Sohag University
Sohag faculty of medicine
2/5/2012
Surgery department Time allowed: 1.5hrs
MD General Surgery Examination
Paper III - Commentary case
A 52-year-old male presented to the emergency department after experiencing pain and redness
of his right leg/foot. The morning of his admission, the patient noticed bulla formation on the
dorsum of his right foot and it became worse in a matter of hours.
The patient denied any trauma to the right foot but noted a fever and generalized malaise. The
past medical history included lower extremity cellulitis, cirrhosis of the liver, hepatitis C, acute
renal failure, hyperkalemia, esophageal varices and morbid obesity.
The patient’s current medications include pantoprazole, propranolol, Calcium
supplementation, multi-vitamins and folic acid. He has no known drug allergies. The patient
does have a past social history of IV drug use but this concluded 15 years ago.
The patient presents with blood pressure of 114/69, heart rate of 81, respiratory rate of 20 and
temperature of 37.7º. The patient has significant lab results with a white blood cell count of 11.5
thousand and an erythrocyte sedimentation rate of 55.
Physical examination revealed palpable dorsalis pedis and posterior tibial pulses in the right
lower extremity with extensive erythema extending from the knee to the base of the digits. Bulla
formation was present on the central and medial aspects of the foot dorsally. The patient also
had pain on palpation to the foot and leg. He was also experiencing calf tenderness.
Comment