A 23-Year-Old Man Comes to the Clinic for Evaluation of a Rash

question 1657

Multiple Choice

A 23-year-old man comes to the clinic for evaluation of a rash.  He reports that reddish bumps began to develop on his shins 4 weeks ago.  Although painful, they are not itchy.  On review of systems, he notes that his stools have become looser than normal over the past 6 months and are associated with intermittent, crampy abdominal pain.  He has unintentionally lost 5 kg (11 lb) in the past month.  The patient has no hematochezia, nausea, vomiting, joint pains, night sweats, or fevers.  Medical and family history are unremarkable.  He does not use tobacco, alcohol, or illicit drugs.  Temperature is 37.2 C (99 F) , blood pressure is 113/72 mm Hg, pulse is 85/min, and respirations are 15/min.  Physical examination reveals several 2- to 3-cm erythematous, tender, nonmobile nodules on the anterior aspect of both lower extremities.  Careful skin examination reveals no other abnormalities.  The abdomen is mildly tender to palpation but without distension, rebound, or guarding.  Which of the following most likely explains this patient's presentation?

• A)Campylobacter jejuni infection
• B)Celiac disease
• C)Colon cancer
• D)IgA vasculitis
• E)Inflammatory bowel disease

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Definitions:

Multitasking

The ability to perform more than one task or activity over a short period of time.

Mental Set

A cognitive bias that involves approaching a problem in a particular way, often one that has been successful in the past, which may block or delay the identification of alternative solutions.

Patterns

Regular and predictable forms, orders, or arrangements that can be observed in various contexts, such as behavior, nature, or mathematics.

Reflective Judgment

The process of reasoning through complex issues with uncertainty and synthesizing evidence and opinion to form a justified conclusion.