PMDM Exam

Question 1

Hx 1

Answer 1

• DM has all SSx of PM with skin manifestations added
• F>M, 5-15yo / 40-60yo
• Dz association with neoplasm and increased Ca risk (esp. with DM)
• SSx onset preceded by acute infection
• onset acute in children
• onset insidious in adults

Question 2

SSx- Systemic

Answer 2

• low grade fever
• fatigue
• LoW

Question 3

SSx- MSK

Answer 3

• affects proximal girdle Mm
• weakness
• symmetrical
• Mm pain / ache / tenderness

Question 4

SSx- Viscera

Answer 4

• Pharynx & upper esophagus:
• affects swallowing,
• predisposing to aspiration
• Lungs:
• interstitial pneumonitis:
• dyspnea and cough
• Heart:
• arrhythmias
• GIT:
• haematemesis
• melena
• ischaemic bowel perforation

Question 5

SSx- Skin 1 (in DM)

Answer 5

• in DM Pts only!
• Rash:
• often = the first manifestation;
• may be pruritic dusky (bluish-purple) and erythematous
• slightly elevated patches
• smooth or scaly
• Distribution:
• forehead
• V of the neck and shoulders
• forearms and lower legs
• radiodorsal surface of PIP’s & MCP’s
• chest and back
• elbows and knees
• medial malleoli
• Gottron’s papules :
• Slightly elevated, violaceous papules & plaques, occurring over bony prominences
• pathognomonic

Question 6

SSx- Skin 2 (in DM)

Answer 6

• Periorbital edema + heliotrope (purplish) rash on eyelids;
• pathognomonic for DM
• Desquamating dermatitis with splitting of the skin over the radial aspects of the fingers
• Subcutaneous calcification (calcinosis): esp. in children; presents as hard lumps
• Raynaud’s syndrome: occurs in response to cold or emotional upset
• The primary skin lesions frequently fade completely but may be followed by 2ary changes:
• brownish pigmentation
• atrophy
• scarring
• vitiligo

Question 7

SSx- Nails (in DM)

Answer 7

• The base and sides of the fingernails red or thickened

* telangiectases in proximal nail fold

Question 8

SSx- Articular

Answer 8

• Mild arthralgia & inflammation (30%)

* Small joints of the hands are the most frequently involved