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:
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 |
C
Answer: C
Dx: Celiac Sprue dz
Sx: herpetiform rash
C.
C
Anti endomicial y anti tissue glutamic antibody y
c- anti endomysial Ab…rash is dermetiformus herpeticum, due to celiac sprue
C.
Search for coeliac disease
C,,,,COELIAC DISEASE
Its Celiac D, anti Transglutimosidase ab.share any Q/concern…..
neel,
mbsnp12@gmail
how to diff,w/ topical sprue?
answer d??
please let us know dr archer
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
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.
C
ASCA tests for what?