A 14 year old girl on exposure to cold has pallor of extremities followed by pain and cyanosis. In later stages of life she is most prone to develop:

Answer is B i.e. (Scleroderma): Pallor of extremities, followed by pain and cyanosis suggests a diagnosis of Reynaud's Phenomenon. Reynaud's phenomenon as the presenting manifestation is most strongly associated with scleroderma or systemic sclerosis. Reynaud's Phenomenon and Scleroderma Reynaud's phenomenon (RP) is the clinical syndrome of episodic color change of the digits in response to cold and in some patients, emotional stress. The typical sequence is pallor (aerial constriction) followed by cyanosis (vasospasm and desaturation) of hemoglobin. Reynaud's Phenomenon is may be associated with a variety of connective tissue disorders including SLE, Rheumatoid ahritis, scleroderma and dermatomyositis (all options provided in question), however its association with scleroderma is exceptionally strong. Secondary causes of Raynaud Phenomenon: Rheumatologic Hematologic disorders Systemic sclerosis (scleroderma) Cryoglobulinemia Systemic lupus erythematosus Paraproteinemia Rheumatoid ahritis Polycythemia Sjogren syndrome Cold agglutinins Dermatomyositis Polymyositis Vasculitis Mechanical Endocrine disorders Vibration injury Hypothyroidism Frostbite Carcinoid syndrome Thoracic outlet syndrome Pheochromocytoma Vascular embolus or occlusion Vasospasm Drugs Migraine headaches Sympathomimetics drugs (decongestants, diet pills) Serotonin agonists (sumatriptan) Chemotherapeutic agents (bleomycin, cisplatin, carboplatin, vinvlastine) Ergotamine tarate Caffeine Nicotine