A 56-Year-Old Man Comes to the Physician Because of an Intermittent

question 373

Multiple Choice

A 56-year-old man comes to the physician because of an intermittent, non-pruritic skin rash that appeared approximately one year ago.  The rash starts as skin irritation followed by blistering and then crusting that is sometimes very painful.  The rash affects the back of his hands and sometimes his neck.  He initially thought the irritation was caused by his soap, but switching to a different brand did not help.  He feels he is in good health otherwise and does not see doctors.  He was told that he has "borderline diabetes" and high blood pressure several years ago.  He is a former intravenous drug abuser.  He smokes one pack of cigarettes per day and drinks beer over the weekend.
His blood pressure is 152/77 mm Hg and pulse is 82/min.  His BMI is 32 kg/m².  The oral mucosa is moist without any lesions.  There is no lymph node enlargement.  Lungs are clear to auscultation and there are no heart murmurs.  Abdomen is non-tender.  Inspection of the skin reveals areas of erosion, crusting, skin hyperpigmentation, and fine scarring affecting the dorsum of both hands, ears, extensor surfaces of the arms, and the back of the neck.
Which of the following is most likely related to this patient's condition?

• A)Chronic viral hepatitis
• B)Fat malabsorption
• C)Insulin resistance
• D)Occult lung malignancy
• E)Parasitic infection

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