A 32 year old woman comes to her primary care provider for a return visit with the chief complaint of joint pain and swelling fo
r several months. At first the pain involved the left wrist and elbow and the right knee, but gradually became bilateral and now involves the metacarpophalangeal and proximal interphalangeal joints. Every morning, she has stiffness that slowly gets better after a couple of hours, but the generalized fatigue and weakness lasts all day. Her eyes often feel gritty and dry. She has had some weight loss over the past few months. There is no skin rash or oral ulcers. However, the oral cavity appears overly dry. There is no history of fever or diarrhea. On examination, the affected joints are bilaterally warm, swollen and tender. The rest of her physical exam is unremarkable. What is your presumptive differential diagnosis
The reflex when Judy vigorously sucks her mother's finger when it is placed in her mouth it is called sucking reflex. This reflex begins in week 32 of pregnancy, but is perfected in week 36.
When judy moves her head toward her mother's hand when it brushes Judy's check is called rooting reflex. This reflex usually stays around by 4 months.
