WBR0403
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Dermatology |
| Prompt | [[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? |
| Answer A | AnswerA::Osteophyte formation |
| Answer A Explanation | AnswerAExp::Osteophyte formation is associated with osteoarthritis. |
| Answer B | AnswerB::Tophus formation |
| Answer B Explanation | AnswerBExp::Tophus formation is associated with gout. |
| Answer C | AnswerC::Pannus formation |
| Answer C Explanation | AnswerCExp::Pannus formation is associated with rheumatoid arthritis. |
| Answer D | AnswerD::Nail pitting |
| Answer D Explanation | AnswerDExp::Nail pitting is associated with psoriatic arthritis, a common complication in patients with psoriasis. |
| Answer E | AnswerE::Spider angiomata |
| Answer E Explanation | AnswerEExp::Spider angiomata are a type of telangiectasia associated with cirrhosis. |
| Right Answer | RightAnswer::D |
| Explanation | [[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.
Educational Objective: 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. Reference:
Van Romunde LKJ, Hermans J, Valkenburg. Psoriasis and arthritis. Rheumatology International. 1984; 4(2):61-65 |
| Approved | Approved::No |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |
