drdg
Forum Senior
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Posts: 176
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a 27-yeal-old black female presents with pain and swelling of joints of her right hand and wrist for the last few days. her other complaints are low-grade fever and malaise. She also finds it difficult to rise the chair and comb her hair. BP: 110/70, T: 37.1 PR: 76,. PE, her metacarpophalangeal and proximal interphalangeal joints are found to be swollen and tender to touch. Exam of oral activity shows painless ulcers on the buccal mucosa. X-ray of hand and the wrist is normal and does not show any erosion. Lab: hematocrit 39%, WBC: 7000, Platelet: 40,000. PT: 9 sec (normal 8.2-10.3), APTT 39 ( normal 21-32). Serological testing shows positive antinuclear antibodies, positive reeumatoid factor and negative anti-SM antibody. Assay for lupus procoagulant is positive. Based on these findings, what is most likely diagnosis?
A. Systemic lupus erythematosus
B. Primary antiphospholipid antibody syndrome
C. Rheumatoid arthritis
D. Mixed connective tissue disease
E. Polymyositis
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| kpmle2
Forum Guru
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Posts: 463
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D. Mixed connective tissue disease
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| Kamsi
Forum Guru
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Posts: 347
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D Pt has features of Polymyositis,RA and anti-phospholipid sundrome
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| hanialkhadher
Forum Elite
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Posts: 262
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A. Systemic lupus erythematosus 
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| titly
Forum Elite
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mixed CT disease
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| Ivonne
Find a way or make one
Topics: 58
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Good question: I remember that anti Smith is very specific but it is not sensitive
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| drdg
Forum Senior
Topics: 31
Posts: 176
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The correct answer is A. Systemic lupus erythematosus
SLE is an autoimmune disorder involving multiple systems like musculoskeletal, cardiovascular, hematological, skin, lung , kidney and serous membranes ( I'M DOWN SHARP). If four or more of diagnostic criteria set for SLE is met either serially or simultaneously diagnosis of SLE is made. The patient has four criteria present: arthritis, oral ulcers, thrombocytopenia and positive antinuclear antibodies. Anti-SM antibodies are highly specific for SLE but they are not very sensitive ( 30-40%).
MCTD is made when serology shows positive anti-RNP antibodies and clinical features of SLE, polymyositis and systemic sclerosis are present simultaneously. Such as swollen hands, synovitis, myositis, acrosclerosis and Raynaud's phenomenon. If three of these features are present along with positive anti-RNP, diagnosis of MCTD is established.
Congrats tohanialkhadher.
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