Examkin

Soru

Zorluk: OrtaOrdering Laboratory Tests

Match each patient's clinical presentation with the most appropriate targeted laboratory test or panel to order for establishing the diagnosis.

  • A 28-year-old pregnant patient at 26 weeks gestation presenting with intense palmar and plantar pruritus that is worse at night, lacking any primary skin lesions.Total serum bile acids
  • A 45-year-old patient presenting with progressive, symmetric proximal muscle weakness (difficulty climbing stairs) and a new violaceous periorbital eruption.Creatine kinase (CK) and aldolase
  • A 68-year-old patient presenting with a new-onset, localized temporal headache, scalp allodynia when brushing hair, and claudication of the mastication muscles.Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
  • A 32-year-old patient presenting for evaluation with a history of recurrent unprovoked venous thromboembolism and two second-trimester fetal losses.Lupus anticoagulant and anti-beta-2-glycoprotein I antibodies

Cevap

Match the clinical presentations to their respective diagnostic laboratory tests: the pregnant patient with pruritus requires total serum bile acids; the patient with proximal weakness and rash requires CK and aldolase; the older patient with headache and jaw claudication requires ESR and CRP; and the patient with recurrent thrombosis and miscarriages requires lupus anticoagulant and anti-beta-2-glycoprotein I antibodies.
Each clinical scenario presents classic pathognomonic features of a specific disease state. Intrahepatic cholestasis of pregnancy is diagnosed via total serum bile acids. Dermatomyositis involves muscle breakdown, detectable via CK and aldolase. Giant cell arteritis is a highly inflammatory condition necessitating ESR and CRP testing. Antiphospholipid syndrome is confirmed through its specific autoantibody panel.

Adım Adım Çözüm

1
Analyze the first clinical presentation (pregnant patient with palmar/plantar pruritus without rash).
Identify the suspected diagnosis as intrahepatic cholestasis of pregnancy (ICP).
ICP characteristically presents with intense pruritus on the palms and soles in the second or third trimester without primary dermatologic lesions. The diagnostic test of choice is total serum bile acids.
2
Analyze the second clinical presentation (patient with proximal muscle weakness and violaceous periorbital rash).
Identify the suspected diagnosis as dermatomyositis.
The combination of symmetric proximal muscle weakness and a heliotrope rash points to dermatomyositis, requiring measurement of muscle enzymes (CK and aldolase) to confirm muscle inflammation and breakdown.
3
Analyze the third clinical presentation (older patient with new headache, scalp tenderness, and jaw claudication).
Identify the suspected diagnosis as giant cell arteritis.
These are classic features of giant cell arteritis, a large-vessel vasculitis. The initial diagnostic step is ordering acute phase reactants (ESR and CRP), which are highly sensitive for the condition.
4
Analyze the fourth clinical presentation (patient with recurrent unprovoked DVT and fetal losses).
Identify the suspected diagnosis as antiphospholipid syndrome.
The clinical criteria for antiphospholipid syndrome include vascular thrombosis and pregnancy morbidity. Diagnosis requires laboratory criteria, specifically testing for antiphospholipid antibodies such as lupus anticoagulant and anti-beta-2-glycoprotein I.

Anahtar Kavram

Targeted laboratory evaluation based on high-yield clinical presentations is essential for establishing accurate diagnoses in systemic and autoimmune conditions.
Bu soruyu puanla

Konular

Ordering Laboratory Tests

Bu konudan daha fazla soru