EMQs in Clinical Medicine.pdf - Peshawar Medical College

Orthopaedics and rheumatology – revision boxes 139
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• Usually middle-aged male
Asthma, rhinitis and systemic vasculitis
eosinophilia
• Usually under 5 years:
Main features are:
– protracted fever (over 5 days)
– acute cervical lymphadenopathy
– bilateral non-purulent conjunctivitis
– dry, cracked, fissured lips
– redness, oedema of palms and soles
Platelets, CRP (C-reactive protein) usually ↑↑
Churg–Strauss syndrome
Kawasaki’s disease
In examination EMQs certain autoantibodies tend to be associated with particular
diseases.
Sensitivity refers to the proportion of patients with a disease that have a positive
result. Therefore an autoantibody test with high sensitivity is useful for screening
purposes.
Specificity refers to the proportion of patients without the disease who have a
negative test result. Therefore a specific autoantibody test with high specificity is
useful for confirming diagnosis but not general screening.
Autoantibodies with high specificity are often mentioned in EMQs to aid diagnosis
(Box 4).
Box 4 Antibodies and screening
Antibody
Anti double-stranded DNA
Anti-Jo1 antibodies
Anti-centromere
Anti-topoisomerase
cANCA, anti-PR3
-Endomysial antibody
Diagnosis
SLE (systemic lupus erythematosus)
Polymyositis
Limited systemic sclerosis
Diffuse systemic sclerosis
Wegener’s granulomatosis
Coeliac disease
Box 5 summarizes some typical presenting symptoms/signs that you may find in
an EMQ that is describing a particular problem in the upper limb.
Box 5 Orthopaedic presentations: upper limb
Presentation
Problem
• Painful shoulder following seizure Posterior dislocation shoulder [50]
• Failure to abduct shoulder after Axillary nerve injury [49]
dislocation
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