HANDBOOK

Question 1

It may be the first manifestation of chronic liver disease, as might occur with chronic hepatitis B or C infection

Answer 1

SLE, systemic lupus erythematosus

Question 2

splenomegaly and thrombocytopenia as a consequence of hypersplenism. It may be the first manifestation of chronic liver disease, as might occur with chronic hepatitis B or C infection

Answer 2

SLE, systemic lupus erythematosus

Question 3

Bruising would also be consistent with this diagnosis, but physical examination would be expected to show signs of chronic liver disease.

Answer 3

SLE, systemic lupus erythematosus

Question 4

The clinical features, particularly severe pain on passive finger extension, are classical of ?

Answer 4

flexor tendon sheath tenosynovitis

Question 5

The proximal interphalangeal flexor crease of the finger is precisely over the proximal interphalangeal joint line as illustrated, and the skin crease is at the site of binding of the deeper layer of the skin to the underlying flexor tendon sheath

Answer 5

flexor tendon sheath tenosynovitis

Question 6

Puncture wounds at this site are particularly prone to involve the underlying sheath and to introduce infection, usually staphylococcal or streptococcal.

Answer 6

flexor tendon sheath tenosynovitis

Question 7

The midpalmar space is a potential fascial space in the palm behind the flexor tendon sheaths to middle, ring, and little fingers, and is not relevant to this situation

Answer 7

flexor tendon sheath tenosynovitis

Question 8

Celulitis is infection of subcutaneous fatty soft tissues - the important diagnosis here is not cellulitis but a?

Answer 8

flexor tendon sheath tenosynovitis

Question 9

Osteomyelitis of the proximal phalanx would need to have spread from primary infective suppurative arthritis of the interphalangeal joint, with more focal signs of sepsis over the joint and the bone

Answer 9

flexor tendon sheath tenosynovitis

Question 10

_______________ in the finger refers to a variant of subcutaneous finger pulp infection, in which a relatively small superficial abscess in the dermis communicates with a much larger abscess in the subdermal distal finger pulp

Answer 10

Collar stud’ abscess

flexor tendon sheath tenosynovitis

Question 11

Resolution is delayed if the deeper abscess is not recognised and also drained.

Answer 11

Collar stud’ abscess

flexor tendon sheath tenosynovitis

Question 12

This vignette addresses the potential causes of a raised jugular venous pressure (JVP) in the absence of cardiomegaly, as reflected in non-displacement of the cardiac apex beat

Answer 12

Cardiac dilatation

Question 13

Mitral regurgitation is the only one of the five options which, with disease progression, invariably causes cardiac dilatation

Answer 13

Cardiac dilatation

Question 14

____________ occurs well in advance of secondary pulmonary hypertension and development of a raised JVP

Answer 14

Cardiac dilatation

Question 15

The JVP can be elevated without cardiomegaly in each of the other options

Answer 15

Cardiac dilatation

Question 16

Elevation of the JVP is one of the cardinal signs to look for in the cardiovascular examination

Answer 16

Cardiac dilatation

Question 17

When a subject is sitting at 45 degrees, the JVP is normally less than 3cm above the angle of the sternum and thus is not visible above the clavicle

Answer 17

Cardiac dilatation

Question 18

The JVP can be visualised by positioning the subject in a more supine position and also by increasing the transmitted venous pressure by pressing over the right hypochondrium and the liver

Answer 18

Cardiac dilatation

Question 19

In a dehydrated volume-depleted patient the JVP may not be seen even in the supine position.

Answer 19

Cardiac dilatation