[mudpiles]

A 30-year-old woman presents to a physician with rather non-specific complaints of fatigue, malaise, low-grade fever, and arthralgias. Screening serum chemistries demonstrate an elevated BUN. The urine shows proteinuria. Testing for which of the following will be most helpful for making the diagnosis?

A. Anticentromeric antibody
B. Antimitochondrial antibody
C. Antinuclear antibody
D. Anti-TSH receptor antibody
E. Rheumatoid factor

 

[mudpiles]

30 year old woman presents

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The correct answer is C. Systemic lupus erythematosus is a favorite on board examinations, and should be considered in any 15- to 45-year-old woman with chronic, poorly defined symptoms.
Clues that help are malar rash, anti-double-stranded DNA antibodies, and renal involvement.
Antinuclear antibody is a good screening test (it is also positive in some other autoimmune diseases) and should be used first in working this patient up. Renal involvement is unusual in most other autoimmune diseases.

Anticentromeric antibody (choice A) is a marker for the CREST form of scleroderma.
Antimitochondrial antibody (choice B) is a marker for primary biliary cirrhosis.
Anti-TSH receptor antibody (choice D) is a marker for Graves' disease.
Rheumatoid factor (choice E) is a marker for rheumatoid arthritis.

 

[khanar]

It looks a Step 3 Question!

Thank you mudpiles, I've been visiting your website and it's awesome.
However, I have a question about the question you posted here. Is that a Step 1 kind of question

 

[doctorF]

yes off course this is a step 1 type of question!!! this is always gonna be on boards step1

 

[mudpiles]

30 year old woman presents

I hope there were no new concept in this question. It was a simple pattern recognition question... from the basic sciences forum. In steps 2/3 expect to see similar questions, however management of these conditions are emphasized. Thank you for the question.

Dr. Walker
www.mudpiles.com

 

[doctorF]

mudpiles.com is very good for practise i will support on it soon!!!

 

[Seetal]

thank u mudpiles.

ill be signing up for sure. i tot the answer was C too but i didnt guess SLE. i guessed, fever and athralgia = infection, kidney involvement + proteinuria = confirmed INFECTION and in athritis if u have infection, u do an antinuclear Ab test. can this be a different way to look at it if i forgot it was SLE?

 

[mudpiles]

30 year old woman presents

I guess it is possible to consider infectious etiologies or other differential for proteinuria... however this goes back to "pattern recognition". This is a "classic" presentation for SLE. But you were on the right tract from the beginning. Keep it up!!!!

Dr Walker
www.mudpiles.com