Go for the Glory Quiz-Skin Lesions and Chest Film Infiltrates: Your Dx?

May 31, 2013

What disorder do these asymptomatic skin lesions and chest film findings point to in a homosexual man? Test your clinical skills in this week’s 5-question quiz.

QUESTION 1:



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A 38-year-old homosexual man presented with cough and multiple asymptomatic skin lesions on his face. A chest radiograph was positive for nodular parenchymal infiltrates, most consistent with an infection from either acid-fast bacilli or fungi. The patient refused bronchoscopy, and his cough was not productive enough to obtain a reliable sputum specimen for culture.

QUESTION 2:

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A 34-year-old woman presents with the sole complaint of fatigue that has come on gradually over the past 6 months. She is sleeping well and is happy in her marriage. She denies fever, chills, nausea, or vomiting. She has gained approximately 5 lb recently, which she attributes to her lack of energy to exercise. The patient had nodular sclerosing Hodgkin disease 4 years ago. The disease was limited to the chest and was treated with radiation and chemotherapy. Her oncologist told her at a visit 8 months ago that there was no evidence of disease.

QUESTION 3:



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A 7-year-old boy presented with a solitary, nearly circular, very pruritic inflammatory facial lesion. He was otherwise in good health.

QUESTION 4:



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A 33-year-old African American woman presents with asymptomatic, slowly expanding, firm, reddish purple plaques at the distal nose and within the nasal septum. Her only additional complaint is dyspnea on exertion.

QUESTION 5:



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A 29-year-old African American woman complains of ankle pain and a nonpruritic rash on her shins that began a week earlier. She has no history of arthritic complaints. She has no fever or chills, abdominal or chest pain, or dyspnea; she is not nauseated and has not vomited. She has not noticed any change in skin color or in the color of her urine. She is sexually active and says she practices “safe sex.” She takes no medications, does not smoke cigarettes, and does not use illicit drugs. She has not traveled outside the US.

ANSWER KEY:



Question 1. Answer: b

Question 2. Answer: a

Question 3. Answer: c

Question 4. Answer: b

Question 5. Answer: d