A 60-year-old male presents to the office complaining of a productive cough for the past 3 months. He mentions that the sputum is plentiful and foul smelling. He is a chain smoker. Vitals are within normal limits except for a mild fever of 37.60C. Physical exam shows finger clubbing. Auscultation of the lungs shows coarse crepitations in both lungs. Chest x-ray reveals increased vascular markings and peribronchial thickening.
What is the diagnostic test of choice for this patient?
Correct Answer C:
High resolution CT scan of the lung is the diagnostic modality of choice for bronchiectasis. Copious foul smelling sputum is a clue. The chest x-ray of our patient is characteristic of bronchiectasis: peribronchial thickening (Tram track appearance).
Bronchography is an old method of diagnosis and it has been replaced nowadays by HRCT.
Bronchoscopy and biopsy would be warranted if a bronchial lesion were seen on chest X ray or CT scan.
Sputum examination and Culture and sputum smear for AFB should be done in clinical practice; however the question is clear and asks for the diagnostic modality of choice.
A 40-year-old woman presents with painful swelling of the joints of her fingers, excessive fatigue and a malar rash.
Which one of the following diseases is most likely?
Correct Answer C: Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of probable autoimmune etiology, occurring predominantly in young women. Common manifestations include arthralgias and arthritis; malar and other skin rashes; pleuritis or pericarditis; renal or CNS involvement; and hematologic cytopenia.
Diagnosis requires clinical and serologic criteria. Treatment of severe ongoing active disease requires corticosteroids, often hydroxychloroquine, and sometimes immunosuppressants.
A female patient with positive ANA, presents with ankle edema, arthralgia, protein in her urine and a butterfly rash on her face.
What is the most likely diagnosis?
Correct Answer A:
Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of probable autoimmune etiology, occurring predominantly in young women. Common manifestations include arthralgias and arthritis; malar and other skin rashes; pleuritis or pericarditis; renal or CNS involvement; and hematologic cytopenia.
Diagnosis requires clinical and serologic criteria. The fluorescent test for ANA is the best screen for SLE. Treatment of severe ongoing active disease requires corticosteroids, often hydroxychloroquine, and sometimes immunosuppressants.
The lupus patient you are following suddenly develops a fever and notes that her urine is dark in color. Analysis of her urine reveals the presence of red cells. She has had some joint aching and been feeling unwell for a few days. Her malar rash is about the same as usual for her.
Which one of the following suggests she is experiencing an exacerbation of her disease?
Correct Answer D:
Serum complement levels (C3 and C4) indicate consumption of immune complexes. In other words, complement plays a substantial role in the clearance of immune complexes and/or apoptotic debris, which is thought to be impaired in lupus. Elevated or normal serum complement levels indicate that immune complexes are being cleared. During a lupus exacerbation, immune complexes are not cleared from the body. Therefore, decreasing serum complement levels are consistent with exacerbation of the disease (lupus flare).
A 32-year-old woman complains of polyarticular symmetric arthritis and a diffuse maculopapular rash that flares up with exposure to sun light. She is afebrile. Physical examination reveals tenosynovitis of her wrists.
Which one of the following is the most likely diagnosis?
Systemic lupus erythematosus is a chronic, multisystem, inflammatory disorder of probable autoimmune etiology, occurring predominantly in young women. Common manifestations include arthralgias and arthritis (polyarticular, symmetric); malar and other skin rashes (Photosensitivity rash); pleuritis or pericarditis; renal or CNS involvement; and hematologic cytopenia. Diagnosis requires clinical and serologic criteria. Treatment of severe ongoing active disease requires corticosteroids, often hydroxychloroquine, and sometimes immunosuppressants.
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