ROLL O:36

PRASANNA VERNAKAR
CLASS 5: ASSIGNMENT

1. A 55-year-old female with a 15-year history of pain at her finger tips on exposure to
cold/immersing her hands in water. Her finger tips turn pale and bluish. The pain subsides
with the finger tips becoming reddish. She now presents with increasing shortness of
breath.
She also reports a 10 year history of belching and epigastric burning sensation- particularly
on lying down. She has noticed tightening of the skin of her fingers with a few digital
ulcerations. She additionally reports stony hard bumps over the elbows and multiple
reddish
pinpoint spots over the face and chest. Cardiac exam reveals a regular rate and rhythm. The
P2 component of the S2 is loud.

Questions
1. Enumerate the 6 clinical features described in the history?
• Pain at finger tips on exposure to cold/immersing hands in water
• Finger tips turn pale and bluish
• Shortness of breath.
• 10 year history of belching and epigastric burning sensation
• Tightening of the skin of her fingers
• Few digital ulcerations
• Stony hard bumps over the elbows and multiple reddish

2. What is the Diagnosis?

• SCLERODERMA

3. Classify the disease

4. What is the reason for her shortness of breath?

• INTESTIAL FIBROSIS
• Pulmonary HTN
• PROGRESSIVE DYSPNEA ON EXERTION
 ROLL O:36
PRASANNA VERNAKAR
2. A 23year old woman delivers a neonate with 3 rd degree heart block. She denies
photosensitivity. She wears contact lenses and denies dryness of eyes. On enquiry does
report dryness of mouth. On examination Schirmer’s test is 6mm. There is no malar rash.
Systemic examination is normal.
Questions:
5. What is her diagnosis?
Sjogren's Syndrome

6. Which antibody is likely to be positive in her?

anti-Ro (SS-A) and anti-La (SS-B)

7. What is the possible explanation for 3 rd degree heart block in her

neonate ?
Sjögren's syndrome is an autoimmune disease characterized by
dryness of the mouth and eyes. Autoimmune diseases feature the
abnormal production of extra antibodies such as anti-Ro (SS-A)
and anti-La (SS-B)