ACEM question of the week.
Week of 26 October 2026. Have a go, then see the reasoning behind every option.
A 68-year-old widower who has eaten almost no fresh food for many months has a leg ulcer that has not healed in 2 months. His gums are swollen and bleed easily. On his shins there are small papules around hair follicles, each ringed by purpura, with coiled, fragmented hairs, and there is a large bruise behind his knee. His platelet count, prothrombin time and activated partial thromboplastin time are normal. Which defect underlies his poor wound healing?
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ACEM-style questions, marked with a reason for every option. Free account, no card.
Earlier weeks
A 35-year-old motorcyclist slid along the road on his left side 5 days ago. Pelvic and femoral X-rays at the time were normal. He now has a soft, fluctuant swelling over the lateral thigh and greater trochanter. The overlying skin is intact, moves unusually freely over the swelling and has reduced sensation. He is afebrile, the swelling is only mildly tender, and knee and hip movement is full. Ultrasound shows a compressible hypoechoic collection containing echogenic lobules, lying superficial to the fascia lata, with normal underlying muscle. What is the most likely diagnosis?
A 24-year-old man has 3 weeks of facial swelling and fullness, worse when bending forward, with distended neck veins and dilated veins over his upper chest. CT shows a large anterior mediastinal mass compressing the superior vena cava. He has no stridor, his airway is not compressed on CT, and he is otherwise stable. What is the most appropriate approach?
A 25-year-old woman at 29 weeks' gestation reports a gush of clear fluid 2 days ago, for which she did not seek care. She now has regular painful contractions every 4 minutes. Her temperature is 38.4 °C and heart rate 116/min. The uterus is tender between contractions, and brown, malodorous fluid is seen in the posterior fornix. The fetal heart rate baseline is 170/min. She has not had corticosteroids. In addition to corticosteroids and magnesium sulfate for neuroprotection, what is the most appropriate management?
A 24-year-old woman has 2 days of a painful, swollen right index fingertip with a cluster of small vesicles on a red base, some of them cloudy. The finger pulp is soft rather than tense, and she has a tender epitrochlear node. What is the best management?
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