QUESTION: 21

A32-year-old woman is referred to you by her dermatologist for further evaluation. She developed these changes gradually in the last year. Her hands are seen in Figure. What other associated disease is most likely?

acquired immune deficiency syndrome (AIDS)
Addison's disease
lymphoma
primary biliary cirrhosis
Hashimoto's thyroiditis

Answer(s): E

Explanation:

Up to 30% of cases of acquired vitiligo are associated with thyroid disease, especially Hashimoto's thyroiditis. It also may occur with pernicious anemia, diabetes, and other autoimmune disorders. Vitiligo has not been reported with AIDS. Addison's disease, lymphoma, and biliary cirrhosis can be associated with hyperpigmentation.

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QUESTION: 22

Which of the following is a useful clue to the diagnosis of Legionella pneumonia?

diarrhea
rash
pedal edema
elevated serum glucose
photophobia

Answer(s): A

Explanation:

The spectrum of infection with Legionella organisms ranges from asymptomatic seroconversion to Pontiac fever (a flu-like illness) to full-blown pneumonia. Cough is usually nonproductive initially. Malaise, myalgia, and headache are common. The diagnosis of Legionella infection is suggested by extrapulmonary signs and symptoms, including diarrhea, abdominal pain, azotemia, and hematuria.

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QUESTION: 23

A60-year-old previously healthy man presents with massive rectal bleeding. Which of the following is the most likely diagnosis?

diverticulosis of the colon
ulcerative colitis
external hemorrhoid
ischemic colitis
carcinoma of the colon

Answer(s): A

Explanation:

The causes of lower gastrointestinal (GI) bleeding include hemorrhoids and anal fissure diverticulosis, carcinoma, vascular ectasia, colitis, and polyps. Carcinoma of the colon usually causes chronic GI bleeding, resulting in anemia. Diverticulosis and vascular ectasia are common causes of massive GI bleeding in the elderly patient. Inflammatory bowel disease can also cause massive GI bleeding but is more frequent in younger age group patients. Most patients with ischemic colitis will be quite sick and will have had symptoms before the onset of bleeding.

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QUESTION: 24

A 24-year-old man runs a marathon on an unusually hot and muggy day. Several hours later he becomes ill with fever, weakness, and painful swollen legs and passes dark brown urine. Which of the following is a common finding with this disorder?

Urine orthotoluidine (Hematest) reaction will be negative.
Serum will be pink.
Serum creatine phosphokinase levels will be elevated.
Serum haptoglobin levels will be elevated.
Serum potassium levels will be lowered.

Answer(s): C

Explanation:

The clinical features of the patient described in the question are characteristic of rhabdomyolysis with myoglobinuria. Skeletal muscle injury releases large amounts of myoglobin into the circulation, and myoglobinuria produces a positive orthotoluidine reaction. Because myoglobin is quickly cleared from serum by the kidneys, the serum does not turn pink, as it does with hemoglobinemia. Muscle damage leads to elevated creatine phosphokinase levels and hyperkalemia. Myoglobin does not bind to haptoglobin as does hemoglobin, so serum haptoglobin levels are normal. The major complication of rhabdomyolysis is acute renal failure.

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