If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 3 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.
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This month’s stumper
Your patient is extremely distressed at a worsening tightening of the skin developing around the face and hands. The patient also has epigastric pain radiating into the chest. There is no shortness of breath or hypertension. Chest x-ray is normal and BUN and creatinine are normal. Echocardiography shows a pulmonary artery pressure that is elevated. Pulmonary function testing is planned. The patient asks about her prognosis.
Which of the following represents the greatest difference between limited scleroderma (CREST syndrome) and diffuse systemic sclerosis?
A. Anti-centromere antibodies.
C. Raynaud’s phenomenon.
D. Esophageal dysmotility.
E. Hand involvement.