Lots of Lesions, Hematemesis, Vaccinations

August 15, 2013

This week’s questions cover a range of disorders-from infectious disease to GI problems, to HIV/AIDS. See how well you do . . .

QUESTION 1:



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A 67-year-old man with a history of non-melanoma skin cancer presented for a total body skin check. Two 4-cm2 freely movable nodules were located on the central and right upper back.

QUESTION 2:



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A 24-year-old man presented with abdominal pain and hematemesis of 3 days’ duration. His symptoms were postprandial, and each episode yielded up to half a cup of blood without clots. CT scan of the chest showed a large (9 × 5.4 × 10-cm), smoothly marginated, hypodense, homogeneous mass that emanated from the azygoesophageal recess and extended along the right aspect of the posterior mediastinum and aorta, displacing the right lower lobe of the lung and esophageal lumen.

QUESTION 3:

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Vaccination-or lack thereof-is a problem in patients with ulcerative colitis and Crohn disease because the immunomodulators and biologics used as part of treatment put these persons at risk for infections and worse outcomes with infections. Regardless of immunosuppression status, however, there are a number of vaccines that are safe and important for patients with inflammatory bowel disease.

QUESTION 4:



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For 2 days, a 54-year-old woman had an asymptomatic red patch on the left anterior distal lower extremity. In the center of the lesion was an erosion where a flaccid blister had broken. She had experienced 2 previous episodes in which an identical lesion had appeared in the same location. These episodes had been preceded by a urinary tract infection for which she received trimethoprim/sulfamethoxazole. The use of an antibiotic from a different class did not result in an eruption.

QUESTION 5:



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A 39-year-old man with AIDS presented with frontal headache and scalp pain of 2 weeks’ duration. Physical examination revealed a small, tender scalp lump, 2 × 2 cm over the left parietal area. A brain CT scan showed multiple lytic lesions in the calvarium. Abdominal CT revealed hepatosplenomegaly with low-attenuation lesions and scattered lucencies throughout the vertebral bodies. There was a progressive increase in the serum calcium level. Biopsy specimens from the scalp lesion and the liver revealed Mycobacterium avium-intracellulare complex (MAIC).

ANSWER KEY:



Question 1. Answer: a

Question 2. Answer: d

Question 3. Answer: e

Question 4. Answer: c

Question 5. Answer: b