Quiz
Mixed diagnoses – 10 cases (11 of 11)

For each of the ten cases, study the image and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

Case 8

A twenty-year-old aerobics instructor complains that she develops an itchy rash on her upper trunk every time she takes a class. It settles after resting for about twenty minutes. Examination after she has taken a run around the block reveals numerous two to three millimetre weals with erythematous flare.

What is the name of this complaint?

Cholinergic urticaria

Apart from exercise, what else may provoke the rash?

An increase in environmental temperature, or body temperature such as with emotional stress, or fever. Cholinergic urticaria appears to relate to the rise in temperature rather than the absolute temperature.

What treatment should be recommended?

Non-sedating antihistamines can help, sometimes requiring a double dose of cetirizine or loratidine. If these are ineffective, a trial of propranolol, or phototherapy may be worthwhile. Severe cases have been treated successfully with stanozolol.

How can she prevent the rash occurring?

Ensure her body temperature is kept as even as possible, by wearing warm clothing during the winter prior to exercise for example. She should exercise regularly.

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