Looking at Women’s Health Issues: A Photo Quiz

April 10, 2014

Many medical problems are common to both men and women, but several occur more frequently in women. This week’s photo quiz tests your knowledge of a variety of these disorders.

Question 1:

Dermatomyositis, which has a variety of cutaneous manifestations, occurs more frequently in women than in men. The characteristic heliotrope rash is seen in this woman.

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Question 2:

Sarcoidosis most often affects women aged 20 to 50 years; 10% of patients present with Löfgren syndrome. A 33-year-old woman had frontotemporal headaches and neck pain without stiffness and, later, a worsening headache and nausea, vomiting, ankle pain with swelling, and fevers. A new rash appeared as erythematous, tender patches on the anterior aspect of her lower extremities. The patient then returned with new-onset diffuse chest pain, abdominal pain, and worsening headache.

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Question 3:

This mildly pruritic, nontender rash erupted on the upper back of a 58-year-old woman in late August. She had not started to take any new medications, and she was not taking photosensitizing drugs. She had Sjögren syndrome; the rest of her history was noncontributory. The diagnosis was subacute cutaneous lupus erythematosus.

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Question 4:

A 77-year-old woman had shortness of breath that worsened when she was supine and intermittent left flank pain. She had had mild nonbloody diarrhea, but no vomiting or oral intake intolerance. She had a history of an embolic cerebral stroke, for which she takes warfarin. There is a large, firm, ecchymotic, exquisitely tender mass over the left side of her abdomen. She had fallen in her bathroom a few days earlier.

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Question 5:

A 62-year-old woman was evaluated in preparation for cholecystectomy. She had no cardiac or pulmonary disorders. The physical examination was unremarkable other than a purplish red lace-like pattern on the skin. The mottling was most prominent on the thighs and forearms. She had been experiencing the rash for 3 years and said that it becomes more pronounced when she is exposed to cold. The lesions caused no itching or pain. This is a classic presentation of livedo reticularis.

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Question 6:

This female patient, an astute self-observer, was sure that the margin of her palm had turned red only in the past few months. The time span corresponded to the duration of clinical liver metastases. Unlike the red palms we experience after sitting on our hands, true palmar erythema shows spottiness within the red zone and central palmar sparing.

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Question 7:

Lice infestation is a rare cause of blepharitis. A 45-year-old woman had ocular irritation, tearing, blurred vision, and eyelid swelling in both eyes. She was treated for allergic conjunctivitis and blepharitis by several physicians. Her medical history included lupus and seasonal allergies, for which she was taking hydroxychloroquine and loratadine, respectively. Slit lamp examination revealed nits on the eyelashes, with associated inflammation of the eyelid margin and mild conjunctival injection in both eyes.

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ANSWER KEY:

Question 1. A

Question 2. B

Question 3. C

Question 4. D

Question 5. D

Question 6. A

Question 7. E