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    • Dermatology
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  • Most Recent
    • Challenge 610
    #610
    A 75-year-old man presented to the emergency department with a 6-month history of epigastric pain, watery diarrhea, and weight loss. Esophagogastroduodenoscopy revealed severe esophagitis, antral erosions, and duodenal ulcers (left). The gastric pH was below 2, and a fasting serum gastrin level was above 1000 pg per milliliter (reference range, 13-115). Cross-sectional imaging identified a single tumor along the distal duodenum that was resected (right). Histopathological analysis showed a well-differentiated neuroendocrine tumor that was positive for gastrin on immunohistochemical staining. The diagnosis in this case is most closely associated with which of the following syndromes?
    5,072
    Challenge 609
    #609
    A 37-year-old man presented to the emergency department with a 1-week history of pain and swelling in the left upper arm that had started after blunt trauma during soccer practice. The heart rate was 120 beats per minute, the blood pressure 96/54 mm Hg, and the body temperature 37.9°C. Examination of the left upper arm was notable for swelling, tenderness, and crepitus. The overlying skin was red and warm to the touch. An initial radiograph is shown. Which of the following factors is most associated with increased mortality in this diagnosis?
    5,472
    Challenge 608
    #608
    A 19-year-old woman presented with a 6-month history of a slowly growing asymptomatic dark spot on her left palm. Examination was notable for a nonscaling, nonpalpable brown patch (left). Dermatoscopy revealed pigmented spicules, and palmar skin scrapings were prepared (right). What is the most likely diagnosis?
    2,594
  • Most Popular
    • Challenge 568
    #568
    A 48-year-old man presented with a 2-week history of fever, shortness of breath, and painful skin lesions with blistering. His temperature was 39.2°C. What is the diagnosis?
    179,114
    Challenge 565
    #565
    A 5-year-old girl presented with a 4-week history of painful swelling on both sides of her lower abdomen. Six weeks before presentation, her parents removed a tick they found buried in her umbilicus. Five days after this she developed fevers. What is the diagnosis?
    126,983
    Challenge 585
    #585
    A 30-year-old man presented with a rash on his face, hands, and feet. He had a history of HIV with a CD4+ T-cell count of 374 per cubic millimeter. Physical examination showed circinate lesions on the palms, soles, and face and patchy alopecia. What is the likely diagnosis?
    121,618
  • Most Difficult
    • Challenge 568
    #568
    A 48-year-old man presented with a 2-week history of fever, shortness of breath, and painful skin lesions with blistering. His temperature was 39.2°C. What is the diagnosis?
    179,114
    Challenge 575
    #575
    A 53-year-old man who worked as a gardener presented to the emergency department with sudden onset of paralysis in the lower legs. He had a 2-month history of intermittent fevers and had undergone a bioprosthetic aortic-valve replacement 6 months prior to presentation. Computed tomographic angiography showed an aortic pseudoaneurysm with emboli. An embolectomy was performed, and a histopathological analysis is as shown. Which organism was the cause of his infection?
    83,563
    Challenge 565
    #565
    A 5-year-old girl presented with a 4-week history of painful swelling on both sides of her lower abdomen. Six weeks before presentation, her parents removed a tick they found buried in her umbilicus. Five days after this she developed fevers. What is the diagnosis?
    126,983
    NEJM Groupy

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