Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Save to My Library
Look up keyword
Like this
4Activity
0 of .
Results for:
No results containing your search query
P. 1
Rheumatology 2013 passmedicine.pdf

Rheumatology 2013 passmedicine.pdf

Ratings:

4.5

(2)
|Views: 116,247|Likes:
Published by Moustafa ElOlimy

More info:

Published by: Moustafa ElOlimy on Mar 02, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

05/01/2014

pdf

text

original

 
Question 1 of 118
 Next
Reactive arthritis is associated with which one of the following HLA antigens?
A.
 HLA-B27
B.
 HLA-A3 
C.
 HLA-DR4 
D.
 HLA-B5 
E.
 HLA-DR3 
Next question
Reactive arthritis
 Reactive arthritis is one of the HLA-B27 associated seronegative spondyloarthropathies. It encompasses Reiter'ssyndrome, a term which described a classic triad of urethritis, conjunctivitis and arthritis following a dysentericillness during the Second World War. Later studies identified patients who developed symptoms following asexually transmitted infection (post-STI, now sometimes referred to as sexually acquired reactive arthritis,SARA).Reactive arthritis is defined as an arthritis that develops following an infection where the organism cannot berecovered from the joint.Epidemiology
 
post-STI form much more common in men (e.g. 10:1)
 
post-dysenteric form equal sex incidenceThe table below shows the organisms that are most commonly associated with reactive arthritis:
Post-dysenteric form
 
Post-STI form
 
Shigella
flexneri
Salmonella typhi
murium
Salmonella
enteritidis
Yersinia enterocolitica
 
Campylobacter 
 
Chlamydia trachomatis
 
Management
 
symptomatic: analgesia, NSAIDS, intra-articular steroids
 
sulfasalazine and methotrexate are sometimes used for persistent disease
 
symptoms rarely last more than 12 months
 
Question 2 of 118
 Next
 A 47-year-old man with a history of chronic sinusitis presents with shortness of breath to the EmergencyDepartment. Initial investigations reveal:
Hb 10.4g/dlPlatelets 477 * 10
9
 /lWCC 14.3 * 10
9
 /lESR 92 mm/hUrea 20 mmol/lCreatinine 198 µmol/lUrine dipstick blood +++
What is the most likely diagnosis?
A.
 Mixed cryoglobulinaemia 
B.
 Churg-Strauss syndrome 
C.
 Wegener's granulomatosis
D.
 Haemolytic uraemic syndrome 
E.
 Henoch-Schonlein purpura 
Next questionThe combination of pulmonary and renal involvement combined with a history of chronic sinusitis points towardsa diagnosis of Wegener's granulomatosis.
Wegener's granulomatosis
 Wegener's granulomatosis is an autoimmune condition associated with a necrotizing granulomatous vasculitis,affecting both the upper and lower respiratory tract as well as the kidneysFeatures
 
upper respiratory tract: epistaxis, sinusitis, nasal crusting
 
lower respiratory tract: dyspnoea, haemoptysis
 
glomerulonephritis ('pauci-immune', 80% of patients)
 
saddle-shape nose deformity
 
also: vasculitic rash, eye involvement (e.g. proptosis), cranial nerve lesions
 
 Investigations
 
cANCA positive in > 90%, pANCA positive in 25%
 
chest x-ray: wide variety of presentations, including cavitating lesions
 
renal biopsy: crescentic glomerulonephritisManagement
 
steroids
 
cyclophosphamide (90% response)
 
plasma exchange
 
median survival = 8-9 years

Activity (4)

You've already reviewed this. Edit your review.
1 hundred thousand reads
1 thousand reads
1 hundred reads
Santosh Parab liked this

You're Reading a Free Preview

Download
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->