A 7-year-old boy arrives at the emergency room in acute
distress. Over the past 3 to 4 days he has become progressively ill with
generalized fatigue and mild, mid-abdominal pain that have become steadily
worse. On physical examination he has a maculopapular rash on his thighs and
feet with some spread of the rash to his buttocks. The rash does not blanch and
the some lesions near the ankles look petechial or bruised. His temperature is
39.0 C(102.2 F) and he is drawing his knees to his chest for relief of his
stomach pains. He is nauseated and vomited once before coming to the hospital.
He has semi-soft dark stool, which is guaiac-positive. The boy has not voided
since early morning and cannot provide a urine sample. The doctor determines
that he is 10% dehydrated and asks the nurse to start intravenous fluids. Which
of the following is the most likely diagnosis?
A 22 year old woman visits her physician for recent onset of fatigue and weakness. She has no headaches, anxiety or depression. Her blood pressure is 140/110 mm of Hg and her pulse rate is 90 per minute. Physical examination reveals systo-diastolic abdominal bruit and normal femoral pulses. laboratory studies show Potassium levels of 2.1 mEq/L. CXR is normal and she has no family history of hypertension. She does not drink alcohol or smoke cigarettes. What is the most likely diagnosis? A) Coarctation of aorta B) Fibromuscular dysplasia C) Pheochromocytoma D) Graves disease E) Primary hyperparathyroidism
The correct answer is D. Henoch Schonlein purpura
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