EMQs in Clinical Medicine.pdf - Peshawar Medical College

130 Orthopaedics and rheumatology
Anti-ro antibodies are found in 75 per cent of patients with primary SS
but only 10–15 per cent patients with secondary SS.
A Schirmer’s test can be used to identify insufficient production of tears.
The test involves placing a strip of filter paper on the inside of the lower
lid. A wetting (measured by the distance the water is absorbed up the
paper) of less than 10 mm in 5 min implies defective tear production.
Salivary gland biopsy to identify the focal infiltrate of lymphocytes is
the best single test for diagnosis.
Management involves treating the symptoms with artificial tears and
saliva.
D
A patient presents to rheumatology clinic with recurrent attacks of
pain and swelling in the nose and external ear.
Polychondritis is an inflammatory condition affecting cartilage that
mainly affects the nose and the ear. Other features include vasculitis and
seronegative arthritis.
47 Complications of fractures
Answers: A H E G L
A
A 25-year-old man presents with a blue right arm with absent radial
pulse and painful passive finger extension after a supracondylar fracture
of humerus.
Fracture can lead to ischaemia in the distal limb by direct injury to the
blood vessel or by the effect of oedema increasing the pressure within
the osteofascial compartment, which limits perfusion. In compartment
syndrome, the increased pressure can lead to profound ischaemia with
necrosis of muscle and nerve tissue. This is a surgical emergency requiring
prompt decompression by open fasciotomy. Once muscle tissue has
become infarcted, it is replaced by inelastic fibrous tissue giving rise to
the complication of Volkmann’s ischaemic contracture.
A 40-year-old woman presents 5 weeks after a radial fracture with a
painful swollen hand. The hand is cold and cyanosed with heightened
temperature sensitivity.
H This condition is now known as complex regional pain syndrome type 1.
The pain and swelling are close to, but not exactly at, the area of injury.
The skin may be oedematous and there may be altered sweat production.
Its aetiology is unknown.
E
A 70-year-old woman complains of right-sided pleuritic chest pain 10
days after a fractured neck of femur.
Pleuritic chest pain after orthopaedic/pelvic surgery should invoke strong
suspicion of pulmonary embolus.