arthralgias with pericardial rub..what is your diagnosis? why? - USMLE Forums
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Old 06-25-2012
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Default arthralgias with pericardial rub..what is your diagnosis? why?

A 52-year-old woman is complaining of several weeks of
swelling of both hands and ankles. She notes stiffness in the
morning that subsides during the day. She has also experienced
generalized weakness, cough, and intermittent low-grade fevers.
The patient denies having a skin rash or dryness of the eyes.
Examination reveals symmetrical swelling and warmth of the
wrists, knees, and proximal interphalangeal and
metacarpophalangeal joints of the hands. There are small
subcutaneous nodules palpated over the tendons of her fingers
and elbows. A faint pericardial rub is auscultated. Initial
laboratory tests reveal: white cell count 11,200/mm3, hematocrit
32%, mean corpuscular volume 92 μm3, platelets 660,000/mm3,
creatinine 1.2 mg/dL, and glucose 150 mg/dL. What should be
the first diagnostic test performed?
(A) X-rays of hands, wrists, and ankles
(B) Rheumatoid factor and sedimentation rate
(C) Antinuclear antibody
(D) Examine the synovial fluid
(E) Echocardiogram
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Old 06-25-2012
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C) ANA

Lupus?
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