Musculoskeletal/CT/Skin Question Set 2

A 70-year-old male came for a routine health check to the outpatient department. He recently completely lost hearing in both ears and has occasional flare-ups of osteoarthritis in his hands and hips. He is a non-diabetic and hypertensive for the past 25 years. His brother recently died due to prostate cancer. His current blood pressure is 126/84 mmHg. Cholesterol levels are within normal limits. He is negative for PSA. Flexible sigmoidoscopy along with stool guaiac test are negative. Serum calcium, phosphorus concentrations and liver function test results are normal; however, ALP levels are increased by more than thrice the upper limit. Radiological tests are normal. The most likely complication of this patient's condition is?

A 32 year old female complains of diplopia. She works as a software engineer and has been complaining of drooping of her eyelids and severe muscle weakness. On further enquiry, she said that her symptoms worsen at the end of the day. Which of the findings are most likely seen?

30 year old male, BMI of 33.7 kg/m2, presented with severe pain in his right toe since morning. He had few beers last night at a friend’s party. On examination, the right toe looks swollen, warm, red and tender to touch. Joint aspiration was done. The examination of fluid will most probably reveal:

A 27-year-old male, who is a tennis player, presents to the Emergency Room complaining of left shoulder pain. He says that pain often worsens when he tries to sleep on his left side. Upon examination of the shoulder, deep tenderness is noted. Rheumatoid factor is positive. What is the most likely diagnosis?

A 24-year-old female presents with blisters and erosions on the upper face, chest, and back. The blisters are associated with erythema, scales and crust formation. Lesions are aggravated especially after sun exposure. Examination shows oromucosal involvement. Histopathology shows row of tombstone arrangement at the base of the blister. The most likely cause for the present condition is?

A 35-year-old male presents with large tense blisters on the flexor surfaces of the upper extremities and trunk. Histology shows a sub-epidermal blister with eosinophil-rich infiltrate. The most likely underlying pathology is?

A 55-year-old female presents with pain in her both hands and wrists for several years. It is associated with the morning stiffness that lasts for almost an hour. Physical examination reveals tenderness and swelling in both hands and wrists. Laboratory investigations reveal the presence of anti-cyclic citrullinated peptide. Which one of the following immune mediate injuries is responsible for this patient’s condition?

A 28-year-old woman comes to the doctor with sudden onset of edematous and hyperemic circular skin lesions all over her body. The lesions are not painful but are pruritic. She also complains of severe genital pruritus. The patient also reported that she ate peanut butter 15-20 minutes before the onset of symptoms. Her vital parameters are normal and there are no signs of any airway obstruction. What is the suggested treatment?

A 10-month-old baby girl is brought in by her mother because of skin lesions on her chest. Upon examination, several skin colored umbilicated papules are visible. Other than that, child appears to be completely healthy, is within the expected growth curve and exhibits no other signs or symptoms. What is the possible treatment of the suggested infection?

A 29-year-old woman comes to the doctor’s office because of the skin lesions that started to appear in the last few months. Lesions, located mostly on her elbows, are not painful and they rarely itch and are raised, inflamed and whitish-silver in color. Patient also complains of some joint pain and has had ocular problems lately (conjunctivitis and corneal dryness). What are the expected histopathological findings in this patient?

A 31-year-old woman comes to the doctor’s office because of the pruritic vesicles that appeared on the right side of her torso. Before the vesicles appeared, patient experienced burning sensation in the affected area. Upon examination, it is obvious that vesicles are localized in one skin dermatome. As herpes zoster seems to be the most likely diagnosis, what is the possible complication that could follow this skin condition?

A 52-year-old woman comes to her GP because of erosions in her mouth that are persistent and painful. For the last several days, she noticed erosions on her skin as well. She reported to have seen several flaccid blisters, but they transform into erosions almost immediately. What is the most likely diagnosis?

A 68-year-old man comes to his GP because of blisters that started to appear on the flexor side of his arms and legs. He had similar blisters before but hasn’t sought medical attention until now. What is the best diagnostic test for the present condition?

A 27-year-old school teacher comes to the doctor’s office because of the skin lesions that started to appear in the last few days. Lesions are mostly located on her torso; they are circular, 1-10mm in diameter, raised and scaly. Patient doesn’t suffer from any other chronic diseases. She reported to have had upper respiratory tract infection several weeks prior to skin lesions. What is the most likely diagnosis?

A 42-year-old homeless man presents with threadlike elevations 2-10mm long between his fingers, flexor sides of his wrists, axillae, scrotum and feet. Lesions are extremely pruritic. Excoriations are visible around the primary lesions. There are no medical records available for the patient, but he claims to be otherwise healthy and suffers with no chronic disease. What is the suggested treatment in this case?

A 2-day-old newborn presents with sudden sleepiness, less food intake, high fever and skin erythema followed by severe exfoliation of the entire skin. The child is rom the first pregnancy that was regularly controlled (without any pathology) that ended with vaginal delivery without any complications. Family history is unremarkable. What is the most likely cause of the disease?

A 22-year-old male visits your office after noticing the appearance of multiple target-like skin lesions on his right and left upper and lower limbs 4 days ago. Over the last 24 hours the lesions have extended to his torso. You notice on his medical records that he consulted your colleague last week referring pruritus and pain on the left border of his lower lip, followed by the development of an oral ulcerative lesion. During physical examination, you find round erythematous papules with a central blister, a pale ring of edema surrounding a dark red inflammatory zone, and an erythematous halo. Mucosal surfaces area free of any ulcerative and exudative lesion. Which of the following statements best explains the pathogenesis underlying the patient’s current condition?

A 39-year-old Caucasian woman presents to your office with 4 of days of fever, sore throat, generalized aching, arthralgia and tender nodules on both of her shins that appeared in the last 48 hours. Her personal medical history is negative for disease, she does not take oral contraceptives or any other medication regularly. During physical examination, you find a body temperature of 38.5 °C (101.3°F), a heart rate of 85 beats per minute, and a blood pressure of 120/65 mmHg, tender and enlarged submandibular lymph nodes, and an erythematous, edematous, and swollen pharynx with enlarged tonsils presenting a patchy white exudate on the surface. She is not pregnant. Examination of her lower limbs reveals erythematous, tender, immobile nodules on both shins. You do not identify ulcers nor similar lesions on other areas of her body. What is the most likely diagnosis in this patient?

A 28-year-old male is referred to the dermatologist for 2 months of increasingly appearance of multiple smooth, circular patches of complete hair loss on his scalp. Symptoms include a burning sensation and pruritus on his scalp, which were not improving with over the counter products recommended by his local hair stylist. He denies pulling his hair intentionally. Examination reveals no inflammation or erythema and no fluorescence was detected under the Wood’s lamp. A punch biopsy evaluation shows peribulbar lymphocytic inflammatory infiltrates surrounding anagen follicles, resembling a swarm of bees. What is the most likely diagnosis?

A 27-year-old man presents to the emergency department with unrelenting muscle spasms for one day. The patient’s girlfriend states that he started having jaw spasms last night but now it includes his neck, back, and arms. The patient states that he has not been to the doctor since he was a little boy and has no significant medical history except that he sustained a puncture wound to his foot 2 weeks ago but states that it is healing fine. On exam, the patient is in obvious discomfort, arched laying on his back. His temperature is 102.4F, his heart rate is 115 bpm, his blood pressure is 145/110 mmHg and respirations are 15/min. Labs are drawn and a basic metabolic panel comes back normal. The complete blood count is normal except for a white blood cell count of 16,900 cells/mm3. Which of the following is the most likely etiology of this patient’s symptoms?

A 3-year-old boy presents to the office with his mother. She states that her son seems weak and unwilling to walk. He learned how to walk recently, a very notable developmental delay. The mother states that some boys on her side of the family have had similar symptoms and worries that her son might have the same condition. A genetic study is performed that reveals an absence of normal functioning dystrophin. Which of the following is the most likely diagnosis?