Abdominal Pain

Determining the Cause

Chief Complaint: Rash

5-month history of a cough producing clear sputum and chest pain. She denies any history of fever. She worked in a rubber factory for 10 years before quitting 2 months ago. She does not smoke herself, but her husband has been smoking about 20 cigarettes per day for the past 15 years. Vital signs are oxygen saturation 92% on room air, respiratory rate 16 breaths/min, heart rate 88 bpm, blood pressure 140/90 mm Hg, and temperature 98.9° F (37.1° C). On physical examination, lung auscultation demonstrates quiet breath sounds. Spirometry reveals the FEV1/FVC ratio to be <0.7, and after a bronchodilator is given, the FEV1 value is 82% of the predicted. Laboratory test findings are unremarkable. Chest x-ray and EKG show no significant findings. Which of the following is correct regarding the prognosis for this patient?

Pivotal Assessment	Findings
History

Physical Exam	Erythematous papules etc	Heliotrope Rash A heliotrope rash is a characteristic skin finding often associated with dermatomyositis, an inflammatory muscle disease. The rash appears as a violet or dusky discoloration, usually located around the eyes and on the upper eyelids. It may also be accompanied by swelling (edema). The name "heliotrope" comes from the Greek word for "sun-following," reflecting the purplish hue of the rash, which resembles the color of the heliotrope flower. In addition to the heliotrope rash, dermatomyositis can cause muscle weakness, other types of skin rashes, and systemic symptoms such as fatigue and fever. The exact cause of dermatomyositis is not fully understood, but it is believed to involve an autoimmune mechanism where the body's immune system attacks its own tissues.
Diagnosis

Pivotal Assessment

Findings

History

Physical Exam

Erythematous papules etc

Heliotrope rash Heliotrope Rash

A heliotrope rash is a characteristic skin finding often associated with dermatomyositis, an inflammatory muscle disease. The rash appears as a violet or dusky discoloration, usually located around the eyes and on the upper eyelids. It may also be accompanied by swelling (edema). The name "heliotrope" comes from the Greek word for "sun-following," reflecting the purplish hue of the rash, which resembles the color of the heliotrope flower.

In addition to the heliotrope rash, dermatomyositis can cause muscle weakness, other types of skin rashes, and systemic symptoms such as fatigue and fever. The exact cause of dermatomyositis is not fully understood, but it is believed to involve an autoimmune mechanism where the body's immune system attacks its own tissues.

Diagnosis