For the past year, a 12-year-old boy has had recurrent episodes of swelling of his hands and feet, which has been getting worse recently. These episodes occur following exercise and emotional stress, last for 2 to 3 days, and resolve spontaneously. The last episode was accompanied by abdominal pain, vomiting, and diarrhea. The results of routine laboratory workup are normal. An older sister and a maternal uncle have had similar episodes, but they were not given a diagnosis. He presents today with another episode as shown in the photographs below. Which of the following is the most likely diagnosis?

a. Systemic lupus erythematosus

b. Focal glomerulosclerosis

c. Congenital nephrotic syndrome

d. Hereditary angioedema

e. Henoch-Schönlein purpura

the answer is below…

The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.

The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.

This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.

The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.

All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.

Medical doctors with an M.D. degree are required to pass this examination before being permitted to practice medicine in the United States of America

The correct answer is d; Hereditary angiodema.[1]

The picture shows edema around the neck. This condition often worsens in adolescents. Although hereditary angioedema is relatively rare as a cause of edema, the recurrent episodes in late childhood, the normal laboratory results, and the family history make the other choices less likely. Hereditary angioedema, transmitted as an autosomal dominant trait, is due to inadequate function (due to either deficient quantity or quality) of an inhibitor of the first step in the complement cascade, which results in the excessive production of a vasoactive kinin. In addition to otherwise asymptomatic subcutaneous edema, edema can occur in the gastrointestinal tract and produce the symptoms mentioned in the question. Laryngeal edema with airway obstruction can also occur.