Scenario: A 46-year-old man presents with hyperpigmented patches in various areas on his body. He says he believes they started approximately 3 days after starting hydralazine for his elevated blood pressure. He wants to know if he should stop taking the medication.

Task: Choose the best method to select the clinical scenario. You do not have a particular diagnosis in mind and you feel choosing an appropriate clinical scenario for an adult with a rash will be intuitive.

Step: Click the Differential Builder button.

Task: View the list of clinical scenarios and determine which is the most appropriate to enter, given the presenting patient.

Step: Under Adult Skin, in the Adult area, to the right of Multiple Lesions Or Rash, click Dark Skin - Multiple Lesions or Rash.

Tip: If you were unsure which clinical scenario to enter, you could click the Guide My Selection button found in the upper-right corner.

Task: Enter findings to build a differential diagnosis.

1. Click the Quick Start button, which first opens the Add Lesion Type window. Click Flat / Macular and then, in the sub-findings window, click Flat / Macular again.
2. In the Add Body Location / Distribution window, under Distributions, click Scattered Few and then click OK.
3. In the Add Key Findings window, under Appearance, select No Acute Distress. Under Timing, select Developed Acutely Over Days To Weeks. Click OK.

Note: The findings you entered are displayed in the Current Findings area.

Task: Use the Type to Add Findings text box to enter the drug hydralazine.

Step: In the Type to Add Findings text box, enter Hydralazine.

Note: Fixed drug eruption matches 5 of the 5 entered findings.

Step: Click the Drug Eruption, Fixed link on the image stack for fixed drug eruption.

Task: View text and images associated with fixed drug eruptions.

Tip: To learn more about the therapy for fixed drug eruptions, such as whether the patient should go off his hydralazine, scroll down to the Therapy section or, under Contents, click the Therapy link.

Task: View all the images for fixed drug eruption.

Step: Click the All Images link in the upper-right corner.

Task: Choose an image to view at its largest size.

Note: Scroll down the page, if necessary.

Step: Click the image of your choice.

• Print the page by clicking the Print button.
• Navigate through more images by clicking the Forward and Back buttons at the bottom of the image or by using the slider bar.
• Return to All Images view by clicking the All Images link.
• Return to the Text and Images view by clicking the Text and Images link.
• Return to the Differential Builder page by clicking the Differential Builder button at the top of the page.
• Return to the VisualDx Home page by clicking the VisualDx logo in the upper-left corner.

Scenario: A 3-year-old child presents with an itchy eruption on the cheeks. On examination, you see erythematous, scaly plaques on both cheeks. The child is otherwise well. He has a past medical history of asthma.

Task: Choose the best method to select the clinical scenario. You do not have a particular diagnosis in mind and you feel choosing an appropriate clinical scenario for a child with a rash will be intuitive.

Step: Click the Differential Builder button.

Task: View the list of clinical scenarios and determine which is the most appropriate to enter, given the presenting patient.

Step: Under Pediatric Skin, in the Child area, click Multiple Lesions Or Rash.

Tip: If you were unsure which clinical scenario to enter, you could click the Guide My Selection button found in the upper-right corner.

Task: Enter findings to build a differential diagnosis.

1. Click the Quick Start button, which first opens the Add Lesion Type window. Click Scaly Papule / Plaque and then, in the sub-findings window, click Scaly Plaque.
2. In the Add Body Location window, click Face, click Cheek, and then click OK.
3. In the Add Key Findings window, under Appearance, select No Acute Distress. Click OK.

Note: The findings you entered are displayed in the Current Findings area.

Task: Use the Type to Add Findings text box to enter the remaining findings.

1. In the Type to Add Findings text box, enter Pruritus.
2. In the Type to Add Findings text box, enter Asthma.

Note: Atopic dermatitis matches 5 of the 5 entered findings.

Step: Click the Dermatitis, Atopic link on the image stack for atopic dermatitis.

Task: View text and images associated with atopic dermatitis.

Task: View all images associated with this diagnosis.

Step: Click the All Images link.

Task: Choose an image to view at its largest size.

Note: Scroll down the page, if necessary.

Step: Click the image of your choice.

• Print the page by clicking the Print button.
• Navigate through more images by clicking the Forward and Back buttons at the bottom of the image or by using the slider bar.
• Return to All Images view by clicking the All Images link.
• Return to the Text and Images view by clicking the Text and Images link.
• Return to the Differential Builder page by clicking the Differential Builder button at the top of the page.
• Return to the VisualDx Home page by clicking the VisualDx logo in the upper-left corner.

Scenario: A 46-year-old man presents with hyperpigmented patches in various areas on his body. He says he believes they started approximately 3 days after starting hydralazine for his elevated blood pressure. He wants to know if he should stop taking the medication.

Task: Choose the best method to select the clinical scenario. You are unsure of the diagnosis and would like to consider the diagnostic possibilities for an adult with a drug eruption.

Step: Click the Differential Builder button.

Task: View the list of clinical scenarios and determine which is the most appropriate to enter, given the presenting patient.

Step: Under Drug Reactions, click Drug Eruptions.

Tip: If you were unsure which clinical scenario to enter, you could click the Guide My Selection button found in the upper-right corner.

Task: Enter findings to build a differential diagnosis.

1. Click the Quick Start button, which first opens the Add Lesion Type window. Click Flat / Macular and then, in the sub-findings window, click Flat / Macular again.
2. In the Add Body Location / Distribution window, under Distributions, click Scattered Few and then click OK.
3. Read the text in the Add Key Findings window and click OK.

Note: The findings you entered are displayed in the Current Findings area.

Task: Use the Type to Add Findings text box to enter more relevant findings.

Step: In the Type to Add Findings text box, enter No Acute Distress.

Step: In the Type to Add Findings text box, enter Developed Acutely Over Days To Weeks.

Step: In the Type to Add Findings text box, enter Hydralazine.

Note: Fixed drug eruption matches 5 of the 5 entered findings.

Step: Click the Drug Eruption, Fixed link on the image stack for fixed drug eruption.

Task: View text and images associated with fixed drug eruptions.

Tip: To learn more about the therapy for fixed drug eruptions, such as whether the patient should go off his hydralazine, scroll down to the Therapy section or, under Table Of Contents, click the Therapy link.

Task: View all the images for fixed drug eruption.

Step: Click the All Images link.

Task: Choose an image to view at its largest size.

Note: Scroll down the page, if necessary.

Step: Click the image of your choice.

• Print the page by clicking the Print button.
• Navigate through more images by clicking the Forward and Back buttons at the bottom of the image or by using the slider bar.
• Return to All Images view by clicking the All Images link.
• Return to the Text and Images view by clicking the Text and Images link.
• Return to the Differential Builder page by clicking the Differential Builder button at the top of the page.
• Return to the VisualDx Home page by clicking the VisualDx logo in the upper-left corner.

Scenario: A 28-year-old student returned from a 2 week "eco-camping" tour in Belize. A lesion on the forearm slowly evolved into a smooth nodule with a central pore.

Task: Choose the best clinical scenario. You are unsure of the diagnosis and would like to consider the diagnostic possibilities in a traveler.

Step: Click the Differential Builder button.

Task: View the list of clinical scenarios and determine which is the most appropriate to enter, given the presenting patient.

Step: Under Adult Skin, in the Specialized Content area, click International Travel.

Tip: If you were unsure which clinical scenario to chose, you could click the Guide My Selection button found in the upper-right corner.

Task: Enter findings to build a differential diagnosis.

Steps:

1. Click the Quick Start button, which first opens the Add Lesion Type window. Click Smooth Papule / Plaque and then, in the sub-findings window, click Nodule.
2. In the Add Body Location window, click Arm, click Upper Arm, and then click OK.
3. Read the text in the Add Key Findings window and click OK.

Note: The findings you entered are displayed in the Current Findings area.

Task: Use the Type to Add Findings text box to enter information about camping in Belize.

Steps:

1. In the Type to Add Findings text box, enter Belize.
2. In the Type to Add Findings text box, enter Camping.

Note: Myiasis matches 4 of the 4 entered findings.

Step: Click the Myiasis link on the image stack for myiasis.

Task: View text and images associated with myiasis.

Task: View all images for myiasis.

Step: Click the All Images link.

Task: Choose an image to view at its largest size.

Note: Scroll down the page, if necessary.

Step: Click the image of your choice.

Note: From this view, you may do the following:

• Print the page by clicking the Print button.
• Navigate through more images by clicking the Forward and Back buttons at the bottom of the image or by using the slider bar.
• Return to All Images view by clicking the All Images link.
• Return to the Text and Images view by clicking the Text and Images link.
• Return to the Differential Builder page by clicking the Differential Builder button at the top of the page.
• Return to the VisualDx Home page by clicking the VisualDx logo in the upper-left corner.