A classic step 3 Q, You will see this in the test - triplehelix

[ArchivalUser]

answers th??????????????

[ArchivalUser]

D. I think Cricoid may be right......arthritis + fever+neurologic symptoms can occur with whipple and may precede the GI symptoms. It can effect the immune system and hence any part of the body.

[ArchivalUser]

please provide the answer. i am confused on this question

[ArchivalUser]

D.........agree

[ArchivalUser]

correct answer is D.

Small-bowel biopsy is indicated for this patient. A history of recurrent posterior uveitis, nystagmus, diplopia, and asymmetrical inflammatory arthritis accompanied by weight loss suggests a diagnosis of Whipple's disease. This condition is a chronic infection with multiorgan manifestations, which mimics a primary systemic autoimmune disorder.

Central nervous system symptoms may be prominent in patients with Whipple's disease, and these patients commonly have a history of symptoms or findings associated with abnormal gaze and ocular movements. Ocular signs of Whipple's disease may be secondary to central nervous system findings or to direct ocular involvement and may include uveitis, supranuclear ophthalmoplegia, diffuse chorioretinitis, glaucoma, epiphora, superficial punctate keratitis, and/or bilateral pannus formation involving the anterior chamber angles and corneal periphery. Constitutional features are common. Any asymmetrical, chronic, often intermittent inflammatory arthritis is characteristic and often suggests a diagnosis of Whipple's disease once crystal arthropathy is excluded.

Findings of bacteria and positive polymerase chain reaction testing on small-bowel biopsy would definitively establish a diagnosis of Whipple's disease. Many patients with this condition do not have diarrhea (malabsorption), and symptoms of wasting may be more notable than gastrointestinal symptoms.

This patient's pattern of symptoms and clinical findings are not highly suggestive of systemic lupus erythematosus. An anti-DNA antibody assay would not be helpful in establishing a diagnosis, because these findings would not definitively establish a diagnosis of systemic lupus erythematosus even if results of this assay were positive. Giant cell arteritis typically develops in elderly patients, whereas this patient is young. In addition, his pattern of inflammatory arthritis is not suggestive of giant cell arteritis. Therefore, temporal artery biopsy is not warranted. Sural nerve biopsy is not indicated for patients without documented clinical or nerve conduction abnormalities when pursuing a diagnosis of polyarteritis nodosa. Sural nerve biopsy frequently is associated with postoperative local morbidity. Bone marrow biopsy is not particularly useful in a patient with persistent fever, uveitis, and inflammatory arthritis unless there is more specific concern for disseminated mycobacterial infection or lymphoma.