daily cycle, and (its release is increased) during stressful events like serious infections.
Addison's patients have an andrenal insufficiency; their bodies can't release cortisol (and sometimes aldosterone) so we treat them with hydrocortisone replacement.

Addison's crisis (acute adrenal crisis) is when Addison's patients suffer from a stressful event so their dose of hydrocortisone replacement suddenly becomes insufficient. Therefore they will mainly suffer from symptoms of shock, because cortisol & aldosterone both aid in vasocostriction.

Erythema multiforme (EM):
• It is usually triggered as an immune reaction to herpes simplex virus (HSV) infection but can be caused by a drug.
• Target lesions and lesions on the palms and soles can be relatively specific findings. These lesions are usually not pruritic.
• Diagnosis is clinical, and biopsy is usually not necessary.
• Treat erythema multiforme supportively and consider prophylactic antiviral drugs if HSV is the suspected cause and recurrences are frequent. (The use of corticosteroids is controversial).

Stevens-Johnson syndrome (SJS) & Toxic epidermal necrolysis (TEN):
• Drugs cause > 50% of SJS and up to 95% of TEN cases, but infection, vaccination, and graft-vs-host disease are also potential causes.
• Confirm the diagnosis by biopsy (showing necrotic epithelium) if clinical characteristics (eg, target lesions progressing to bullae, ocular and mucous membrane involvement, positive Nikolsky sign, desquamation in sheets) are inconclusive.
• Early treatment decreases the often high mortality rate.
• Except for mild cases, treat SJS/TEN in a burn unit and with intensive supportive care.
• Consult ophthalmology if the eyes are affected.
• Consider cyclosporine and possibly plasmapheresis for severe cases.

I think this is more likely to be EM than SJS, because Nikolsky sign is -ve, the lesions are raised (SJS lesions are macular), and the trunk is not affected.

If anyone has any other dx, plz tell me

Carpal bones