WBR0403: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 20: Line 20:
|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Dermatology
|SubCategory=Dermatology
|Prompt=A 32 year old gentleman presents to his physician’s office complaining of skin lesions on his elbows.  On physical examination, the physician notes the lesions are plaques with silvery scaling that bleed when scraped off.  An image of the patient’s lesions is shown below.  Which of the following additional abnormalities should the physician expect to find during work-up?
|Prompt=A 32-year-old male presents to the physician’s office with complaints of skin lesions on his elbows.  Upon physical examination, you note that the lesions are plaques with silvery scaling, which bleed when scraped off.  An image of the patient’s lesions is displayed below.  Which of the following additional abnormalities should the you expect to find during work-up?


[[Image:Arm Psoriasis WBR.jpg]]
[[Image:Arm Psoriasis WBR.jpg]]
|Explanation=The patient is presenting with psoriasis.  Psoriasis is an immune-mediated disease that primarily has skin manifestations.  It is characterized by silvery plaques that bleed when scraped off (Auspitz sign).  Psoriasis is associated with psoriatic arthritis, a common complication that affects 30% of patients with psoriasis.  It is called a “seronegative arthritis” because it presents with arthritis yet no rheumatoid factor in the serum.  It occurs usually in patients with tissue type HLA-B27.  Psoriatic arthritis presents with painful stiffness in the joints, dactilytis, and nail pitting.
|Explanation=The patient in this scenario is likely presenting with [[psoriasis]].  [[Psoriasis]], an immune-mediated disease that primarily manifests on the skin, is characterized by silvery plaques that bleed when scraped off ([[Auspitz sign]]).  [[Psoriasis]] is frequently associated with [[psoriatic arthritis]], a complication that affects 30% of patients with [[psoriasis]].  [[Psoriatic arthritis]], a “seronegative arthritis,” manifests as arthritis yet patients demonstrate no [[rheumatoid factor]] in the serum.  It occurs usually in patients with tissue type HLA-B27.  [[Psoriatic arthritis]] manifests with painful stiffness in the joints, [[dactilytis]], and nail pitting.


Educational Objective:
|EducationalObjectives= [[Psoriasis]], an immune-disease with skin and extra-cutaneous manifestations, is characterized by silvery plaques that bleed when scraped off ([[Auspitz sign]]).  It is associated with [[psoriatic arthritis]], where patients often present with  painful stiffness in the joints, [[dactilytis]], and nail pitting.
Psoriasis is an immune-disease that has skin and extra-cutaneous manifestations.  It is characterized by silvery plaques that bleed when scraped off (Auspitz sign).  It is associated with psoriatic arthritis, where patients usually have arthritis and nail pitting.
|References=Van Romunde LKJ, Hermans J, Valkenburg.  Psoriasis and arthritis.  Rheumatology International.  1984; 4(2):61-65
 
Reference:
Van Romunde LKJ, Hermans J, Valkenburg.  Psoriasis and arthritis.  Rheumatology International.  1984; 4(2):61-65
|AnswerA=Osteophyte formation
|AnswerA=Osteophyte formation
|AnswerAExp=Osteophyte formation is associated with osteoarthritis.
|AnswerAExp= Osteophyte formation is typically associated with [[osteoarthritis]].
|AnswerB=Tophus formation
|AnswerB=Tophus formation
|AnswerBExp=Tophus formation is associated with gout.
|AnswerBExp=Tophus formation is typically associated with [[gout]].
|AnswerC=Pannus formation
|AnswerC=Pannus formation
|AnswerCExp=Pannus formation is associated with rheumatoid arthritis.
|AnswerCExp=Pannus formation is typically associated with [[rheumatoid arthritis]].
|AnswerD=Nail pitting
|AnswerD=Nail pitting
|AnswerDExp=Nail pitting is associated with psoriatic arthritis, a common complication in patients with psoriasis.
|AnswerDExp=Nail pitting is associated with [[psoriatic arthritis]], a frequent complication in patients with psoriasis.
|AnswerE=Spider angiomata
|AnswerE=Spider angiomata
|AnswerEExp=Spider angiomata are a type of telangiectasia associated with cirrhosis.
|AnswerEExp=[[Spider angiomata]], a type of telangiectasia, is frequentlly associated with cirrhosis.
|RightAnswer=D
|RightAnswer=D
|Approved=No
|WBRKeyword= arthritis, nail pitting, psoriasis, immune, immune disease, immune system, dermatology, psoriatic arthritis
|Approved=Yes
}}
}}

Revision as of 18:32, 17 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Dermatology
Prompt [[Prompt::A 32-year-old male presents to the physician’s office with complaints of skin lesions on his elbows. Upon physical examination, you note that the lesions are plaques with silvery scaling, which bleed when scraped off. An image of the patient’s lesions is displayed below. Which of the following additional abnormalities should the you expect to find during work-up?

File:Arm Psoriasis WBR.jpg]]

Answer A AnswerA::Osteophyte formation
Answer A Explanation [[AnswerAExp::Osteophyte formation is typically associated with osteoarthritis.]]
Answer B AnswerB::Tophus formation
Answer B Explanation [[AnswerBExp::Tophus formation is typically associated with gout.]]
Answer C AnswerC::Pannus formation
Answer C Explanation [[AnswerCExp::Pannus formation is typically associated with rheumatoid arthritis.]]
Answer D AnswerD::Nail pitting
Answer D Explanation [[AnswerDExp::Nail pitting is associated with psoriatic arthritis, a frequent complication in patients with psoriasis.]]
Answer E AnswerE::Spider angiomata
Answer E Explanation [[AnswerEExp::Spider angiomata, a type of telangiectasia, is frequentlly associated with cirrhosis.]]
Right Answer RightAnswer::D
Explanation [[Explanation::The patient in this scenario is likely presenting with psoriasis. Psoriasis, an immune-mediated disease that primarily manifests on the skin, is characterized by silvery plaques that bleed when scraped off (Auspitz sign). Psoriasis is frequently associated with psoriatic arthritis, a complication that affects 30% of patients with psoriasis. Psoriatic arthritis, a “seronegative arthritis,” manifests as arthritis yet patients demonstrate no rheumatoid factor in the serum. It occurs usually in patients with tissue type HLA-B27. Psoriatic arthritis manifests with painful stiffness in the joints, dactilytis, and nail pitting.

Educational Objective: Psoriasis, an immune-disease with skin and extra-cutaneous manifestations, is characterized by silvery plaques that bleed when scraped off (Auspitz sign). It is associated with psoriatic arthritis, where patients often present with painful stiffness in the joints, dactilytis, and nail pitting.
References: Van Romunde LKJ, Hermans J, Valkenburg. Psoriasis and arthritis. Rheumatology International. 1984; 4(2):61-65]]

Approved Approved::Yes
Keyword WBRKeyword::arthritis, WBRKeyword::nail pitting, WBRKeyword::psoriasis, WBRKeyword::immune, WBRKeyword::immune disease, WBRKeyword::immune system, WBRKeyword::dermatology, WBRKeyword::psoriatic arthritis
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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