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All posts with tag: "rheum"

PEM Questions

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You are seeing a 3 year old girl who was discharged from the hospital a week ago. At that time, she presented with fever, intermittent polyarthralgias, and an evanescent salmon pink rash. She was diagnosed with new onset systemic juvenile idiopathic arthritis, treated with ibuprofen, and initially did well. She now presents with unremitting fever and rash, bruising, petechiae, gum bleeding, hepatosplenomegaly, and lethargy. Labs reveal elevated transaminases, ferritin, LDH, and triglycerides, but a low ESR.

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You are seeing a 16yo girl who has been followed by her primary physician and a rheumatologist for systemic lupus erythematosus since being diagnosed 1 year ago. She is presenting with chest pain.

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(Click the link to comment and to vote - voting not working through email, sorry!) You are seeing a 14 year old boy who hiked in the snow yesterday with inadequate warm clothes and footwear. He has developed swollen violaceous papules and nodules on the toes of both feet. He states that the areas are itchy and sometimes have a burning sensation. Which of the following courses of action would be appropriate?
  1. Advise him to avoid further cold exposure and to use appropriate protective footwear
  2. Perform gentle rewarming in 37 to 39 degree Celsius water
  3. Perform a COVID-19 test
  4. Reassure him that this is a benign Raynaud phenomenon
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