新英格兰杂志经典病例图片问答

Image Challenge,What is the diagnosis?1. Digitalis intoxication2. Dextrocardia3. Pacemaker malfunction4. Electrical alternans5. Cardiac allograft,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,5. Cardiac allograftThe electrocardiogram shows two QRS complexes with different axes. The patient has a cardiac allograft in addition to his native heart.Read More: New Engl J Med 356;7:e6,Image Challenge,This patient presented with loss of vision. What is the diagnosis?1. Central retinal artery occlusion2. Diabetic retinopathy3. Tay-Sachs disease4. Hypertensive retinopathy5. Papilledema,Q:,Answer:,Image Challenge,This patient presented with loss of vision. What is the diagnosis?,Q:,1. Central retinal artery occlusionDiffuse retinal whitening, constriction of the arteriole and venule with segmentation and a cherry red spot in the macula are most consistent with central retinal artery occlusion.Read More: New Engl J Med 356;8:841,Image Challenge,Which one of the following organs is enlarged?1. Colon2. Ovary3. Stomach4. Spleen5. Gall bladder,Q:,Answer:,Image Challenge,Which one of the following organs is enlarged?,Q:,3. StomachMassive dilation of the stomach with distal gas is most consistent with gastric outlet obstruction.Read More: New Engl J Med 356;9:942,Image Challenge,What is the diagnosis?1. Rheumatic fever2. Atrial myxoma3. Endocarditis4. Patent foramen ovale5. Pericardial effusion,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,1. Rheumatic feverA calcified left atrial thrombus is visible on the echocardiographic image. This patient has mitral stenosis and a history of rheumatic fever.Read More: New Engl J Med 356;10:e9,Image Challenge,This patients serum was found to be discolored four hours following a surgical procedure. What is the most likely cause?1. Fluorescent dye2. Methemoglobinemia3. Propofol4. Pseudomonal sepsis5. Ethylene glycol,Q:,Answer:,Image Challenge,This patients serum was found to be discolored four hours following a surgical procedure. What is the most likely cause?,Q:,1. Fluorescent dyeThe patient had undergone intraoperative angiography with a fluorescent dye and a Woods lamp was used to evaluate mesenteric-vessel viability.Read More: New Engl J Med 356;11:e10,Image Challenge,What is the diagnosis?1. Carpal tunnel syndrome2. Rheumatoid Arthritis3. Scleroderma4. Diabetic peripheral neuropathy5. Dupuytens contracture,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,5. Dupuytens contractureThe pictured flexion contractures involving bilateral third digits and the right fifth digit are most consistent with Dupuytrens contracture.Read More: New Engl J Med 356;12:e11,Image Challenge,What is the diagnosis?1. Chalazion2. Papilloma3. Pterygium4. Pinguecula5. Coloboma,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,2. PapillomaThis 9-year-old boy was diagnosed with conjunctival viral papilloma.Read More: New Engl J Med 356;13:1352,Image Challenge,What is the diagnosis?1. Subcutaneous metastases2. Filariasis3. Caput Medusae4. Neurofibromatosis5. Hepatocellular carcinoma,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,3. Caput MedusaeThese enlarged veins on his abdomen are consistent with caput medusae.,Image Challenge,This 9-kg liver was removed at the time of liver transplantation. What is the diagnosis?1. Macronodular cirrhosis2. Hepatocellular carcinoma3. Echinococcosis4. Polycystic liver disease5. Trophoblastic tumor,Q:,Answer:,Image Challenge,This 9-kg liver was removed at the time of liver transplantation. What is the diagnosis?,Q:,4. Polycystic liver diseaseThe cystic changes are most consistent with polycystic liver disease. Polycystic kidney disease was also diagnosed in this patient.Read More: New Engl J Med 356;15:1560,Image Challenge,What is the diagnosis?1. Intracranial hemorrhage2. Osteoma3. Neurocysticercosis4. Arachnoid cyst5. Meningioma,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,5. MeningiomaThis well-circumscribed and highly calcified extra-axial mass is most consistent with a meningioma.Read More: New Engl J Med 356;16:e14,Image Challenge,What is the diagnosis?1. Syphilis2. Phenytoin exposure3. Marfan syndrome4. Torus palatinus5. Kaposi sarcoma,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,4. Torus palatinusThe appearance of this mass is most consistent with torus palatinus.Read More: New Engl J Med 356;17:1759,Image Challenge,In what vessel is this patients dialysis catheter?1. Left axillary vein2. Left internal mammary vein3. Left-sided superior vena cava4. Azygous vein5. Highest intercostal vein,Q:,Answer:,Image Challenge,In what vessel is this patients dialysis catheter?,Q:,3. Left-sided superior vena cavaThis left internal jugular dialysis catheter is in a left-sided superior vena cava that drained into the right atrium via a coronary sinus.Read More: New Engl J Med 356;18:1870,Image Challenge,What is the diagnosis?1. Central retinal vein occlusion2. Profilerative diabetic retinopathy3. Hypertensive retinopathy4. Chorioretinitis5. Papilledema,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,2. Profilerative diabetic retinopathySevere bilateral proliferative diabetic retinopathy with significant optic-disk neovascularization is visible.Read More: New Engl J Med 356;19:1979,Image Challenge,What is the diagnosis?1. Pulmonary embolism2. Blalock-Taussig shunt3. Azygous vein4. Interlobar mesothelioma5. Cervical rib,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,3. Azygous veinA contrast-enhanced azygous vein is visible in the posterior right upper lobe.Read More: New Engl J Med 356;20:2082,Image Challenge,These lesions developed over 1 to 2 years. What is the diagnosis?1. Melanocytic nevi2. Seborrheic keratoses3. Pemphigus erythematosus4. Bowenoid papulosis5. Guttate psoriasis,Q:,Answer:,Image Challenge,These lesions developed over 1 to 2 years. What is the diagnosis?,Q:,2. Seborrheic keratosesMultiple eruptive seborrheic keratosis are visible. In this case, they were associated with renal cell carcinoma.Read More: New Engl J Med 356;21:2184,Image Challenge,What is the diagnosis?1. Nocardiosis2. Adenocarcinoma3. Ventricular rupture4. Alpha-1 antitrypsin deficiency5. Pulmonary hemosiderosis,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,2. AdenocarcinomaBiopsy of the pictured pulmonary adenocarcinoma resulted in a pneumothorax. Read More: New Engl J Med 356;22:2312,Image Challenge,These lesions appeared spontaneously in a patient with untreated multiple myeloma. Coagulation studies were normal and platelet count was 80,000 per cubic millimeter. What is the diagnosis?1. Orbital fracture2. Disseminated intravascular coagulation3. Tuberous sclerosis 4. Amyloid purpura5. Horners syndrome,Q:,Answer:,Image Challenge,These lesions appeared spontaneously in a patient with untreated multiple myeloma. Coagulation studies were normal and platelet count was 80,000 per cubic millimeter. What is the diagnosis?,Q:,4. Amyloid purpuraThese lesions were consistent with amyloid purpura. Read More: New Engl J Med 356;23:2406,Image Challenge,What is the diagnosis?1. Hypertriglyceridemia2. Hypertensive retinopathy3. Optic atrophy4. Central retinal artery occlusion5. Cytomegalovirus retinitis,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,1. HypertriglyceridemiaThe creamy white vessels in the fundus resulted from extreme hypertriglyceridemia.,Image Challenge,These lesions appeared in a recent immigrant from Pakistan. The lesions were neither pruritic nor hypoesthetic. What is the diagnosis?1. Granuloma annulare2. Scrofula3. Leprosy4. Pityriasis rosea5. Tinea corporis,Q:,Answer:,Image Challenge,These lesions appeared in a recent immigrant from Pakistan. The lesions were neither pruritic nor hypoesthetic. What is the diagnosis?,Q:,3. LeprosyLeprosy (Hansens disease) of the borderline lepromatous type was diagnosedRead More: New Engl J Med 344;17:1293,Image Challenge,This patient presented with hypertension, proteinuria, and renal failure. What is the most likely diagnosis?1. Mycosis fungoides2. Wegeners granulomatosis3. Invasive aspergillosis4. Sarcoidosis5. Polychondritis,Q:,Answer:,Image Challenge,This patient presented with hypertension, proteinuria, and renal failure. What is the most likely diagnosis?,Q:,2. Wegeners granulomatosisThe patient was diagnosed with Wegeners granulomatosisRead More: New Engl J Med 356;26:2720,Image Challenge,What is the diagnosis?1. Deep venous thrombosis2. Necrotizing fasciitis3. Chemical burn4. Scleroderma5. Digital ischemia,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,5. Digital ischemiaThis patient developed severe digital ischemia during treatment for shock complicated by disseminated intravascular coagulation. Read More: New Engl J Med 357;1:52,Image Challenge,This patient developed progressive thickening of the skin following failure of a transplanted kidney. What is the most likely diagnosis?1. Eosinophilic fasciitis2. Myxedema3. Nephrogenic fibrosing dermopathy4. Scleroderma5. Vitiligo,Q:,Answer:,Image Challenge,This patient developed progressive thickening of the skin following failure of a transplanted kidney. What is the most likely diagnosis?,Q:,3. Nephrogenic fibrosing dermopathyThe patient was diagnosed with nephrogenic fibrosing dermopathy, an uncommon sclerosing skin condition that has been associated with the use of gadolinium in patients with renal failure. Read More: New Engl J Med 357;2:e2,Image Challenge,This patient developed jaundice and an enlarging neck mass. What is the diagnosis?1. Medullary carcinoma of the thyroid2. Peripancreatic malignancy3. Scrofula4. Hodgkins lymphoma5. Pancoast tumor,Q:,Answer:,Image Challenge,This patient developed jaundice and an enlarging neck mass. What is the diagnosis?,Q:,2. Peripancreatic malignancyThe patient had a fungating mass around the Vaters ampulla. Abdominal cancers can metastasize through the thoracic duct to the left supraclavicular fossa. Read More: New Engl J Med 357;3:282,Image Challenge,This patient presented with chest pain. What is the diagnosis?1. Acute pulmonary embolism2. Hypertrophic cardiomyopathy3. Ascending aortic aneurysm4. Coarctation of the aorta5. Lymphoma,Q:,Answer:,Image Challenge,This patient presented with chest pain. What is the diagnosis?,Q:,3. Ascending aortic aneurysmA widened mediastinum is visible on chest radiography. The patient was diagnosed with a 9.5-cm ascending aortic aneurysm. Read More: New Engl J Med 357;4:e5,Image Challenge,This patient presented with acute onset of erythema. Nearly a year earlier she was treated for invasive breast cancer. What is the diagnosis?1. Erythrasma 2. Recurrent breast cancer3. Radiation dermatitis4. Cellulitis 5. Lymphedema,Q:,Answer:,Image Challenge,This patient presented with acute onset of erythema. Nearly a year earlier she was treated for invasive breast cancer. What is the diagnosis?,Q:,4. Cellulitis The patient was diagnosed with cellulitis. Though the rash does not cross the midline, the timing is atypical for radiation dermatitis. The appearance is not consistent with erythrasma or lymphedema. There is no indication of a recurrent breast cancer. Read More: New Engl J Med 357;5:488,Image Challenge,What is the diagnosis?1. Helminthic infection2. Transitional cell carcinoma3. Sigmoid volvulus4. Retained surgical sponge5. Bladder stones,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,5. Bladder stonesThese calcified abdominal masses were most consistent with bladder stones. A 3-cm stone and an 8-cm stone were removed during cystotomy. Read More: New Engl J Med 357;6:e7,Image Challenge,What is the diagnosis?1. Molluscum contagiosum2. Pearly penile papules3. Secondary syphilis4. Obstruction of smegma-producing gland5. Condyloma accuminatum,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,2. Pearly penile papulesThese multiple tiny, smooth, skin-colored papules distributed circumferentially along the coronal sulcus of the glans penis are typical of pearly penile papules.Read More: New Engl J Med 357;7:691,Image Challenge,This 12-year-old boy presented with abdominal pain. What is the diagnosis?1. Cowden syndrome 2. Cronkhite-Canada syndrome3. Osler-Weber-Rendu syndrome4. Peutz-Jeghers syndrome5. VonWillebrand syndrome,Q:,Answer:,Image Challenge,This 12-year-old boy presented with abdominal pain. What is the diagnosis?,Q:,4. Peutz-Jeghers syndromeThe presence of mucocutaneous pigmented lip lesions suggests the diagnosis of Peutz-Jeghers syndrome, an autosomal dominant disorder characterized by development of multiple hamartomatous gastrointestinal polyps. Read More: New Engl J Med 357;8:e9,Image Challenge,What is the diagnosis?1. Cytomegalovirus retinitis2. Lipemia retinalis3. Central retinal vein occlusion4. Diabetic retinopathy5. Retinitis pigmentosa,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,2. Lipemia retinalisThe creamy appearance of the vessels in the posterior pole and in the peripheral area of the eye is consistent with lipemia retinalis. Typically the retinal findings do not occur until the triglyceride level reaches 2500 mg/dl. Read More: New Engl J Med 357;10:e11,Image Challenge,What is the diagnosis?1. Cutis laxa2. Turners syndrome3. Ehlers-Danlos syndrome4. Pseudoxanthoma elasticum5. Marfan syndrome,Q:,Answer:,Image Challenge,What is the diagnosis?,Q:,3. Ehlers-Danlos syndromeHyperextensibility and hypermobility are features of Ehlers-Danlos syndrome, and result from quantitative or qualitative abnormalities in collagen synthesis. Read More: New Engl J Med 357;11:e12,Image Challenge,What is the diagnosis? 1. Herpetic glossitis2. Aphthous ulc