WBR0403
| 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? |
| 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. |
| 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:: |
