ReA Exam

Question 1

Hx 1

Answer 1

• triggered following infections (enteric or urogenital/STI)
• Symptoms:
• 1-3/52 post infection
• acute or insidious onset
• disappear in most patients 3-4/12 post onset
• Signs:
• may go unnnoticed
• transient over weeks / months
• Joint inflammation & associated SSx reccur over years (50% Pt)
• For most Pts:
• generally no permanent disability
• recovery within 1y -> but can potentially become chronic
• note differing clinical picture btw Pts (not all SSx in all Pts)

Question 2

Systemic Manifesations

Answer 2

• Usually mild
• Malaise
• Low Grade Fever
• Myalgia (early)

Question 3

UTI / Urethritis- Male Pt

Answer 3

• common
• Urinary urgency (= a sudden, compelling urge to urinate);
• Incontinence
• Urethral discharge
• Burning or stinging on urination
• Urinary hesitancy (difficulty in beginning the flow of urine)
• Dull pelvic ache

Question 4

UTI / Cystitis- Male Pt

Answer 4

• frequent urination (8x in 24h)
• dull aching pain in the pelvic region
• burning sensation when urinating
• fever

Question 5

UTI / Prostatitis- Male Pt

Answer 5

• less common
• fever / chills
• urinary frequency (8x in 24h)
• burning sensation when urinating
• prostate tenderness (80%)

Question 6

UTI- Female Pt

Answer 6

• often asymptomatic
• Cervicitis
• Manifestations of Urethritis
• Manifestations of Cystitis (more common)
• Manifestations of salpingitis
• Manifestations of vulvovaginitis (inflammation of the vulva and vagina) (uncommon)

Question 7

Occular Manifestation- Conjunctivits

Answer 7

• common
• mild conjunctivitis (50% UTI / 75% enteric)
• appears within 2-3/52 onset of arthritis
• resolves within 10/7
• pink, itchy eye
• discharge
• burning pain

Question 8

Occular Manifestation- Uveivits

Answer 8

• less common
• red eye
• blurred vision
• eye pain
• photophobia

Question 9

MSK Manifestations- Enesthesopathy

Answer 9

• Muscle aching (enthesitis)
• Heel pain (2ary to enthesopathy; common);
• heel spurs (less common);
• plantar fasciitis
• Achilles tendon pain (2ary to enthesopathy)
• Costochondritis

Question 10

MSK Manifestations- Arthritis

Answer 10

• common
• mld-severe
• Joint pain, heat, swelling & stiffness:
• Asymmetric, oligoarthritis ie a few joints are usually affected at once
• Affects mainly LEX
• Common: large joints (knee, ankle); toe joints
• Uncommon: wrists, fingers etc
• LBP (spondylitis; and asymmetric sacroiliitis)
• Sausage fingers/toes caused by uniform inflammation & enthesopathy
• Spondylitis or sacroiliitis (less common)

Question 11

Mucous Membrane Manifestation

Answer 11

• Less common
• Small, painless ulcers on the soft palate & tongue;
• Balanitis circinata: small, shallow, painless sores or rash on the glans penis (20-40% of ♂)

Question 12

Cutaneous Manifestations

Answer 12

• Less common
• Skin lesions on the soles and palms (may resemble psoriasis)
• Keratoderma blennorrhagica (uncommon): rashes of small hard, nodules on the soles of the feet, and less often on the palms of the hands or elsewhere.
• Skin redness or inflammation

Question 13

Cardiac Manifestations

Answer 13

• Valvular Lesions (esp. in progressed Dz -> aortic regurgitation)
• pericarditis

Question 14

GIT Manifestations

Answer 14

• Dysentery

- recurrent abdo complaints after precipitating bout of diarrhoea