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Old 09-11-2012
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Question Woman with fatigue and oral ulcers

Q) A 36 year old black woman comes to a physician with several months' history of malaise, fatigue and mild fever. She also has complaints of two oropharyngeal ulcers, which started two weeks ago.The woman is sexually active, but she denies alcoholism or smoking. On examination, she has thick, red scaly patches on the skin. She says her skin in sensitive to sunlight, and admits to using copious amounts of sunscreen. The physician orders a laboratory test for the patient after auscultation (where he hears a scratchy friction rub.) Which of the following will be associated with a poor prognosis in this woman?

A) Elevated CK-MB.
B) Diffuse ST segment-elevations in all leads except aVR and V1.
C) Anti- Desmoglein.
D) Sterile verruocus wart-like vegetations on both sides of mitral valve.
E) Anti ds-DNA.
F) Anti DNA-Toposiomerase 1.
G) Anti-SM.
H) Anti-phopholipid antibody.

Can you name another association mentioned in the stem, which can cause increased severity in this disease?

Last edited by dockhi; 09-11-2012 at 07:09 AM.
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  #2  
Old 09-11-2012
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Is it pericardial effusion cos of that friction rub due to some STD???


I am confused.

I wil go with DDDDD for now.

OR is it Kaposi Sarcoma in Primary stage of HIV?

I think I should start some business.lolz
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Old 09-11-2012
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It might be SLE , my choice would be E
and the association might be D
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Old 09-11-2012
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i agree wt anders..i tink its sle..d photosenstvty+frictn rub+young lady..
so answer must b E..anti-ds DNA abs- asso wt renal involvment
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Old 09-11-2012
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Quote:
Originally Posted by sruthi View Post
i agree wt anders..i tink its sle..d photosenstvty+frictn rub+young lady..
so answer must b E..anti-ds DNA abs- asso wt renal involvment
I see the association here is Libman sack endocardiditis as it's described verruocus like vegetation on mitral valve in this clinical vignette.
(D)
but ur right as renal involvement is common in SLE.
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Old 09-11-2012
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Default Correct answer.

E) Anti ds-DNA.

SLE is a Type III Hypersensitivity autoimmune disease caused by antibody-immune complex formation. SLE most often harms the heart, joints, skin, lungs, blood vessels liver, kidneys and CNS, with an unpredictable course. Suspect SLE in a young woman presenting with manifestations that are multi-systemic. In the stem given, classic epidemiological clues leading to diagnosis are her age(14-45 years) and sex (Female). 90% of patients are females within this age range. Her manifestations which include photosensitivity (sunscreen to avoid damage), 'Discoid rash' (thick, red scaly patches on the skin), mucositis (oropharyngeal ulcers), and pleuritis (scratchy friction rub on auscultation) are all consistent with SLE. Of the options given, only D, E and G are found in SLE. But since the question asks for a prognostic indicator, the answer is anti-ds DNA.
Anti-dsDNA antibodies are specific for SLE, and are generally used in the diagnosis of SLE. The levels of circulating anti-dsDNA antibodies, however, fluctuate with disease activity in SLE. Increases in titres of the antibodies can coincide with, or even precede an increase of disease activity. For this reason titres are serially monitored by clinicians to assess disease progression. Choice G) Anti-SM, though specific for SLE, has no prognostic value. Choice D describes Libman-Sacks lesions in SLE, which rarely produce significant valve dysfunction and the lesions only rarely embolize.


In the stem given, another association with severity is her race. The disease is most common and most severe in Black females. Renal diseae (high serum creatinine, hypertension, nephrotic syndrome) are also poor prognostic factors.

Last edited by dockhi; 09-11-2012 at 10:18 AM.
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The above post was thanked by:
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  #7  
Old 09-11-2012
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Cool ,,,

I will go with E
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Old 09-11-2012
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Default My answer is E.

Hypersensitive to sunshine exposure and fricition rub on heart auscultation give us clue of SLE, which is an antoimmune disease and anti-dsDNA antibody and anti-SM antibody are used to lead to the diagnosis. Anti-dsDNA antibody is not specific, while anti-SM is much more specific to SLE. The pericardial friction rub is caused by anto-antibody attacking the tissue on preicardium, leading to its inflammation.
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