HPI: SM is a 22 yo female presents to the exam room complaining of (c/o) aching joints including her knees, hips, elbows and wrist progressively worsening over the previous 4 weeks

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HPI: SM is a 22 yo female presents to the exam room complaining of (c/o) aching joints including her knees, hips, elbows and wrist progressively worsening over the previous 4 weeks. She states she so tired she has been unable to work for the past week. Then this morning, she woke up with a non-itching rash across her nose and cheeks. PMH: Depression Medication: sertraline FH: Mother alive @ age 47 with hypothyroidism Father deceased @ age 50 due to motor vehicle accident (MVA) 2 Brothers ages 26 and 30 both healthy SH: No Smoking, No Drugs. She is currently attending the local community college majoring in Education. She does not exercise much as she is always studying as exams are coming up soon. ROS: ROS: General: + weight loss, + fatigue, +intermittent fever HEENT: NEG for headache, congestion, nasal drainage, vision problems, throat pain Cardiac: NEG for chest pain, palpitations, swelling, loss of consciousness Resp: + Dyspnea, Neg for cough, wheezing, PND GI: + Nausea, Neg for Vomiting, Diarrhea, dysphagia, pain, anorexia MS: + Joint pain, +Joint Swelling, Neg for falls HEME: + bruising on lower legs, NEG for bleeding, night sweats ENDO: Neg for thirst, heat or cold intolerance NEURO: + dizziness, Neg for confusion, numbness, aphasia PSYCH: + memory loss, Neg for nervousness, suicidal ideation VS: Ht: 5’2 Weight 145 BP: 145/80 HR: 85 Resp: 16 Temp: 98.6 O2 Sat: 94% Physical Exam: Alert, Oriented 22 y o female who appears her stated age. Appropriated dressed and well groomed, NAD HEENT: Normocephalic, Long brown hair w/o alopecia. PERRL, Nasal turbinates w/o discharge TM clear, Pharynx w/o enlargement or erythema. Macular erythema rash across cheeks and nasal bridge. Chest: Reg S1S2, No murmurs, rubs or gallops, No pain Lungs: Clear with equal bilateral breath sounds Abdomen: Soft, non-tender, Bowel Sounds equal x 4 quads, Neg. HJR, Hepatomegaly, or Splenomegaly Extremities: Bilateral Elbow swelling and tenderness with FROM, R Knee Swelling > L Knee Swelling with erythema and tenderness. R Knee with limited extension. Psych: quiet, depressed mood, appropriate language, insight Initial Labs: WBC 4000 /ul Sodium: 145 mEq/L RBC 4.1 Potassium: 4.3 mEq/L HGB: 13.3 g/dl Chloride: 125 mEq/L HCT: 38% CO 2: 25 mmol/L Platelet: 120,000/mm3 BUN: 9 mg/dl Cr: 1.0 mg/dl Discuss the problematic findings within this case. List your differential diagnoses. What additional tests would you order to finalize or Rule Out your diagnosis. What are the 4 criteria presented here needed to finalize the diagnosis?

 
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