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?
Answer(s): E
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.
Which of the following is a useful clue to the diagnosis of Legionella pneumonia?
Answer(s): A
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.
A60-year-old previously healthy man presents with massive rectal bleeding. Which of the following is the most likely diagnosis?
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.
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?
Answer(s): C
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.
A 70-year-old man presents with shuffling gait, tremor, masked facies, and rigidity which have progressed over the last 9 months. Parkinson's disease is diagnosed. In this patient, which neurotransmitter deficiency primarily is responsible for his symptoms?
Answer(s): D
Deficiency of dopamine primarily is responsible for the signs and symptoms of Parkinson's disease.Specifically, the loss of dopamine from the substantia nigra is thought to be primarily responsible for the akinesia and rigidity. Tremor, akinesia, and rigidity are the classic triad of signs seen in Parkinson's disease. The tremor typically is a resting tremor; often a "pill rolling" tremor is seen in the hand. Well over 90% of patients with Parkinson's disease do have a good initial response to levodopa
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