EMQs in Clinical Medicine.pdf - Peshawar Medical College

Orthopaedics and rheumatology – revision boxes 137
REVISION BOXES
Orthopaedics and rheumatology
Seronegative refers to the fact that the conditions are not associated with production
of rheumatoid factor. These conditions commonly appear in EMQs (Box 1).
You should particularly look out for the associations mentioned as they may
appear as clues in the EMQ.
Box 1 Seronegative spondyloarthritides
Seronegative factors
Condition
• Triad of urethritis, conjunctivitis, arthritis Reiter’s syndrome [42]
Associated lesions include circinate
balanitis
Keratoderma blenorrhagica
Mouth ulcers
• Young male, buttock/sacroiliac pain Ankylosing spondylitis [45, 52]
worse in morning, relieved by exercise;
syndesmophytes, ‘bamboo spine’ on
radiograph
Associations include 4As: arthritis,
anterior uveitis, apical lung fibrosis,
aortic regurgitation
• Nail dystrophy, ‘pitting’ Psoriatic arthritis [42]
Joints show central erosion on
radiograph
Can be highly deforming (arthritis
mutilans)
• Arthritis in ulcerative colitis (UC)/Crohn’s Enteropathic arthropathy
disease patient
Asymmetrical, mainly affects lower limbs
Box 2 summarizes the distinctive features of some connective tissue diseases that
may assist you in answering EMQS.