MKSAP: 21-year-old woman with a rash in the lower extremities

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some relief. History is significant for gastroesophageal reflux disease and acne. Medications are over-the-counter famotidine as needed and minocycline. On physical examination, temperature is 38.2 °C (100.8 °F), blood pressure is 110/60 mm Hg, pulse rate is 92/min, and respiration rate is 16/min. BMI is 24. Mild swelling of the wrists, knees, and ankles is noted. There are scattered 1- to 2-cm painful erythematous nodules as well as livedo reticularis in the lower extremities beginning at the thighs. The remainder of the examination is normal. Laboratory studies: Antinuclear antibodies Positive (titer: 1:320) Anti–double-stranded DNA antibodies Negative Anti-Smith antibodies Negative Anti-U1-ribonucleoprotein antibodies Negative Anti-Ro/SSA antibodies Negative Anti-La/SSB antibodies Negative Antihistone antibodies Negative ANCA Positive (titer: 1:320) in a perinuclear pattern; negative for myeloperoxidase Urinalysis Normal Chest radiograph is normal. Which of the following is the most appropriate next step in management? A: Start az...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Rheumatology Source Type: blogs

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This holiday season we are all in search of the perfect gift. What is the one thing you truly desire for yourself and your family? Don’t you think we all want it? What if you were handed a beautifully wrapped box containing a miraculous tool that caused dramatic weight loss without limiting calories or requiring exercise? What if this gift reduced appetite, shrunk belly fat, dropped your dress size into the single digits, and accomplished all of this while sparing you from a Biggest Loser sob fest? What if that same gift freed you from acid reflux, heartburn, bowel urgency, and diarrhea, but also improved mood, incre...
Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: News & Updates Dr. Davis Gliadin gluten gluten-free grain-free grains wheat belly Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Lifestyle acid reflux detoxification grains IBS Inflammation joint pain opiates withdrawal Source Type: blogs
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Source: PickTheBrain | Motivation and Self Improvement - Category: Consumer Health News Authors: Tags: depression featured self improvement anxiety bad habits chronic stress Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Undoctored Wheat Belly Lifestyle acid reflux anti-aging autoimmune blood sugar bowel flora cholesterol Dr. Davis energy Gliadin gluten gluten-free grain-free grains health healthcare Inflammation joint pain low-carb Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Lifestyle asthma diabetes gluten grains skin rash Weight Loss Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Dr. Davis Priceless Gift Weight loss Wheat allergy Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat Watch Wheat-Free Lifestyle Detox diabetes gluten gluten-free grain grains Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Dr. Davis Priceless Gift Weight loss Wheat allergy Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat Watch Wheat-Free Lifestyle Detox diabetes gluten gluten-free grain grains Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Lifestyle acid reflux Detox energy fatigue weight loss gluten grains IBS Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Lifestyle abdominal pain anxiety bloating Depression diarrhea gluten grains joint pain rash re-exposure seizure vomiting Source Type: blogs
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Source: Wheat Belly Blog - Category: Cardiology Authors: Tags: Wheat Belly Success Stories acid reflux allergy asthma astigmatism gluten grains Source Type: blogs
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