Pediatrics Q# 147................................. - triplehelix

[ArchivalUser]

A 17-year-old girl comes to the clinic with
several weeks of joint pain and rash. The
joint pain is most prominent in the hands.
She states that the pain is most severe in the
morning and tends to improve over the day.
She has noted some swelling of her fingers.
She has also had a rash on her face that becomes
more prominent when she is outside.
She states that the sunlight tends to bother
her eyes. On further questioning, she states
that she has not felt well for several months.
She has had intermittent fever, has been
more tired than usual, and has lost weight
even though she has not been dieting. On
physical exam, she looks tired. She has lost 5
pounds since her last visit one year ago. She
has an erythematous rash on her cheeks. She
has several shallow ulcers in her mouth. She
has fusiform swelling of her fingers and pain
with movement of her fingers. Which of the
following in the most likely diagnosis?
(A) systemic lupus erythematosus (SLE)
(B) dermatomyositis
© juvenile rheumatoid arthritis
(D) rheumatic fever
(E) Lyme disease

[ArchivalUser]

A......

[ArchivalUser]

aa

[ArchivalUser]

AAA

[ArchivalUser]

AAAAAAAAAAAAAAAAAA

[ArchivalUser]

aaa

[ArchivalUser]

AAAAAA

[ArchivalUser]

Correct answer is A.

(A) SLE is an autoimmune disorder that affects
multiple organs. The diagnosis is based
on the presence of four or more major criteria.
These include malar rash, oral ulcers,
arthritis, and photosensitivity. This patient
has all of these symptoms, as well as the systemic
symptoms often seen at presentation.
The disorder is predominately a disease of
women, and in the pediatric population is a
disease of adolescence. Chronic renal disease
is an important and common cause of morbidity
and mortality among patients with
SLE. (Rudolph et al, pp 486“488)