A 22-Year-Old Man Comes to the Office Due to Recurrent

question 85

Multiple Choice

A 22-year-old man comes to the office due to recurrent blistering on the back of his hands and forearms for the past several years.  The patient usually develops small itchy spots but lately has had large blisters that heal with hyperpigmentation after rupturing.  He has used over-the-counter topical hydrocortisone and emollients, but the symptoms have not improved.  The patient works as a night security guard and has had no exposure to chemicals or animals.  He drinks 2-3 cans of beer daily.  Physical examination shows vesicles and erosions on the dorsum of both hands.  Which of the following enzymes is most likely deficient in this patient?

• A)δ-Aminolevulinate dehydratase
• B)δ-Aminolevulinate synthase
• C)Bilirubin glucuronyl transferase
• D)Porphobilinogen deaminase
• E)Uroporphyrinogen decarboxylase

---

Definitions:

Multiaxial System

A framework used in psychiatric diagnosis that considers multiple aspects of an individual's mental condition and situation.

Mental Retardation

An outdated term now referred to as intellectual disability; characterized by below-average intellectual function and limitations in adaptive behavior commencing before the age of 18.

DSM-Based Diagnosis

The use of the Diagnostic and Statistical Manual of Mental Disorders as a guide for identifying and classifying mental health disorders.

Axes

Refers to the plural of axis, which are imaginary lines around which an object rotates or is symmetrically arranged.