A 54-year-old woman who has had two Colle's fractures in the past three years has a DEXA scan:
What does the scan show?
Correct Answer D:
Osteoporosis: DEXA scan:
Basics:
T score:
An 28-year-old man is investigated for recurrent lower back pain. A diagnosis of ankylosing spondylitis is suspected.
Which one of the following investigations is most useful?
Correct Answer B: X-ray of the sacro-iliac joints is the most useful investigation for diagnosis and monitoring, but changes may not be seen for many years after the onset of symptoms.
Ankylosing spondylitis: investigation and management:
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 5:1) aged 20-30 years old.
Investigation:
1- Inflammatory markers (ESR, CRP) are typically raised although normal levels do not exclude ankylosing spondylitis.
2- HLA-B27 is of little use in making the diagnosis as it is positive in:
3- Plain x-ray of the sacroiliac joints is the most useful investigation in establishing the diagnosis.
Radiographs may be normal early in disease, later changes include:
4- Spirometry may show a restrictive defect due to a combination of pulmonary fibrosis, kyphosis and ankylosis of the costovertebral joints.
Management:
Early diagnosis is now more important following the advent of anti-TNF therapy:
Which one of the following conditions is least associated with HLA-B27?
Correct Answer D: There is an indirect association between HLA-B27 and Crohn's as some patients may develop enteropathic arthritis, but this is the least common association of the above.
Seronegative spondyloarthropathies:
Common features:
Spondyloarthropathies:
You are doing the annual review of a 50-year-old woman who has rheumatoid arthritis.
Which one of the following complications is most likely to occur as a result of her disease?
Correct Answer E: Rheumatoid arthritis: patients have an increased risk of IHD.
Rheumatoid arthritis: complications:
A wide variety of extra-articular complications occur in patients with rheumatoid arthritis (RA):
Less common:
A 54-year-old male presents with weakness of his upper arms. On examination he is found to have a macular rash over his back and the extensor aspects of his upper arms. He is a heavy smoker and his sodium is 121 mmol/l.
What is the most likely underlying diagnosis?
Correct Answer D: This man may have an underlying small cell lung cancer causing Syndrome of Inappropriate Antidiuretic Hormone Secretion.
Dermatomyositis: Overview:
Skin features:
Other features:
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