Medical MCQ - A 45-year-old woman presents with a 4-month history of severe headaches and pain, and blanching of the hands upon exposure to cold. She is a nonsmoker. Over the past 6 months, she has noticed progressive difficulty in swallowing solid food. Physical examination reveals smooth and tight skin over the face and fingers. The serologic test for anti-Scl-70 (antitopoi-somerase) is positive. Painful hands in this patient are best described using which of the following terms?

A 45-year-old woman presents with a 4-month history of severe headaches and pain, and blanching of the hands upon exposure to cold. She is a nonsmoker. Over the past 6 months, she has noticed progressive difficulty in swallowing solid food. Physical examination reveals smooth and tight skin over the face and fingers. The serologic test for anti-Scl-70 (antitopoi-somerase) is positive. Painful hands in this patient are best described using which of the following terms?

Chilblains

Homans' sign

Intermittent claudication

Raynaud phenomenon

Question Category:

Pathology

Correct Answer:

Raynaud phenomenon

Description:

This patient suffers from scleroderma complicated by Raynaud phenomenon. The latter refers to intermittent, bilateral attacks of vasospasm of the fingers or toes (sometimes affecting the ears or nose), resulting in pallor, paresthesias, and pain from ischemia. The symptoms are precipitated by cold or emotional stimuli and relieved by heat. Raynaud phenomenon may occur as an isolated disorder or as a feature of a number of systemic diseases, including systemic lupus erythematosus and scleroderma. Intermittent claudication (choice C) is associated with peripheral vascular disease (atherosclerosis). Chilblains (choice A) represent itchy or tender red or purple bumps that occur as a reaction to cold.Diagnosis: Scleroderma

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