This Week’s EMCQs – Week 2

QUESTION 1

A 67-year-old man presents to Emergency Department for consultation regarding increasing swelling in both his hands. He has painful swelling and stiffness of his hands for the last few months. His symptoms have worsened in the last few days.

A photograph of his hands is attached below:

hands

Which one of the following is the most likely diagnosis of this patient?

A: Osteoarthritis

B: Psoriatic arthritis

C: Rheumatoid arthritis

D: Scleroderma

A: Osteoarthritis

B: Psoriatic arthritis (Correct answer)

C: Rheumatoid arthritis

D: Scleroderma

Commentary

Stiffness, swelling, and pain are symptoms common to all forms of arthritis, and sometimes it can be difficult to determine which type of arthritis a patient has.

Findings classic for Psoriatic arthritis include:

  • Diffusely swollen finger—sausage digit—especially the middle joint in the finger (PIP joint).
  • Pitting, ridging, or crumbly appearance of nails.
  • Deformity at the end joint (DIP) of the finger.
  • Dry, red, scaly skin patches which can occur anywhere, including the earlobe and hairline.

QUESTION 2

During the management of a patient with severe hypothermia, the patient is found to have atrial fibrillation.

Which one of the following statements is CORRECT regarding the management of the above patient?

A: Slow AF is benign rhythm and require no chemical or electrical correction

B: Synchronised DC cardio version is safe and effective for this arrhythmia

C: Correct electrolyte abnormality should take priority to treatment of this patient

D: Treating his irregular heart rate should be a treatment priority

A: Slow AF is benign rhythm and require no chemical or electrical correction (Correct answer)

B: Synchronised DC cardio version is safe and effective for this arrhythmia

C: Correct electrolyte abnormality should take priority to treatment of this patient

D: Treating his irregular heart rate should be a treatment priority

Commentary

Slow AF is a benign rhythm in severe hypothermia and it usually resolves spontaneously after rewarming. Treatment priority should be rewarming and to avoid/limit unnecessary stimulation. Reference: Textbook of adult emergency medicine, Cameron P et al, 4th edition. Page 919.