Macleod's III

Question 1

Which conditions are linked to human leucocyte antigen HLA B27?

Answer 1

Reactive arthritis, Ankylosing spondylitis, psoriatic arthritis (in some forms), and enteropathic arthritis such as those a/w ulcerative colitis and Crohn’s

Question 2

What is Gower’s sign?

Answer 2

It is a sign of proximal muscle weakness. seen in Duchenne Muscular dystrophy

Question 3

Define Valgus and Varus

Answer 3

Valgus is when the distal part of the limb deviates away from the midline.
Varus is when the distal part of the limb deviates towards the midline.

Question 4

What is the typical progression of colour changes in Raynaud’s phenomenon?

Answer 4

blanching (white) followed by cyanosis (blue), and reactive hyperaemia (red)

Question 5

Raynaud’s phenomenon is a frequent feature in which conditions?

Answer 5

Systemic sclerosis, SLE systemic lupus erythematous, Rheumatoid arthritis, and Sjogren’s syndrome

Question 6

What are small, dark red vasculitic spots present on the skin due to? What are they indicative of?

Answer 6

Small, dark red vasculitic spots can be due to capillary infarcts. They are indicative of active disease

Question 7

Where are the common sites of petechiae?

Answer 7

Nail folds, finger and toe tips and other pressure areas/

Question 8

What are the signs of systemic sclerosis?

Answer 8

In systemic sclerosis, the thickened tight skin produces a characteristic facial appearance: ‘beaking’ of the nose and tight skin around the mouth.
In the hands, flexion cotractures.
Calcium deposits in the finger pulps and tissue ischaemia leading to ulceration.
The telengiectasias of systemic sclerosis are purplish and blanch with pressure. Most are found on the hands and face.

Question 9

Where does subcutaneous nodules in rheumatoid arthritis commonly occur in?

Answer 9

Subcutaneous nodules in rheumatoid arthritis most commonly occur on the extensor surface of the forearm, and other sites of pressure or friction, such as the sacrum or Achilles tendon.

Question 10

Describe the nodules in rheumatoid arthritis as compared to in osteoarthritis

Answer 10

Bony nodules in osteoarthritis affects the hand and are smaller and harder than rheumatoid arthritis

Question 11

What are gouty tophi?

Answer 11

Gouty tophi are firm white irregular subutaneous crystal collection (monosodium urate monohydrate)

Question 12

What are the complications of gouty tophi?

Answer 12

In gouty tophi, the overlying skin may ulcerate, discharge crystals and become secondarily infected.

Question 13

Why is the Schirmer’s tear test done?

Answer 13

The Schirmer tear test helps to diagnose keratoconjunctivitis sicca.

Question 14

What is keratoconjunctivitis sicca? What can keratoconjunctivitis sicca lead to?

Answer 14

Keratoconjunctivitis sicca is dry eye syndrome.

It can lead to conjunctivitis and blepharitis.

Question 15

What is blepharitis?

Answer 15

Inflammation of the eyelids

Question 16

In which condition does keratoconjunctivitis sicca occur in?

Answer 16

It occurs in Sjogren’s sundrome and as secondary changes in rheumatoid arthritis and other connective tissue disorder

Question 17

In which conditions are there scleritis or episcleritis?

Answer 17

Scleritis and Episcleritis are found in psoriatic arthritis and rheumatoid arthritis.

Question 18

In which conditions are anterior uveitis (iritis) present?

Answer 18

Anterior uveitis is seen in ankylosing spondylitis, and reactive arthritis

Question 19

What is the GALS screen?

Answer 19

Gait, arms, legs and spine. It is a rapid screen for musculoskeletal and neurological deficits, and functional ability.

Question 20

What conditions is Thomas’s test used to rule out?

Answer 20

hip flexion contracture and psoas syndrome

Question 21

What is hypermobility? Which conditions will present with hypermobility?

Answer 21

Hypermobility refers to increased range of joint movement.

Ehlers-Danlos syndrome and Marfan’s syndrome causes hypermobility.