Photo Diagnosis An illustrated quiz on problems seen in everyday practice
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1 An illustrated quiz on problems seen in everyday practice Case 1 A 48-year-old woman, treated one year ago with radioactive iodine for Graves disease (presently euthyroid), presented with left eye pain, prominence, and increased lacrimation. 2. Can it happen one year after treatment? 3. Can it affect one eye? 1. Graves ophthalmopathy (left eye proptosis, 21 mm by Hertel ophthalmometer [normally < 18]). 2. Yes, it can happen even years after treatment. 3. Frequently, it can be unilateral or asymmetrical. A magnetic resonance image of the orbits in this woman was negative for left retro-orbital tumour. Provided by Dr. M. Usman Chaudhry, Moncton, New Brunswick. Share your photos and diagnoses with us! Do you have a photo diagnosis? Send us your photo and a brief text explaining the presentation of the illness, your diagnosis and treatment, and receive $25 per item if it is published. The Canadian Journal of Diagnosis 955, boul. St. Jean, suite 306, Pointe-Claire (Quebec) H9R 5K3 diagnosis@sta.ca Fax: (514) The Canadian Journal of Diagnosis / November
2 Case 2 A 17-month-old infant presented with a history of pruritic, dry patches on the face, and extensor surfaces of his extremities since the age of three months. 1. What is the differential diagnosis? 3. What is the significance? 1. Atopic dermatitis. 2. Hydrocortisone ointment or cream (1%), with emollient, should be applied twice daily, with recommendation to avoid contact irritants. 3. Atopic dermatitis is an acute or subacute, but usually chronic, pruritic inflammation of the epidermis and dermis. It often occurs in association with personal or family history of hay fever, asthma, or allergic rhinitis. Provided by Dr. Jerzy Pawlak, Winnipeg, Manitoba. Case 3 This patient presented with a rash, which began a week after being bitten by an insect. 1. Erythema chronicum migrans (Lyme disease). 2. Doxycycline, 100 mg to 200 mg per day for 14 days. Provided by Dr. Rob Miller, Halifax, Nova Scotia. 44 The Canadian Journal of Diagnosis / November 2003
3 Case 4 This 25-year-old woman developed a rash five days after having an outbreak of a cold sore on her lips. She had a similar reaction one year ago. 2. What is the cause? 1. Erythema multiforme (EM). 2. EM has many underlying causes. While many cases are idiopathic in nature, EM may be precipitated by infectious agents, such as herpes simplex virus. Another infectious agent is mycoplasma. Provided by Dr. Rob Miller, Halifax, Nova Scotia. Case 5 The mother of this two-year-old boy is concerned about the look of the umbilicus of the child. 2. What is the significance? 1. Cutis navel. 2. Cutis naval is a harmless condition and no treatment is necessary. Provided by Dr. Alexander K.C. Leung and Dr. Justine H.S. Fong, The Canadian Journal of Diagnosis / November
4 Case 6 A 50-year-old man presented with a cystic mass in the left upper popliteal fossa for six months. The mass was not pulsatile. He had a long-standing history of multiple joint pain. 2. What is the significance? 1. Baker s cyst. 2. Baker s cyst is caused by herniation of the synovium of the knee joint into the popliteal space. Baker s cyst appears in elderly patients with long-standing osteoarthritis and in younger patients with rheumatoid arthritis. Provided by Dr. Alexander K.C. Leung and Dr. Justine H.S. Fong, Case 7 A 28-year-old man presented with whitish discolouration of the nails. 1. Onychomycosis. 2. Onychomycosis is best treated with oral antifungal agents (terbinafine or itraconazole) in combination with trimming of the affected nails. Provided by Dr. Alexander K.C. Leung and Dr. Alexander G. Leong, 46 The Canadian Journal of Diagnosis / November 2003
5 Photo Diagnosis Case 8 This 42-year-old man is very tall, thin, and has large hands and pectus excavatum. Question Answer 1. Marfan syndrome. Provided by Dr. Benjamin Barankin, Edmonton, Alberta. Case 9 A three-year-old boy has caries that mainly affect his upper incisors. 2. What is the cause? 1. Nursing bottle syndrome. 2. Nursing bottle syndrome results from prolonged exposure to sucrose-enriched liquids during sleep. Dx Provided by Dr. Alxander K.C. Leung and Dr. Justine H.S. Fong, ALL FULL COVERAGE on Provincial Formularies* *BC,AB, SK, MB, ON, QC, NS, NB, NFLD, and PEI. REMERON is a registered trademark of Organon Canada Ltd.
Share your photos and diagnoses with us!
Illustrated quizzes on problems seen in everyday practice Case 1 A 23-year-old man presented with an itchy rash over the posterior part of his neck. 2. What is the cause? 3. What is the treatment? 1. Folliculitis.
Questions. Answers. Share your photos and diagnoses with us!
Illustrated quizzes on problems seen in everyday practice Case 1 A 32-year-old woman had an enlargement of the right side of the body since early infancy. 2. What is the significance? 1. Hemihypertrophy.
Photo Diagnosis An illustrated quiz on problems seen in everyday practice
An illustrated quiz on problems seen in everyday practice Case 1 A 48-year-old man presented with heat intolerance, weight loss (despite a good appetite), palpitations, tremor, increased fatiguability,
Photo Diagnosis. An illustrated quiz on problems seen in everyday practice ANSWERS ON PAGE 52. Provided by Dr. Benjamin Barankin, Edmonton, Alberta.
An illustrated quiz on problems seen in everyday practice Case 1 A 67-year-old man had surgery on the chest two years ago after significant weight loss and night sweats. 2. What factors can increase the
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Illustrated quizzes on problems seen in everyday practice CASE 1 A 45-year-old female presents with a history of psoriasis and is concerned about changes to her tongue. Her tongue is asymptomatic, but
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Illustrated quizzes on problems seen in everyday practice CASE 1 A 65-year-old man is noted to have a lazy, grey ring separated from the limbus with a clear interval in both eyes. 2. What is the significance?
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Illustrated quizzes on problems seen in everyday practice CASE 1 A 66-year-old male presents with ruddy-brown, pruritic papules on his chest and back that have been present for several years. The patient
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Illustrated quizzes on problems seen in everyday practice Case 1 An 80-year-old man presented with a slowly growing, asymptomatic, pearly telangiectatic nodule on the chest. He had worked much of his life
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An illustrated quiz on problems seen in everyday practice Case 1 A 57-year-old male presented with a history of recurrent abdominal pain and weight loss over the last three months. A computed tomography
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Illustrated quizzes on problems seen in everyday practice Case 1 A 54-year-old man presented with a two-month history of a non-healing, crusted plaque on his right forearm. The plaque appeared after the
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Illustrated quizzes on problems seen in everyday practice Case 1 A 56-year-old woman presented with a two-week history of pruritic urticarial plaques and tense bullae on both erythematous and normal skin.
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Illustrated quizzes on problems seen in everyday practice Case 1 A 62-year-old man with insulin-dependant diabetes presents with a three-week history of right ear pain. The pain has become severe and keeps
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Illustrated quizzes on problems seen in everyday practice Case 1 A 58-year-old woman presents with an unsightly thickening of her lower lip, which she has had for over a year. It is asymptomatic and she
Photo Diagnosis. Case 1 This patient suffers acute onset swelling and tenderness of the face and right ear. Questions 1. What is the diagnosis?
An illustrated quiz on problems seen in everyday practice Case 1 This patient suffers acute onset swelling and tenderness of the face and right ear. 2. What is the differential diagnosis? 3. What investigations
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Illustrated quizzes on problems seen in everyday practice CASE 1: NELLY S NOSE Nelly, a 36-year-old female, presents with an asymptomatic, red papule on her nose present for several years. 1. What is your
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Illustrated quizzes on problems seen in everyday practice CASE 1 A 16-year-old girl presents with a sudden onset of tearing and itching in her left eye, with swelling of the conjunctiva. She has a history
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