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3170 Medicine

A young woman presents to the clinic for evaluation of a facial rash, as well as symptoms of arthralgias and fatigue. The symptoms started a few months ago and are not resolving. On physical examination, the rash on her face is erythematous and raised, the heart and lungs are normal, and the wrists are swollen and tender on palpation. Laboratory evaluation is only significant for mild thrombocytopenia (90,000/mL). Which of the following is the most appropriate initial autoantibody test?

Aanti-double-stranded (ds) deoxyribonucleic acid (DNA)
Banti-Sm
Canti-Ro or La
DANA
Medicine
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3171 Medicine

A 65-year-old man presents to your clinic after falling several times in the past few months. On examination, his most notable findings are an unstable, wide-based gait and marked retropulsion. He does have bradykinesia with masked facies and dysahria. You find no evidence of cogwheeling or resting tremor. His symptoms do not respond to levodopa/carbidopa. During the next few months, his eye movements are notable for the slowing of veical saccades and fast phases. What is the most likely diagnosis?

AL-DOPA resistant PD
BProgressive supranuclear gaze palsy
CMultiple system atrophy
DFoville syndrome
Medicine
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