ImageIQ Do-Over: 5 Hardest Quizzes 2015

Every month, Consultantlive.com tests your visual diagnostic skills with an ImageIQ. We offer a little clinical history and a single striking image-you guess the diagnosis. And, most of the time, you’re right. But sometimes the condition is rare or it closely mimics another. So, here’s your second chance. We’ve selected the 5 ImageIQs that stumped the most people this year. Have another go: What’s your diagnosis?

Note: If you would like more information on any of the ImageIQs, links to the full original cases are provided in the References section, on the last page.

#1. Victual Avoidance

A 25-year-old man presents with dysphagia to solids that has progressed over the past year. He now avoids breads, meats, and other foods he fears may lodge in his esophagus. Liquids present no problem. PMH includes eczema and seasonal allergies. Upper endoscopy image is shown above.

Answer and ImageIQ #2 on Next Page »

The correct answer is A. Eosinophilic esophagitis.

#2. Unusual Facial “Bruise” on a Baby

A 20-month-old boy presents with an unusual bruise that arose after he bumped his face against his toy chest 4-5 weeks ago. The nodule is reddish-blue, very firm, and feels as though it has several lumps within it. He has no other skin lesions. The only laboratory test performed is a CBC which reveals a normal differential and normal indices. The child is otherwise well.

Answer and ImageIQ #3 on Next Page »

The correct answer is D. Pilomatrixoma

#3. Elbow Erosions

A 42-year-old man presents with a pruritic rash characterized by pink, scaly plaques with a few crusted erosions on the elbows (Figure) knees, lower back, and buttocks. Review of systems was negative, although there was a strong positive family history of celiac disease. He took no medications and was otherwise healthy.

Answer and ImageIQ #4 on Next Page »

The correct answer is A. Dermatitis herpetiformis

#4. An Unusual Summer Tan

An 18-year-old boy presents with a hypopigmented scaly macular rash appearing predominately on his back, chest, and arms. The rash became more apparent as he acquired his “usual summer tan.” He reports no other skin problems.

Answer and ImageIQ #5 on Next Page »

The correct answer is C. Tinea versicolor

#5. A Scaly Rash

An 11-year-old boy presents with a rash of tear-drop shaped scales spread symmetrically on his trunk and proximal extremities. The scale is adherent and attempts to scrape the lesions result in punctate bleeding. Other than a case of strep throat last week for which he was treated with antibiotics, he is otherwise in good health.

Answer and Links to Cases on Next Page »

The correct answer is C. Guttate psoriasis

Original Cases

1. Victual Avoidance

2. Unusual Facial “Bruise” on a Baby

3. Elbow Erosions

4. An Unusual Summer Tan

5. A Scaly Rash