EM Coach: Positively chilling

What caused this teen girl’s breakout of hives? Question Stem A 14-year-old girl is brought to the emergency department to be evaluated for diffuse hives (pictured below). They developed while the family was swimming in a cold lake where they were picnicking. No one else in the family developed any symptoms. It took her parents 30 minutes to get her to the hospital, and her symptoms started to resolve by the time she arrived. Which of the following findings may be used to confirm the suspected diagnosis? Question Answer Choices A. Development of vesicles hours later B. History of Raynaud’s phenomenon C. Positive Allen test D. Positive ice cube test E. Recurrence of symptoms after diphenhydramine Question Explanation Incorrect answer choices: Pernio (or chilblains) is a non-freezing cold injury that occurs due to prolonged intermittent exposure to cold, wet conditions. The classic lesions are erythematous or purple and develop on the feet, hands, legs or thighs 12- to 24-hours after the cold exposure. Severe cases have vesicular lesions (Choice A). Symptoms include pruritus and a burning pain that often worsens with warming. Treatment is supportive, and lesions are generally self-limited. In contrast to pernio, cold urticaria should not lead to the delayed development of a vesicular rash. Raynaud’s phenomenon (Choice B) is a disorder of episodic arterial vasospasm, typically in the fingers and toes, in response to triggers such as cold, vibration, moisture or emotional...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Source Type: news