mrs. L.H, a 30 y.o presented for an obstetrics follow up, 6 weeks post miscarriage. she was 10 weeks pregnant when she had the miscarriage. she has been off work since, and complains of joint pains and extreme tiredness. she is not on any medications. notice a decrease in her appetite with slight weight loss, stiffness on her joints and difficulty to sleep and her mood has been low since the miscarriage. she also wears sun block more often now when going out.
had a hx of seizure a year ago. family hx is unremarkable.
O/E: no obvious rash noted. joint stiffness and swelling of the hands + wrist bilaterally. heart examination is normal. no murmus. chest is clear.
others: hb is low, LFTs & TFTs is normal. ESR is markedly elevated.
questions:
p.s: this is a case that i'll be presenting later this week. so, those who follow my blog will have the first view. i'll post the answers within the next few days.
had a hx of seizure a year ago. family hx is unremarkable.
O/E: no obvious rash noted. joint stiffness and swelling of the hands + wrist bilaterally. heart examination is normal. no murmus. chest is clear.
others: hb is low, LFTs & TFTs is normal. ESR is markedly elevated.
questions:
- what further questions that you would like to ask in the hx?
- what is the most likely diagnosis?
- what are the differentials that you would consider in this case?
- what tests would you do to confirm or outrule your diagnosis/differentials?
- how would you manage this patient?
p.s: this is a case that i'll be presenting later this week. so, those who follow my blog will have the first view. i'll post the answers within the next few days.
