Question 189
A 25-year-old male graduate student is being seen by his family physician. Over the past two years, on several occasions during each year, he has developed several painful oral ulcers that resolved within about a week. Once during the last year, he developed a painful ulcer on his penis; however, he is not sexually active and did not seek treatment. Today, he presents with red lesions on his legs and he also reports a cluster of painful ulcers in his mouth. Of the following, in which country was he most likely born?
A. Turkey
B. Russia
C. Scotland
D. Brazil
E. Mexico
Answer for Question 189
Answer: A (Turkey)
Explanation: In young males, the combination of oral ulcers, genital ulcers and skin lesions is consistent with Behcet syndrome. Skin lesions can include a variety of conditions, including erythema nodosum, which would produce the red lesions on the legs. The incidence of Behcet syndrome is highest from the eastern Mediterranean to China, which would include Turkey.
Question 190
A 26-year-old male is found unresponsive in his apartment after not reporting for work. An autopsy is performed, revealing a left hemothorax due to a ruptured thoracic aortic aneurysm. His past medical history includes recurrent oral ulcers, sometimes occurring in clusters, at least 5-6 times per year. The oral ulcers have been associated with occasional ulcers of the penis and several times, eye pain and redness. Of the following, which HLA type is associated with his disease process?
A. HLA B21
B. HLA B27
C. HLA B40
D. HLA B43
E. HLA B51
Answer for Question 190
Answer: E (HLA B51)
Explanation: In a young male, recurrent episodes of apthous ulcers associated with penile ulcers and eye symptoms is consistent with Behcet syndrome. While not characteristic for the disease process, other organ systems can be involved, including the thoracic aorta in around 3-5% of patients. Behcet syndrome is associated with HLA B51.
Question 191
A 46-year-old male, who was diagnosed with asthma 4 years ago, and has had one outpatient surgery for nasal polyps, presents to an acute care clinic with complaints of a cough, fever and dyspnea with exertion. A complete blood count reveals an elevated concentration of eosinophils (14%). A chest x-ray reveals patchy infiltrates. Additional laboratory testing reveals MPO-ANCA. Of the following, what is the most likely diagnosis?
A. Granulomatosis with polyangiitis
B. Exacerbation of asthma
C. Illicit drug reaction
D. Polyarteritis nodosa
E. Eosinophilic granulomatosis with polyangiitis
Answer for Question 191
Answer: E (Eosinophilic granulomatosis with polyangiitis)
Explanation: The clinical presentation (male patient in their 40s with a history of asthma, nasal polyps, eosinophilia and pulmonary infiltrates) is consistent with eosinophilic granulomatosis with polyangiitis (formerly known as Churg Strauss syndrome). Some of these patients (about 40%) will have MPO-ANCA (p-ANCA) directed against myeloperoxidase. Granulomatosis with polyangiitis is not associated with asthma or eosinophilia, and PR3-ANCA (c-ANCA) is most often present. Polyarteritis nodosa rarely involves the lungs, is not associated with eosinophilia, and is not routinely associated with ANCA. An exacerbation of asthma or illicit drug reaction would not explain the ANCA.
Question 192
A 49-year-old male, who was diagnosed with asthma 3 years ago and frequently has episodes of allergic rhinitis, presents to an acute care clinic with complaints of a cough and fever. A complete blood count reveals an elevated concentration of eosinophils (15%). A chest x-ray reveals patchy infiltrates. Additional laboratory testing reveals MPO-ANCA. Of the following, which test or procedure would best confirm the diagnosis?
A. Lung biopsy
B. Pneumonectomy
C. Pulmonary function tests
D. MRI of the chest
E. Echocardiogram
Answer for Question 192
Answer: A (Lung biopsy)
Explanation: The clinical presentation (male patient in their 40s with a history of asthma, allergic rhinitis, eosinophilia and pulmonary infiltrates) is consistent with eosinophilic granulomatosis with polyangiitis (formerly known as Churg Strauss syndrome). Some of these patients (about 40%) will have MPO-ANCA (p-ANCA) directed against myeloperoxidase. The best diagnostic procedure would be a lung biopsy to confirm the presence of the vasculitis. Removal of an entire lung is not necessary. While pulmonary function tests, MRI of the chest, and echocardiogram could be performed to help determine extent of the disease process, as eosinophilic granulomatosis with polyangiitis can involve the heart, none of these procedures would allow for a specific diagnosis such as a biopsy would.