A 60-year-old Caucasian female presents to your office with several months history of a sandy sensation in her eyes, especially in the evening, and while watching TV or working in front of the computer. Her past medical history is significant for right knee osteoarthritis. She occasionally takes naproxen to relieve her knee pain. Her family history is significant for a father with hypertension and a mother who was diagnosed with breast cancer at the age of 65. She drinks one cup of decaffeinated coffee in the morning. Physical examination reveals several white patches on her buccal mucosa. Her recent fasting blood glucose level was normal. Which of the following questions is most appropriate in this case?

Question

A 60-year-old Caucasian female presents to your office with several months history of a sandy sensation in her eyes, especially in the evening, and while watching TV or working in front of the computer.  Her past medical history is significant for right knee osteoarthritis.  She occasionally takes naproxen to relieve her knee pain.  Her family history is significant for a father with hypertension and a mother who was diagnosed with breast cancer at the age of 65.  She drinks one cup of decaffeinated coffee in the morning.  Physical examination reveals several white patches on her buccal mucosa.  Her recent fasting blood glucose level was normal.  Which of the following questions is most appropriate in this case?

Quizplus · Accepted Answer

Explanation: Patients with Sjogren syndrome may have a variety of symptoms because many organs may be involved. This clinical scenario is highly suggestive of sicca syndrome, which is usually manifested by dry eyes (keratoconjunctivitis sicca) and dry mouth (xerostomia). The patient has keratoconjunctivitis sicca and oral candidiasis. Complications of dry mouth include dental caries, candidiasis (upto 70% patients), and chronic esophagitis. To reveal xerostomia in the patient's medical history, some yes/no questions may be asked, such as: "Do you wake up at night feeling dry, and then drink some water?" or "Do you frequently drink water to help you swallow some dry foods?" The other given questions are less relevant in this case. (Choice D)Sleep disturbances can be observed due to nocturia, but early morning awakening is typical for depression. (Choices E and A)Headaches over the temporal area, especially when accompanied by weight loss, may suggest temporal arteritis. Educational Objective: To reveal xerostomia in patients suspected with Sjogren's/sicca syndrome, some yes/no questions may be asked, such as: "Do you wake up at night feeling dry, and then drink some water?" or "Do you frequently drink water to help you swallow some dry foods?"

A 60-Year-Old Caucasian Female Presents to Your Office with Several