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PATIENT PRESENTATION

Chief Complaint

“I have an itchy rash on my stomach and feet that won’t go away.”

History of Present Illness

RP is a 16-year-old male who presents to his primary care provider’s clinic at his mother’s insistence because of a persistent pruritic rash on his trunk and feet. He is a high school sophomore and a member of the wrestling team. He reports having two areas on his trunk that are circular, red, and itchy. He says they have increased in size since he first noticed them about 3 weeks ago. He says his feet have always smelled bad, but he first started to notice redness and “extreme itching” between his toes on both feet about 2 weeks ago. He has used over-the-counter hydrocortisone cream on the rash on his trunk without improvement. He also started applying deodorizing spray to his feet a week ago without improvement.

Past Medical History

Seasonal allergies; asthma as a young child (asymptomatic for 10 years)

Surgical History

None

Family History

Father has diabetes, diagnosed at age 45; mother has HTN, diagnosed at age 38; both parents are living

Social History

Lives at home with parents and elder sister; denies tobacco, alcohol, and illegal drug use

Allergies

NKDA

Home Medications

Loratadine 10 mg PO daily

Occasional ibuprofen for muscle pain/sports injuries

Physical Examination

Vital Signs

BP 118/78 mm Hg, P 60, RR 18 breaths per minute, Ht 5′11″, Wt 82 kg

General

Healthy-looking teenager, muscular build, well-developed, well-nourished, in NAD

HEENT

Normocephalic, atraumatic, PERRLA, EOMI, moist mucous membranes

Pulmonary

Normal breath sounds, no crackles or wheezes

Cardiovascular

NSR, no m/r/g

Abdomen

Soft, non-distended, non-tender, normal bowel sounds

Genitourinary

Normal male genitalia without erythema or scaling

Neurology

AAO × 4

Skin

Two round, erythematous, and scaly areas visible on the trunk; each measures about 1 to 2 inches in diameter; each with a well demarcated, raised border and area of central clearing

Extremities

Foul-smelling, dry, scaling feet with localized redness and white flaking between the toes. Toenails on both feet appear normal and without discoloration.

QUESTIONS

1. Which infections are consistent with RP’s presentation? Select ALL...

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