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Old 09-03-2014
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Arrow Practice Question #1

A 25-year-old woman presents with pain and tenosynovitis of the wrists and ankles, and arthralgias of other joints. She notes two prior episodes similar to the present one. She just had her menstrual period during the previous week. Physical examination reveals ulcerated lesions overlying the wrists and ankles.

These symptoms are likely due to deficiency of which of the following?

(A) C1 esterase inhibitor
(B) Ciliary function
(C) Complement (C6-C8) components
(D) Endothelial adhesion molecules
(E) Eosinophils
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Last edited by MananaMD; 09-03-2014 at 02:14 PM.
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I think its C disseminated gonococcemia can caus above symptoms
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Originally Posted by Dr.ann View Post
I think its C disseminated gonococcemia can caus above symptoms
Yes! The correct answer is C !

This patient has disseminated gonococcemia. Gonococcal arthritis and tenosynovitis are characteristic of disseminated gonococcal disease. Females are at particular risk of gonococcemia during menstruation - sloughing of the endometrium allows access to the blood supply, necrotic tissue enhances the growth of Neisseria gonorrhoeae, and there is an alteration of the pH.
Patients who have a C6-8 deficiency have an increased risk of disseminated gonococcemia and tend to have multiple episodes.

C1 esterase inhibitor deficiency (choice A). Patients have angioedema without urticaria. The syndrome is also associated with recurrent attacks of colic and episodes of laryngeal edema.
Ciliary dysfunction (choice B) The syndrome includes infertility, bronchiectasis, sinusitis, and situs inversus.
Endothelial adhesion molecule deficiency (choice D), or beta 2 integrin deficiency, is characterized by failure of neutrophils to express CD18 integrins on their surface. Patients have impaired phagocyte adherence, aggregation, chemotaxis, and phagocytosis of C3b-coated particles. Clinically, there is delayed separation of the umbilical cord, sustained agranulocytosis, recurrent infections of skin and mucosa, gingivitis, and periodontal disease.
Eosinophil deficiency (choice E), or eosinopenia, occurs with stressors such as acute bacterial infection and following administration of glucocorticoids. There is no known adverse effect of eosinopenia.
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Quote:
Originally Posted by MananaMD View Post
A 25-year-old woman presents with pain and tenosynovitis of the wrists and ankles, and arthralgias of other joints. She notes two prior episodes similar to the present one. She just had her menstrual period during the previous week. Physical examination reveals ulcerated lesions overlying the wrists and ankles.

These symptoms are likely due to deficiency of which of the following?

(A) C1 esterase inhibitor
(B) Ciliary function
(C) Complement (C6-C8) components
(D) Endothelial adhesion molecules
(E) Eosinophils

That is an interesting Qs.
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