Xanthogranuloma? Lung Cancer?

January 8, 2014

A beautiful baby with a yellow plaque. . . . idiopathic chilblains . . . 5 questions here to challenge you.

Question 1:

A neonate had a soft, yellowish plaque on the temple. The pregnancy was uneventful and Apgar scores at delivery were satisfactory.

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Question 2:

An 86-year-old woman presented with a 1-week history of worsening dyspnea, wheezing, orthopnea, and paroxysmal nocturnal dyspnea. Her past medical history included bioprosthetic aortic and mitral valve replacement for severe mitral stenosis and aortic regurgitation, paroxysmal atrial fibrillation, and rheumatoid arthritis. She had hypoxemia with a high alveolar-arterial gradient; intrapulmonary shunt fraction was 27%. A CT scan of the chest with contrast was obtained.

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Question 3:

 

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Question 4:

Idiopathic chilblains was diagnosed in a 20-year-old woman who presented in mid-winter with a mildly painful, swollen, and discolored left toe.

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Question 5:

 

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ANSWER KEY:

Question 1. B

Question 2. D

Question 3. B

Question 4. C

Question 5. A