Rosh Internal Medicine Boost Practice Exam

What is the most likely diagnosis for a patient with bilateral swelling of cheeks, dry mouth and eyes, and elevated rheumatoid factor?

1. Lymphoma

2. Rheumatoid arthritis

3. Sjögren syndrome

4. Systemic lupus erythematosus

The correct answer is: Sjögren syndrome

The presentation of bilateral swelling of the cheeks, dry mouth, and dry eyes, combined with elevated rheumatoid factor, strongly suggests Sjögren syndrome. This autoimmune condition is characterized by exocrine gland dysfunction, primarily affecting the salivary and lacrimal glands, leading to xerostomia (dry mouth) and xerophthalmia (dry eyes). Bilateral swelling of the cheeks can indicate parotid gland involvement, which is common in Sjögren syndrome due to inflammation and enlargement of these glands. The elevation of rheumatoid factor, while not exclusive to Sjögren syndrome, is commonly seen in many autoimmune diseases, including this condition. Sjögren syndrome can often exist as a primary condition or be associated with other autoimmune disorders such as rheumatoid arthritis or systemic lupus erythematosus, but the specific combination of symptoms points more clearly toward Sjögren syndrome. Other conditions mentioned, such as lymphoma, rheumatoid arthritis, and systemic lupus erythematosus, do not align as closely with the symptoms, particularly the hallmark signs of dry mouth and dry eyes, which are distinctive of Sjögren syndrome. Thus, the clinical presentation and findings align well with a diagnosis of Sjögren syndrome.