(BMJ) - A 49-yo woman presents w/ proximal myopathy and purple striae on torso and thighs. PMHx: DM, HTN, hypokalemia. Meds: insulin, metformin, 2 BP meds. Later she reveals using a skin-whitening moisturizer and topical clobetasol. What is the diagnosis?
Metabolic syndrome
Cushing syndrome
Elephantiasis
Lichen sclerosus
Scleroderma
You are correct. The patient had Cushing syndrome secondary to exogenous corticosteroid use. She had been applying a steroid-containing skin whitener + topical 0.05% clobetasol for the past 10 yrs. A morning cortisol was suppressed at 11 nmol/L (ref: 171-536 nmol/L). Two months later, off all corticosteroids, morning cortisol and ACTH were normal, and she was off insulin and antihypertensives.
(BMJ) – A post-op patient admitted to the ICU complained of acute pain and paresthesia in the first 3 digits of her left hand seconds after aspiration of blood for ABG from a radial artery catheter. What is the diagnosis?
Buerger disease
Raynaud phenomenon
Vitiligo
Frostbite
Arterial air embolism
You are correct. This patient acquired an arterial air embolism during radial artery catheterization during arterial blood gas analysis. The nurse immediately noticed that air had been entrained in the tubing and removed the line promptly. The patient’s signs and symptoms resolved spontaneously within a few minutes.
(BMJ) – A 32-yo male presented with a 2-mo Hx of fatigue, 4-kg weight loss, and dyspepsia. PMHx: none. Labs: mild normocytic anemia. Upper endoscopy: unusual raised lesion in 2nd part of duodenum. What is the diagnosis?
Crohn disease
Duodenal ulcer
Metastatic melanoma
Protrusion of ampulla of Vater
Retained bile
You are correct. Histology and immune studies confirmed metastatic melanoma. CT showed lung, adrenal, and cerebral mets, but skin exam was normal. Histological review of a nevus excised 6 yrs prior revealed a subtle melanoma, not appreciated originally. GI involvement occurs in 60% of metastatic melanoma pts w/ only 4% diagnosed before death. Initial presentation w/ duodenal mets is unusual; typical sx may include pain, bleeding, and obstruction.
(BMJ) - A 3-wk-old boy born via uncomplicated spontaneous vaginal delivery at 39 wks presented with a 1-wk Hx of facial pustules. Prenatal care did not start until 22 wks gestation. The infant was otherwise well-appearing and did not seem bothered by the rash. What is it?
Acne neonatorum
Atopic dermatitis
Neonatal pustular melanosis
Herpes simplex
Group A streptococcus
You are correct. Acne neonatorum, also known as neonatal cephalic pustulosis, is a benign, self-limited rash that presents shortly after birth. Acneiform papules and pustules are located on the cheeks, forehead, and, sometimes, chest. Herpes lesions, in contrast, are vesicular. Group A strep infection is usually associated with signs of sepsis. Neonatal pustular melanosis typically affects the entire body including palms and soles. Atopic dermatitis is often itchy and doesn't present until after 3 mos of life.