Rosh Internal Medicine Boost Practice Exam

In a case of recently diagnosed scleroderma, which symptom is most consistent with the condition?

1. Dry mouth and dry eye complaints

2. Skin tightening around the fingers with pitting at the fingertips

3. Tenderness at the temporal areas

4. Weakness of proximal muscles without pain

The correct answer is: Skin tightening around the fingers with pitting at the fingertips

The presence of skin tightening around the fingers with pitting at the fingertips is highly characteristic of scleroderma, a systemic connective tissue disease. Scleroderma, or systemic sclerosis, often manifests with significant changes in the skin, where thickening and hardening, also referred to as fibrosis, occurs. In the fingers, this can result in changes like pitting or indents, which can be symptoms of digital ischemia or other dermal issues due to vascular alterations and fibrosis. In this context, other options may present related symptoms, yet they do not specifically align with the hallmark features of scleroderma. For instance, dry mouth and dry eye complaints are more commonly associated with Sjögren's syndrome, while tenderness at the temporal areas may indicate temporal arteritis or other inflammatory conditions not specific to scleroderma. Weakness of proximal muscles without pain is typically seen in conditions such as polymyositis or other myopathies rather than scleroderma. Thus, the symptom of skin tightening around the fingers with pitting at the fingertips distinctly signals the underlying pathology of scleroderma, making it the most consistent symptom related to this condition.