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Question: A 19 y.o. female patient presents to your student health clinic complaining of a rash and says that she thinks she has the “flu or something.” She returned 3 weeks ago from a spring break trip to the beach.

11 Oct 2022,9:39 PM

 

CASE STUDY

Chief Complaint

A 19 y.o. female patient presents to your student health clinic complaining of a rash and says that she thinks she has the “flu or something.” She returned 3 weeks ago from a spring break trip to the beach. The rash started out “like acne,” located on her face, back, and chest. She now thinks she must have caught something during her trip, as she has developed joint pain in addition to the rash. The pain is most notable in her hands, although she has some stiffness and pain in both of her wrists, ankles, and knees.

Past Medical History

  • Denies surgeries or serious illnesses/hospitalizations

Physical Examination

  • Vital signs: T 99.6, BP 110/78, RR 20, HR 82, HT 5′8″, WT 124 lbs.
  • General: Well-developed and neurologically intact. No acute distress.
  • CV: RR&R, no murmurs.
  • Respiratory: Clear A&P.
  • MS: Notable for mild swelling bilateral hands; other joints without visible abnormalities. ROM of fingers slightly decreased with mild stiffness of movement and tenderness to interphalangeal palpation. ROM to other joints is intact, but with mild discomfort on motion to bilateral elbows, wrists, ankles, and knees.
  • Skin: Warm and dry with resilient turgor. Red maculopapular lesions scattered on cheeks and nose, more sparsely scattered on upper chest and back. No other lesions identified.

 

Questions

  1. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?
  2. What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?
  3. What is the final diagnosis?

 

Expert answer

 

Question 1. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?

 

•Systemic lupus erythematosus - 

Systemic lupus erythematosus is a chronic autoimmune disease that can affect any organ in the body. The most common symptoms are fatigue, joint pain, rash, and fever. It is very important to make a differential diagnosis of SLE because the treatment can be very different depending on the diagnosis. Some of the diseases that need to be considered in the differential diagnosis of SLE include:

 

-Rheumatoid arthritis

-Sjogren's syndrome

-Systemic sclerosis

-Polymyositis/dermatomyositis

-Hashimoto's thyroiditis

-Crohn's disease

-Wegener's granulomatosis

 

 

•Rheumatoid arthritis - 

Rheumatoid arthritis (RA) is a chronic autoimmune disease that results in inflammation of the joints. RA is a common type of arthritis, affecting 1-2% of the population. Symptoms can include joint pain, stiffness, swelling, and reduced range of motion. RA is typically diagnosed through a combination of medical history, physical examination, and laboratory tests.

 

There are several different types of RA, each with its own characteristic features. The most common type is called seropositive RA, which is characterized by the presence of antibodies called rheumatoid factors (RFs). Other types of RA include seronegative RA, juvenile RA, and psoriatic arthritis.

 

The diagnosis of RA can be difficult, especially in early stages when symptoms are mild. There are a number of different tests that can be used to help diagnosis RA, including blood tests, X-rays, and joint aspiration. Treatment for RA generally involves a combination of medication and lifestyle changes.

 

 

•Viral infection - •Secondary syphilis - There are a few differentials for secondary syphilis, the most common of which is Lyme disease. Other possibilities include other infections, such as tuberculosis or HIV, or a non-infectious condition, such as lupus. If the patient has any symptoms that suggest one of these other conditions, tests can be performed to rule them out.

•Secondary syphilis - There are a few differentials for secondary syphilis, the most common of which is Lyme disease. Other possibilities include other infections, such as tuberculosis or HIV, or a non-infectious condition, such as lupus. If the patient has any symptoms that suggest one of these other conditions, tests can be performed to rule them out.

•Rheumatoid arthritis - 

Rheumatoid arthritis (RA) is a chronic autoimmune disease that results in inflammation of the joints. RA is a common type of arthritis, affecting 1-2% of the population. Symptoms can include joint pain, stiffness, swelling, and reduced range of motion. RA is typically diagnosed through a combination of medical history, physical examination, and laboratory tests.

 

There are several different types of RA, each with its own characteristic features. The most common type is called seropositive RA, which is characterized by the presence of antibodies called rheumatoid factors (RFs). Other types of RA include seronegative RA, juvenile RA, and psoriatic arthritis.

 

The diagnosis of RA can be difficult, especially in early stages when symptoms are mild. There are a number of different tests that can be used to help diagnosis RA, including blood tests, X-rays, and joint aspiration. Treatment for RA generally involves a combination of medication and lifestyle changes.

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