#oldrecallmccqe1
A 40-year-old man presents with numerous brown spots on the skin. He reports a history of chronic diarrhea and generalized itching, the latter manifesting frequently after he takes aspirin or drinks alcoholic beverages. He has noticed that slight rubbing on affected skin results in redness and itching. He has had recurrent asthmatic episodes in the past few years. His recent medical history is also significant for 8-kg (18-lb) weight loss in the past 6 months. On examination, there are dozens of small, red-brown macules on the trunk and upper limbs. The spleen is palpable 4 cm below the left costal arch. A biopsy of these macules reveals a dense dermal infiltrate of cells that stain positively for toluidine blue. Which of the following is the most appropriate investigation for this patient?
(A) Allergen skin testing
(B) Bacterial cultures of skin scrapings
(C) HIV testing
(D) Microscopic examination of KOH-treated skin scrapings
(E) Stroking on skin lesions with a blunt object
(F) Serum IgE assays (RAST or ELISA)
A 40-year-old man presents with numerous brown spots on the skin. He reports a history of chronic diarrhea and generalized itching, the latter manifesting frequently after he takes aspirin or drinks alcoholic beverages. He has noticed that slight rubbing on affected skin results in redness and itching. He has had recurrent asthmatic episodes in the past few years. His recent medical history is also significant for 8-kg (18-lb) weight loss in the past 6 months. On examination, there are dozens of small, red-brown macules on the trunk and upper limbs. The spleen is palpable 4 cm below the left costal arch. A biopsy of these macules reveals a dense dermal infiltrate of cells that stain positively for toluidine blue. Which of the following is the most appropriate investigation for this patient?
(A) Allergen skin testing
(B) Bacterial cultures of skin scrapings
(C) HIV testing
(D) Microscopic examination of KOH-treated skin scrapings
(E) Stroking on skin lesions with a blunt object
(F) Serum IgE assays (RAST or ELISA)
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