WBR0403: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|QuestionAuthor={{Rim}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Dermatology
|SubCategory=Dermatology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
|MainCategory=Pathology
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|MainCategory=Pathology
|MainCategory=Pathology
|SubCategory=Dermatology
|SubCategory=Dermatology
|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?
|Prompt=A 32-year-old man presents to the outpatient clinic for a pruritic skin lesion on his left elbow. He reports that the lesion has been present for several months, but started out as a small area of erythema that eventually enlarged and became scaly. On physical examination, you note a large plaque with overlying silvery scaling which bleeds when scraped off.  An image of the patient’s lesion is displayed below.  Which of the following additional abnormalities should the you expect to find during work-up?


[[Image:Arm Psoriasis WBR.jpg]]
[[Image:WBR0403.jpg]]
|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.
|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.
|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.
|References=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 typically associated with [[osteoarthritis]].
|AnswerAExp=Osteophyte formation is typically associated with [[osteoarthritis]].
|AnswerB=Tophus formation
|AnswerB=Tophus formation
|AnswerBExp=Tophus formation is typically associated with [[gout]].
|AnswerBExp=Tophus formation is typically associated with [[gout]].
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|AnswerE=Spider angiomata
|AnswerE=Spider angiomata
|AnswerEExp=[[Spider angiomata]], a type of telangiectasia, is frequentlly associated with cirrhosis.
|AnswerEExp=[[Spider angiomata]], a type of telangiectasia, is frequentlly associated with cirrhosis.
|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.
|References=Van Romunde LKJ, Hermans J, Valkenburg.  Psoriasis and arthritis.  Rheumatology International.  1984; 4(2):61-65
|RightAnswer=D
|RightAnswer=D
|WBRKeyword= arthritis, nail pitting, psoriasis, immune, immune disease, immune system, dermatology, psoriatic arthritis
|WBRKeyword=arthritis, nail pitting, psoriasis, immune, immune disease, immune system, dermatology, psoriatic arthritis
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 23:09, 3 August 2014
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology
Sub Category SubCategory::Dermatology
Prompt [[Prompt::A 32-year-old man presents to the outpatient clinic for a pruritic skin lesion on his left elbow. He reports that the lesion has been present for several months, but started out as a small area of erythema that eventually enlarged and became scaly. On physical examination, you note a large plaque with overlying silvery scaling which bleeds when scraped off. An image of the patient’s lesion is displayed below. Which of the following additional abnormalities should the you expect to find during work-up?

File:WBR0403.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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