Photo Quiz Question – Q.001

Photo Quiz Question – Q.001 – June 10, 2011

As this web site has developed I’ve continually tried to adapt it to the interests of my readers.

At medical conferences, photo quizzes are always popular, and at the-end-of-the-world-as-we-know-it, diagnosis will be largely clinical, that is, based on history and physical exam, rather than testing or X-rays.

So what does the above image depict and how is it treated?

To be honest, submit your response in the box below before turning to the answer.

For the correct answer, CLICK HERE.

About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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5 Responses to Photo Quiz Question – Q.001

  1. Elizabeth B says:

    This looks like an “old” wound, due to the rolled margins, and is obviously necrotic. My guess is some kind of insect bite, perhaps a spider, or some other sort of chemical trauma to the tissue.

  2. Chris MD says:

    In light of your comment, I’ll go with cutaneous anthrax. I agree with the comment about history, though.

  3. kf says:

    This is quite difficult without any patient history at all.
    It could be a myriad of diagnoses, dependent on his history and physical.

    But, since all I have is this picture to go on, here goes.

    I would suspect a caustic chemical burn or radiation burn due to the splash-like, irregular conformation of the wound boundaries, the inner wound well appears to have smooth necrosis, and the rolled inner thickening of the outer wound edges.

    In the tropics, wounds which are more circumferential with similar eschar necrosis are usually suspect of toxic spider bites or from scorpion stings.

    Lastly, if these are not the causes, I would be suspect of bacterial infection.

    Did I even get warm?

    • Doc Cindy says:

      Nice differential, KF. Dr. House would approve. I assume you’ve checked the answer. Next time I’ll try to give some history. If you’ve seen the answer, you’ll understand why I started here.

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