tommyk
05-20-2006, 12:33 PM
Hy 2226
A flashy 25-year-old homosexual man presents complaining of pain with defecation. He denies any symptoms of diarrhea, abdominal pain, or fevers or chills. Six months earlier, he developed traveler's diarrhea while vacationing in Mexico. On physical examination, he is afebrile and has an unremarkable abdominal examination. On examination of the perianal area, there is a group of five clustered ulcers adjacent to the anal orifice and extending into the anal canal. A sigmoidoscopy reveals normal rectosigmoid mucosa. An RPR test is negative, as is an HIV test. Which of the following is the most likely diagnosis?
1- Cytomegalovirus infection
2- HIV infection
3- Syphillis
4- Chylamidia
5- Neisseria gonorrhea
6- Ulcerative colitis
7- Chron’s Dx
8- Prostate Enlargement
9- Shigella
10- Herpes
Ans) #10, This patient is complaining of pain with defecation without any associated abdominal or bowel symptoms. The reference to traveler's diarrhea is a red herring. The grouped ulcers are characteristic of a herpetic infection. The ulcers begin as vesicular lesions and then painfully ulcerate. The perineal region is frequently involved, and the lesions may spread into the anal canal but do not usually cause any evidence of proctosigmoiditis. These symptoms are often accompanied by neuropathic symptoms, as the herpes resides in the dorsal ganglia. Cytomegalovirus infection may involve the colon in a severely immunocompromised HIV patient whose CD4 count is less than 50. This man has no evidence of HIV and furthermore has no colitic symptoms. In addition, cytomegalovirus will not cause ulceration on the exterior perianal skin. Neisseria gonorrhea may be the cause of a sexually transmitted proctitis but will present with a mucopurulent discharge and perhaps symptoms of mild proctitis but without ulceration. Shigella dysenteriae will present as an invasive type of diarrhea with bloody, mucoid stools and may cause ulceration in the colon or small bowel but does not cause ulcerations in the anal canal or perianal region. Ulcerative colitis would have an abnormal sigmoidoscopic appearance and present with bloody diarrhea. Ulcerations of the perineal region are not characteristic of ulcerative colitis.
A flashy 25-year-old homosexual man presents complaining of pain with defecation. He denies any symptoms of diarrhea, abdominal pain, or fevers or chills. Six months earlier, he developed traveler's diarrhea while vacationing in Mexico. On physical examination, he is afebrile and has an unremarkable abdominal examination. On examination of the perianal area, there is a group of five clustered ulcers adjacent to the anal orifice and extending into the anal canal. A sigmoidoscopy reveals normal rectosigmoid mucosa. An RPR test is negative, as is an HIV test. Which of the following is the most likely diagnosis?
1- Cytomegalovirus infection
2- HIV infection
3- Syphillis
4- Chylamidia
5- Neisseria gonorrhea
6- Ulcerative colitis
7- Chron’s Dx
8- Prostate Enlargement
9- Shigella
10- Herpes
Ans) #10, This patient is complaining of pain with defecation without any associated abdominal or bowel symptoms. The reference to traveler's diarrhea is a red herring. The grouped ulcers are characteristic of a herpetic infection. The ulcers begin as vesicular lesions and then painfully ulcerate. The perineal region is frequently involved, and the lesions may spread into the anal canal but do not usually cause any evidence of proctosigmoiditis. These symptoms are often accompanied by neuropathic symptoms, as the herpes resides in the dorsal ganglia. Cytomegalovirus infection may involve the colon in a severely immunocompromised HIV patient whose CD4 count is less than 50. This man has no evidence of HIV and furthermore has no colitic symptoms. In addition, cytomegalovirus will not cause ulceration on the exterior perianal skin. Neisseria gonorrhea may be the cause of a sexually transmitted proctitis but will present with a mucopurulent discharge and perhaps symptoms of mild proctitis but without ulceration. Shigella dysenteriae will present as an invasive type of diarrhea with bloody, mucoid stools and may cause ulceration in the colon or small bowel but does not cause ulcerations in the anal canal or perianal region. Ulcerative colitis would have an abnormal sigmoidoscopic appearance and present with bloody diarrhea. Ulcerations of the perineal region are not characteristic of ulcerative colitis.