Which of the following findings is not typical in a patient with antiphospholipid syndrome?
Correct Answer B: Antiphospholipid syndrome: arterial/venous thrombosis, miscarriage, livedo reticularis.
Thrombocytopenia is associated with antiphospholipid syndrome.
Antiphospholipid syndrome: Antiphospholipid syndrome is an acquired disorder characterized by a predisposition to both venous and arterial thromboses, recurrent fetal loss and thrombocytopenia. It may occur as a primary disorder or secondary to other conditions, most commonly systemic lupus erythematosus (SLE).
A key point for the exam is to appreciate that antiphospholipid syndrome causes a paradoxical rise in the APTT.
This is due to an ex-vivo reaction of the lupus anticoagulant autoantibodies with phospholipids involved in the coagulation cascade.
Features:
Associations other than SLE:
Management - based on BCSH guidelines:
Which one of the following is least recognized as a risk factor for developing osteoporosis?
Correct Answer C: Long-term phenytoin therapy may cause enhanced vitamin D metabolism leading to osteomalacia, rather than osteoporosis.
Osteoporosis: causes:
Risk factors:
Diseases which predispose:
*Research is ongoing as to whether warfarin is a risk factor
Which one of the following is least recognized in polyarteritis nodosa?
Correct Answer A: Perinuclear-antineutrophil cytoplasmic antibodies are found in around 20% of patients.
Polyarteritis nodosa:
Polyarteritis nodosa (PAN) is a vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation. PAN is more common in middle-aged men and is associated with hepatitis B infection.
A 51-year-old male presents with an acute onset of swelling and pain in his right knee. Aspiration shows negatively birefringent crystals with no organisms seen. His pain fails to settle with NSAIDs.
What is the most appropriate next step in his management?
Correct Answer A:
Gout: management:
Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 450 μmol/l).
Acute management:
Allopurinol prophylaxis:
Indications for allopurinol*:
Lifestyle modifications:
*Patients with Lesch-Nyhan syndrome often take allopurinol for life
Which of the following is least likely to be associated with ankylosing spondylitis?
Correct Answer D:
Ankylosing spondylitis features - the 'A's:
Achalasia is not a recognized association of ankylosing spondylitis.
Ankylosing spondylitis: features:
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 5:1) aged 20-30 years old.
Clinical examination:
Other features - the 'A's:
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