00:01
Hello students, in this question you have been told that a patient, your patient is married, 47 year old, white female homemaker with two children and 18 year history of systemic lupus erythematosus.
00:22
She has no known allergies and her the patient takes an occasional naproxen for joint pain and an antacid for heartburn but no other otc or other medication or prescriptions.
00:46
She neither smokes nor drinks alcohol and except for lupus, the patient's medical history is unremarkable.
01:01
She is 5 feet 5 inches in height and weighs about 102 pounds which is a decrease in weight of 23 pounds since her last physical examination nearly a year ago.
01:17
She had several small patches of hair loss on her head and her joint often hurt.
01:29
Her esr erythrocyte sedimentation rate is elevated at 70.
01:34
She has a red rash on the sun exposed parts of her skin that's looks like vasculitis.
01:42
She has four brothers, four brothers and three sisters.
01:47
The older sister has rheumatoid arthritis and an aunt with pernicious anemia and her deceased mother had graves disease.
02:03
She had been aware of these problems for approximately four months.
02:07
A physical examination was conducted during which her pcp noted multiple rashes like lesion on sun exposed areas of the the arms and the legs.
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So the tissue biopsy on one of those lesions was carried out and an ana test was positive.
02:38
The lungs were clear of auscultations.
02:40
Heart sounds were normal with a prominent s1 and s2.
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There was no evidence of enlarged lymph nodes.
02:50
Blood tests revealed an hct of 23 % and an rbc count of 3 .5 million per millimeter cube.
03:10
She also, she was also jaundiced with some yellowing within the sclera.
03:16
A microscopic examination of peripheral blood smear revealed that rbcs were normal in shape, size and color.
03:27
Rolling out iron, folate or vitamin b12 deficiency...
