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  #1  
Old 06-12-2012
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Question A 43-year-old woman has been bothered by a chronic, dry cough for the past...

A 43-year-old woman has been bothered by a chronic, dry cough for the past 5 years. She has had increasing difficulties with blurred vision for the past year. On physical examination, she has a perforated nasal septum, bilateral mild corneal scarring, and oral cavity fissuring of the tongue and corners of her mouth. Laboratory studies show antibodies to SS-A and SS-B. The serum creatinine is 2.5, and the urea nitrogen is 25 mg/dl. A renal biopsy specimen examined microscopically shows tubulointerstitial nephritis. Which of the following is the most serious condition likely to complicate the course of her disease?

A) Chronic renal failure
B) Endocarditis
C) Non-Hodgkin lymphoma
D) Photosensitivity
E) Sclerodactyly
F) Subcutaneous nodules
G) Urethritis

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Old 06-12-2012
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I'd go with B) Endocarditis

Sjogren's pts can have other autoimmune diseases. And this pt most likely has SLE (cause of her nephropathy) and SLE can lead to Libman-Sacks Endocarditis.
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Old 06-12-2012
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Sjogerns has an increased risk of b cell lymphoma....C is the correct answer.
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Old 06-12-2012
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i go with C too
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Old 06-12-2012
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Dammit. I just checked on google and Lymphoma does seem to be the correct answer.

Can't it be endocarditis though from the explanation I gave? Or is Lymphoma the best answer here because its more commonly associated with Sjogrens than Endocarditis (if at all) ?
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Old 06-12-2012
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Got to be C.
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Old 06-12-2012
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increase risk of b-cell lymphoma FA 2012-418p

c is the correct answer

Last edited by irakly; 06-12-2012 at 02:44 PM.
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Old 06-12-2012
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I go for C as well..
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Old 06-12-2012
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Two conditions to remem for NHL- Sjogrens syn and Hashimoto thyroiditis.
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Old 06-13-2012
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Default correct answer :)

Correct answer is C) Non-Hodgkin lymphoma

This patient suffers from Sjorgen syndrome:

- dry eye -> difficulties with blurred vision for the past year,
- destruction of lacrimar glands -> bilateral mild corneal scarring,
- dryness and crusting of the nose- > perforated nasal septum,
- destruction of salivary glands -> oral cavity fissuring of the tongue and corners of her mouth
- antibodies to SS-A and SS-B (SS - Sjorgen syndrome)
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Old 06-13-2012
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Just look in: SS-A and SS-B, which are the markers for Sjorgen syndrome and all px with this syndrome may be complicated with Non-Hodgkin Lymphoma or Hashimoto thyroidal disease
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