Question of the Week # 443

Posted on May 28, 2013 by Archer USMLE Reviews

443 ) A 38 year old man is evaluated in your office for a chronic rash on his elbows. He reports this has been worsening over the last 6 months and is intensely itchy. He lost about 8lbs weight in the past 6 months. Review of systems is normal except for 4 to 5 episodes of loose stools every day. Laboratory investigations reveal moderate microcytic anemia. On examination, he is afebrile. There is a vesicular rash on the extensor aspects of his bilateral elbows as shown below:

elbows

Which of the following is most helpful in diagnosing this condition?

A) Fecal occult blood testing and Sigmoidoscopy

B) Anti-nuclear antibodies

C) Anti-Endomysial antibodies

D) Small bowel follow through

E) Anti-Sacharomyces Cerviseae antibodies ( ASCA)

Filed under: Uncategorized, USMLE Test Prep | Tagged: ARCHER GASTROENTEROLOGY, Archer hematology, Hematology, USMLE STEP 3 DERMATOLOGY, usmle step 3 dermatology images, USMLE STEP 3 GASTROENEROLOGY, USMLE step 3 Hematology |

15 Responses

MysticMD, on May 28, 2013 at 7:50 am said:

C

Reply
Dr. Arabi, on May 28, 2013 at 12:19 pm said:

Answer: C
Dx: Celiac Sprue dz
Sx: herpetiform rash

Reply
Archana, on May 28, 2013 at 3:02 pm said:

C.

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Alan, on May 28, 2013 at 8:25 pm said:

C

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Roy, on May 29, 2013 at 12:46 am said:

Anti endomicial y anti tissue glutamic antibody y

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inner_peace, on May 29, 2013 at 2:54 pm said:

c- anti endomysial Ab…rash is dermetiformus herpeticum, due to celiac sprue

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Dr.Esmail Qasem, on May 31, 2013 at 1:32 am said:

C.
Search for coeliac disease

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ANU, on June 20, 2013 at 1:36 pm said:

C,,,,COELIAC DISEASE

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neel, on August 4, 2013 at 3:41 am said:

Its Celiac D, anti Transglutimosidase ab.share any Q/concern…..
neel,
mbsnp12@gmail

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neel, on August 4, 2013 at 3:43 am said:

how to diff,w/ topical sprue?

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ria, on October 24, 2013 at 2:10 pm said:

answer d??

please let us know dr archer

Reply
- Archer USMLE Reviews, on October 26, 2013 at 9:53 pm said:
  
  Answer is C.
  the patient has clinical features suspicious for Celiac disease. Rash on the extensor surfaces resemble Dermatitis Herpetiformis which can be associated with celiac disease. Frequent diarrhea indicates a possible GI disorder and microcytic anemia from possible iron malabsoroption is additional clue for celiac disease. Putting these three clues together most likely etiology is Celiac disease and Anti-Endomysial antibodies are good screening tests for this disease.
  Small Bowel Follow Through are x-rays useful in detecting small bowel crohns, malignancy, obstruction etc
  
  Reply
dr tom, on December 18, 2014 at 1:40 pm said:

Dermatitis herpetiformis. Classic celiac. Autoimmune disorders are on a significant rise in the usa. Wheat in usa has 50x the gluten than it did 50 yrs ago. Gf diet is recommended.

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Sobia Mahar, on February 14, 2015 at 12:00 pm said:

C

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seb, on August 3, 2015 at 11:45 am said:

ASCA tests for what?

Reply