A 41-year-old man presents with persistent fatigue for the past 8 months.
Which one of the following features is least consistent with a diagnosis of chronic fatigue syndrome?
Correct Answer C: Physical or mental exertion usually makes the symptoms worse.
Chronic fatigue syndrome:
Diagnosed after at least 4 months of disabling fatigue affecting mental and physical function more than 50% of the time in the absence of other disease which may explain symptoms.
Epidemiology:
Fatigue is the central feature, other recognized features include:
Investigation:
Management:
Better prognosis in children.
*Children and young people only.
Which one of the following is least associated with Behcet's syndrome?
Correct Answer C: Oral ulcers + genital ulcers + anterior uveitis = Behcet's.
Mouth ulcers, genital ulcers, deep vein thrombosis and aseptic meningitis are all recognized features of Behcet's syndrome.
Ocular involvement is the most feared complication of Behcet's syndrome. Conjunctivitis is seen rarely and is much less common than anterior uveitis. Other ocular problems seen include retinal vasculitis, iridocyclitis and chorioretinitis.
Behcet's syndrome:
Behcet's syndrome is a complex multisystem disorder associated with presumed autoimmune mediated inflammation of the arteries and veins. The precise aetiology has yet to be elucidated however.
The classic triad of symptoms are oral ulcers, genital ulcers and anterior uveitis.
Features:
Diagnosis:
*More specifically HLA B51, a split antigen of HLA B5.
A 31-year-old patient is diagnosed with rheumatoid arthritis.
Which of the following is associated with a good prognosis?
Correct Answer C:
Rheumatoid arthritis: prognostic features:
A number of features have been shown to predict a poor prognosis in patients with rheumatoid arthritis, as listed below.
Poor prognostic features:
In terms of gender there seems to be a split in what the established sources state is associated with a poor prognosis. However both the American College of Rheumatology and the recent NICE guidelines (which looked at a huge number of prognosis studies) seem to conclude that female gender is associated with a poor prognosis.
A 44-year-old female with a history of Raynaud's phenomenon is reviewed in the rheumatology clinic. She is currently being investigated for dysphagia. On examination she is noted to have tight, shiny skin over her fingers.
Which one of the following complications is she most likely to develop?
Correct Answer C: This patient is likely to have CREST syndrome, a sub-type of limited cutaneous systemic sclerosis. Malabsorption can develop in these patients secondary to bacterial overgrowth of the sclerosed small intestine.
Whilst diffuse systemic sclerosis is associated with more severe and rapid internal organ involvement it is also seen in the limited form.
Systemic sclerosis:
Systemic sclerosis is a condition of unknown aetiology characterized by hardened, sclerotic skin and other connective tissues. It is four times more common in females.
There are three patterns of disease:
1- Limited cutaneous systemic sclerosis:
2- Diffuse cutaneous systemic sclerosis:
3- Scleroderma (without internal organ involvement):
Antibodies:
Which one of the following features is least typical of polymyalgia rheumatica?
Correct Answer A:
Polymyalgia rheumatica:
Pathophysiology:
Investigations:
Treatment:
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