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Review of Clinical Signs Review Questions

Clinical Signs of Systemic Sclerosis

Bernard M. Karnath, MD

Questions 1 through 5 are based on the following case:

A 53-year-old man with a past medical history of hypertension and coronary artery disease presents to the emergency department complaining of chest pain and shortness of breath that started about 1 hour ago. Four weeks ago, he was admitted to the hospital after having a myocardial infarction (MI). Cardiac enzymes, chest radiograph, and an electrocardiogram (ECG) are ordered. The ECG (above) shows the following:

1. Which of the following complications is least likely to develop in this patient?

  1. Interstitial lung disease
  2. Glomerular nephritis
  3. Renal crisis
  4. Pulmonary hypertension
  5. Esophageal reflux
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2. Which of the following findings is seen prior to or at the time of diagnosis of scleroderma?

  1. Arthritis
  2. Interstitial lung disease
  3. Pulmonary hypertension
  4. Raynaud’s phenomenon
  5. Renal crisis
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3. This patient is likely to test positive for which of the following antibodies?

  1. Anti-CCP (cyclic citrullinated peptide)
  2. Anti-Jo1
  3. Anti-SCL-70
  4. Anti-Smith
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4. The case patient was diagnosed with scleroderma after the first visit. Which of the following medications is least likely to be beneficial as chronic medication?

  1. Angiotensin-converting enzyme (ACE) inhibitors
  2. Calcium channel blockers
  3. High-dose corticosteroids
  4. Proton pump inhibitors
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5. The patient presents again after 2 years with dry cough and dyspnea on exertion. Which of the following lung diseases is most likely?

  1. Diaphragmatic weakness
  2. Interstitial lung diseases
  3. Lung nodule
  4. Shrinking lung syndrome
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Updated 1/31/08 • kkj