Five Clinical Cases: 5 Tough Questions

November 22, 2013

Here: 5 cases submitted by your colleagues: see if you know what the findings in each case indicate.

Question 1:

A 22-year-old woman presented with right lower quadrant and suprapubic abdominal pain. A CT scan of the abdomen and pelvis revealed a thickened tubular structure in the right lower quadrant with a hypodense mass directly adjacent to it. Radiographic interpretation included an adnexal mass, but appendicitis could not be ruled out. The patient underwent emergent laparoscopy. During surgery, a large ovary, thickened fallopian tube, and adnexal fluid were visualized on the right side. The appendix appeared normal. A significant number of adhesions that involved the liver were noted. The diagnosis was Fitz-Hugh-Curtis syndrome.

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Question 2:

A 41-year-old woman with chest pain and dysphagia has profound neutropenia. Her WBC count is 2200/μL; absolute neutrophil count, 300/μL; hemoglobin level, 12.3 g/dL; and mean corpuscular volume, 83 f. Her platelet count is normal. She has hepatitis B and C, schizophrenia, and recently had a keratoplasty. She smokes 4 or 5 cigarettes a day and crack cocaine 2 or 3 times a week.

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Question 3:

A 29-year-old man had pain and circular, soft swelling over the anterior left knee, superficial to the patellar ligament. For the past 10 years, he has worked laying floor tile.

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Question 4:

A 37-year-old man had painful, burning, blistering skin lesions that started on the face and spread to his trunk and extremities. Ten days earlier, he had received a diagnosis of AIDS and had started therapy.

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Question 5:

An asymptomatic, firm, nontender mass had been growing on the neck, slightly left of midline at the level of the hyoid bone, of a 54-year-old man. The mass was mobile on protrusion of the tongue and during swallowing. An axial thoracic CT scan revealed a 3 x 3-cm cyst attached to the hyoid bone.

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ANSWER KEY:

Question 1. B

Question 2. E

Question 3. D

Question 4. B

Question 5. A