A healthy 84-yo woman had 3 mo of double vision, droopy eyelids (worse on the right and in evening), and progressive bilateral arm weakness that was worse on exertion and better after rest. Cognition, reflexes, and sensation were normal. Diagnosis?
Posterior circulation stroke
Myasthenia gravis
Botulism
Cavernous sinus thrombosis
Guillain-Barre syndrome
You are correct. The autoimmune disease myasthenia gravis often presents with bilateral complex external ophthalmoplegia. Symptoms are often worse in the evening and after exertion. Long tract signs, sensory symptoms, and headache are absent. Diagnosis is confirmed with IV edrophonium test. This patient improved with the usual treatment of anticholinesterase drugs and corticosteroids.
(BMJ) - A healthy 22-yo woman presented with painful genital ulcers for 1 year, unresponsive to various treatments. Exam revealed labia majora and cervix lesions, aphthous-like oral lesions, and leg folliculitis. ESR was elevated. What is the diagnosis?
Herpes zoster
Systemic lupus erythematosus
Behcet disease
Disseminated gonorrhea
Ulcerative colitis
You are correct. She meets criteria for Behcet disease: recurrent oral ulcers with 2 of these 4: recurrent genital ulcerations, eye lesions (uveitis or retinal vasculitis), skin lesions (erythema nodosum or folliculitis), positive pathergy test (a small red bump or sterile pustule after an intracutaneous insult). Most common along the Old Silk Road from the Far East to the Mediterranean, the condition was named after Turkish dermatologist Hulusi Behcet. The patient improved on corticosteroids and colchicine.
A 45-yo man presented with a 6-mo hx of diarrhea, abdominal pain, weight loss, and iron-deficiency anemia. Extensive work-up including stool studies, UGI, and limited colonoscopy was negative. Abdominal US and capsule endoscopy were performed. Diagnosis?
Yersinia enterocolitica
Cecal malignancy
Whipworms (Trichuris trichiura)
Meckel diverticulum
H pylori infection
You are correct. Capsule endoscopy revealed whipworms, Trichuris trichiura, a major nematode species affecting the human bowel, in the ileocecal valve. Ultrasound findings of thickened ileal wall and fluid-filled loops are not pathognomonic, but in the clinical context raise the suspicion of a malabsorption condition. The patient recovered rapidly with a course of mebendazole and short-term iron supplementation.
A 6-yo boy presents with 1 mo of itchy 1- to 3-mm pearly, dome-shaped papules in a red, scaly, and slightly edematous area on the thighs. He is healthy with no history of atopy. What is it?
Molluscum-associated dermatitis
Scabies
Lichen planus
Herpes zoster
Impetigo
You are correct. The image shows molluscum-associated dermatitis caused by the molluscipoxvirus. The small, pearly, dome-shaped papules with central umbilication favor intertriginous areas, although they may appear anywhere. Molluscum contagiosum infection may result in an associated dermatitis thought to be secondary to a delayed hypersensitivity reaction to the virus. The specific onset of dermatitis confined to the site of the molluscum favors the diagnosis of molluscum-associated dermatitis over atopic dermatitis. The condition is usually self-limited.
By vgreene, 1 April, 2013