(BMJ)—An otherwise healthy 9-year-old boy had an enlarging nodule on his R shoulder x2mo. Review of symptoms: negative. FHx: unremarkable. Exam: 1x1-cm indurated yellow nodule with ulceration. Bx confirmed the dx. What is it?
Spitz nevus
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Necrobiotic xanthogranuloma
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Giant juvenile xanthogranuloma
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Mastocytoma
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Multicentric reticulohistiocytosis
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(BMJ)—A 59-year-old woman with poorly controlled HTN presented with a 1-day hx of R eyelid drooping of sudden onset. She complained of diplopia on L gaze, dull R periorbital pain, and intermittent throbbing headache. The noncontrast cranial CT she received earlier that day was negative.
Physical exam: severe R-sided ptosis (8 mm), mydriasis (5 mm) with sluggish reaction to light, and a downward, lateral deviation of the R eye; intact muscular strength; normoreflexia. What’s the dx?
Physical exam: severe R-sided ptosis (8 mm), mydriasis (5 mm) with sluggish reaction to light, and a downward, lateral deviation of the R eye; intact muscular strength; normoreflexia. What’s the dx?
Horner syndrome
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Myasthenia gravis
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Oculomotor nerve palsy
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Orbital myositis
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Preseptal cellulitis
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(BMJ)—A previously healthy woman in her 30s had fever, arthralgia, and SOB x5mo. Physical exam: bilateral 3/5 deltoid and quad strength, hyperpigmented lesions on palms, scaly digits. Labs: creatine kinase 12,193 IU/L; LDH 1,162 IU/L. Complement concentrations, anti-dsDNA antibodies, rheumatoid factor negative. CT: bilateral ground-glass opacities. What’s the dx?
Systemic lupus erythematosus
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Antisynthetase syndrome
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Rheumatoid arthritis
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Systemic scleroderma
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Polymyositis
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