Systemic Lupus Erythematosus

Patient Images

Consultant’s Review

Following comments are from Dr.Sadia Mohsin ( Consultant Dermatologist )

Aoa
I saw all your videos and heard the presentation as well. The patient wasn’t very audible so.pardon me if i assume you missed something.

LE is a very imp case. Very very imp. And one or 2 cases are always present in the exam. Short and long case both.

Regarding History :

So for LE while taking history please do keep the ACR criteria in mind so you can defend your diagnosis.

Coming to your hx, the cutaneous hx was a bit inadequate. And not very clear. I couldn’t make out when you asked about Photosensitivity while asking about the malar/discoid rash or about scarring over face. And any relieving factors.

If LE is your first dd after the presenting complaints then do ask all cutaneous manifestations first. Which includes vasculitic lesions which the patient c/o. Raynauds again i didnt hear but you mentioned in your presentation but uski bi details are imp. Exacerbating/relieving etc.

When probing hair loss ask about whether it’s localized or diffuse. Falls in clumps. Texture changes etc.

Once you’re done with cutaneous then start with other parameters mentioned in ACR. Like fever. And yes its details are imp. Cold sweats, chills. Renal hx i didn’t hear as well. so i don’t know what you asked. But too imp for SLE.

Rest in systemic you covered most and also associations i.e dermatomyositis,SSc as well. 1-2 questions of each are enough.
But neurological mai you need to ask about depression,moodiness, weakness and seizures all. Since LE is a systemic disease so systemic history is very imp. Also ask hx of HepB/C/HIV in every hx.

You need to organize your history taking. So that when listening, everything falls smoothly in place.

On Examination :
It was very inadequate. Very rushed. And i don’t know if the video you sent was incomplete but i didn’t see systemic examination at all.

Even cutaneous was poorly done. Better to start in sitting posture. Vitals then GPE including lymph nodes. Then cutaneous. And while doing cutaneous privacy is an issue i know but if you practice doing it now you’ll be able to do it during the exam as well. Keep a sheet and cover patient. And examine covered areas too.

Scalp should also be done in sitting posture with hair open. You don’t want to miss a patch of scarring alopecia which has happened to ppl in long cases of LE.

You missed diascopy of the finger pulp lesions. As well as over the face if there were telangiectasis.

I didn’t see cardiac/respiratory or abdominal exam.

Please practice as much as you can.

Presentation was very long. Shorten it up a bit. Did you present your examination findings as well?

Good luck! You can do it. Just a little tweaks here and there.