Example of a first order, low difficulty question:
A 62 year old male has a 5 year history of scaling, silvery plaques on the extensor surfaces of his elbows for a period of 5 years now.
He also for the last 18 months has complained of pain in both wrists and shoulders and difficulty lifting boxes. He denies rash, ocular symptoms, GI symptoms, or unrinary symptoms.
He was seen by his family physician who ordered screening labs including a CBC, chemistry, and autoimmune panel.
He has a past medical history of reflux on pantoprazole, dyslipidemia on Crestor, and had surgery to correct an avulsion fracture on the right ankle which was an uneventful procedure.
He is a retired office manager, lifelong non smoker, and drinks alcohol socially at gatherings.
His family history is notable for his mother having a disabling arthritis diagnosed in her 20’s, but he cannot recall the specifics.
On exam he is noted to have pitting of the nails, and he is referred to a specialist regarding which of the following diagnostic considerations.
1: SLE
2: Rheumatoid Arthritis
3: scleroderma
4: Psoriatic arthritis
5: Seronegative arthritis
Please state your answer and rationale. Second and third order questions to follow related to this case
Correct. That was clearly too easy.
Psoriatic arthritis has a characteristic pitting of the nails that is seen in this condition. It is a characteristic finding (but not specific to psoriatic arthritis)
What if this was a 35 year old female with nail pitting and shortness of breath and conjunctivitis? What condition would you think of then ?
The other options are less likely in terms of gender and age of presentation.
Seronegative arthritis is a possibility. Age of presentation is less likely.