Course/ Mock Exam Cases Drill
Here are some of the cases for the preparatory course/ mock exam.
Case 1: Please examine this lady's hand and tell me your findings.
Case 2: This patient has difficulty in holding objects in her hands. Please examine her.
Case 1: Please examine this lady's hand and tell me your findings.
Case 2: This patient has difficulty in holding objects in her hands. Please examine her.
Labels: Station 5
posted by Axonopathic @ 10/12/2007 06:13:00 PM
16 Comments:
irst patient has symmetrical deforming polyarthropathy with multiple chronic topaceous gout leading to disuse atrophy as evident by wasting of small muscles of the hand specially the dorsal interossei. function of the hand is limited because of the deformities
2nd patient ahs bony swellings of the distal interphalangeal joint of the left hand calles ad herbedens nodes diagnosis of osteoarthritis in the differtial diagnosis with psoriasis as teh other diagnosis
osteoarthritis involving distal interphalyngeal joints left greater than right
case 1 is classical gouty tophi
Jaccoud arthrorpathy, as evidenced by the deforming arthropathy affecting the MCP joints but can be corrected voluntarily.
Proceed to look for signs of SLE and rheumatic fever.
1rst patient has deforming polyarthropathy with multiple topaceous gout and reduced function of the hand and also wasting of the small muscles because of disuse atrophy specially of the introssie
2nd patient has bony swellings of the distal interphalngeal joints of the right hand and the little finger of thr right hand probably herbedens nodes
Haha...I just realised that there are two pairs of hands, belonging to two different patients.
So clearly not Jaccoud.
Which reemphasized the importance of reading the instructions carefully before jumping in to examine the patients
the first patient has chronic topaceous gout
the second pt has rheumatoid arthritis as evidenced by swan neck and ulnar deviation
OA in view of herbeden nodes with
possible left ulnar palsy as evident by loss of hypothenar eminence as well as atrophic 4th 5th finger.
2nd hand is it Osteoarthritis or rhemataoid arthritis please whats the answer
Case 1: Chronic tophaceous gout
Case 2: Primary osteoarthritis
Straight-forward cases as in the real PACES :)
One of my colleagues took the mock exam and saw the 2nd case. He was speechless when asked about the possible differential diagnoses for OA. We shouldn't be taken aback by such question as all!
After all, this is what we physicians are trained to be :)
Differential diagnosis of OA:
Psoriatic arthropathy affecting DIPs
Non-classical presentation of RA
Chronic gout
HLA-B27 spondyloarthropathies but will have evidence of other disease process
Infective arthritis
Anonymous: Good differentials. Nicely done :)
As a general rule of thumb, we should have at least 5 causes or differentials for every condition. :D
Well, RA spares distal PIP. And as such should not be one of the differentials. HLA B27 disease is a bit far fetched. I am of opinion not to give such differentials as we may be digging grave for ourselves. Adequate to give psoriatic arthropathy and chronic tophaceous gout I feel.
Case 1: complete joint destruction with juxta athricular nodes and gross wasting of the small muscles of the hands.My differentials are rheumathoid athritis and chroinic typhiceous gouty arthritis.
Case 2: the hands shows swan neck deformity of the left middle and fouth fingers and swelling of the MCPJ.Them showed erythema.this patient has RA.
Yes I agree that to offer good differentials, it's really depend on the specific case that you're dealing with.
RA TYPICALLY spares DIP jt.
Mention the more likely differentials in front, then offer the least likely at the end if you're being pushed.
And to the comment by anonymous right before me. Nope, the diagnosis for case 1 is not RA. And i think you should put chronic tophaceous gout as the 1st diagnosis in case 1.
Regards,
Axonopathic
ist case chronic tophaceous gout with chronic renal failure as long term complication of renal urate stones.The evidense of renal failure is ecchymosis with distal gray discoloration of nails{half moon sign}
2nd case primary nodular OA ,heberden nodules at distal phalanges.
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