You are correct. A biopsy showed squamoproliferative change with evidence of dermal inflammation, suggestive of nodular prurigo, an idiopathic condition characterized by itchy, firm lumps. “Saddle sores” are well recognized in the cycling fraternity but clinicians may not be familiar with this condition. Once established, treatment can be challenging. The use of specialized shorts, anti-chafing cream (often referred to as chamois cream), and excellent hygiene are recommended.

You are correct. The fundoscopic examination of this pt showed a macular hemorrhage involving 3 tissue layers (trilaminar), characteristic of a ruptured retinal artery macroaneurysm: preretinal (obscuring the ruptured macroaneurysm—A); intraretinal (feathery border appearance—B); and subretinal (beneath the fovea, w/ retinal vessels coursing over—C). Because she presented promptly, the hemorrhage was successfully displaced after intravitreal injection of tPA and sulfur hexafluoride gas, plus a short postop period of face-down head posturing. Retinal artery macroaneurysms classically occur in elderly women and are strongly associated w/ HTN.