EMQs in Clinical Medicine.pdf - Peshawar Medical College

138 Orthopaedics and rheumatology
Box 2 Connective tissue disease
Feature
CT disease
• Usually woman: persistently cold,
Raynaud’s phenomenon
cyanosed fingers
Calcinosis (nodules) Systemic sclerosis [46]
Raynaud’s phenomenon (in almost all cases)
Oesophageal dysmotility (difficulty swallowing)
Sclerodactyly
Telangiectasia
• More common in Turkish, Iranian patients Behçet’s disease [46]
Orogenital ulceration, uveitis, arthritis
Pathergy reaction is pathognomonic
• Proximal muscle weakness, pain and tenderness Polymyositis [31, 46]
↑ serum CK (creatine kinase)
Above plus heliotrope (purple) rash Dermatomyositis [46]
• Dry eyes, dry mouth Sjögren’s syndrome [46]
Positive Schirmer’s test
Vasculitis can give rise to pathology in several organs and must therefore be considered
in the differential diagnosis of a patient with an unidentified multi-system
disorder.
Box 3 summarizes some of the vasculitides with distinctive features that commonly
appear in EMQs.
Box 3 Vasculitides
Feature
Vasculitide
• Usually elderly patient with Temporal/giant cell arteritis [29, 40]
headache Scalp tenderness, jaw
claudication very suggestive
Amaurosis fugax, sudden unilateral
blindness can occur associated with
polymyalgia rheumatica
• Granulomas in respiratory tract, Wegener’s granulomatosis [13]
generalized vasculitis
Classic anti-neutrophil cytoplasmic
antibody (cANCA), anti-PR3 positive
• Usually child (particularly under age 5) Henoch–Schönlein purpura [69]
Purpuric rash over buttocks,
extensor surfaces
Associated with arthritis, abdominal
pain, nephritis
continued overleaf