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Question 1

38 yo from Eastern Europe with 2 months SOB and fatigue, taking isoniazid for latent TB, and vegan for 5 months. PE w/ pallor and vitiligo. macrocytic anemia
Dx and test?

Answer 1

Pernicious anemia

• a/w autoimmune problems
  test: anti-intrinsic factor Ab

Question 2

normal skin at birth –> dry scaly skin w/ horny plates over extensor surface of skin. dx?

Answer 2

ichthyosis vulgaris

Question 3

60 yo w/ hx smoking, recent presentation with cough, dry mouth, symmetric proximal limb muscle weakness, low BMI and lung mass on chest CT, absent DTR, test? dx? txt?

Answer 3

Lambert-Eaton myasthenic syndrome

• autoAb against voltage-gated CA channels in presynaptic motor terminal
• a/w small cell CA
• check for autoAb against Ca channels
• electrophysiological studies
• txt: guadnidine or 3,4 diaminopyridine to inc presynaptic Ach
• refractory –> IVIG or immunosuppressants

Question 4

isolated systolic HTN - cause? treatment?

Answer 4

• decreased elasticity of arterial wall

- monotxt with low dose thaizide, ACE inhibitor, long-acting CCB

Question 5

57 yo with intermittent arthralgias for 8 yrs, transient elebated hepatic transaminases, mild jaundice 2 years ago; takes warfarin. PE: vesicles and erosions on dorsum of hands. Disorder?

Answer 5

Hep C
- Essential mixed cryoglobulinemia
(circulating immune complex deposit in small to medium vessels, low complement)
- porphyria cutanea tarda
- membranoproliferative glomerulonephritis