Discolored Hands and Joint Pain

November 18, 2014

The key diagnostic clue: it looks like she tried to wipe grease off her hands, but didn’t succeed.

 

Question 1:

A 60-year-old black woman presented with a history of muscle weakness, Raynaud phenomenon, joint pain, and discoloration of her hands. Physical examination showed proximal muscle weakness and mild synovitis in her metacarpophalangeal joints. Autoantibody tests were positive for antinuclear antibodies and anti-Jo1 antibodies.

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The correct answer is b. Mechanic’s hands.
For a discussion of the case, click here.

 

Question 2:

A 45-year-old woman noted painless, red, crusted papules on the hand. This was followed by the appearance of deep, slightly tender red nodules on the arm and ipsilateral axillary adenopathy. Tissue obtained from the lesions grew Mycobacterium marinum.

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The correct answer is d. All of the above.
For a discussion of the case, click here.

 

Question 3:

A 63-year-old woman with long-standing psoriasis and a decades-long history of methotrexate ingestion presents with a solitary, hard, slightly tender nodule on the hand. Her history also revealed extensive phototherapy.

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The correct answer is a. Squamous cell carcinoma.
For a discussion of the case, click here.

 

Question 4:

A 30-year-old man presented for treatment of a lifelong condition consisting of prominent skin dryness and scaling. Neither of his parents was similarly affected, nor were 3 sisters.

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The correct answer is c. Recessive X-linked ichthyosis.
For a discussion of the case, click here.

 

Question 5:

An 18-year-old woman had recalcitrant warts on her hands. She had been treated with intralesional injections of bleomycin. At the time she was treated, she was also taking an antimalarial drug as prophylaxis.

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The correct answer is e. All of the above. For a discussion of the case, click here.