Scenario
A 54 year old woman presents to the ED with three days of painful swelling in her left wrist and hand.
Question
Describe and interpret this woman’s photograph. (100%)
Answer
FACEM VAQ Exam 2006.1 – Question 7
- Overall pass rate for this question was 28/40 (70%).
- The clinical photograph given shows an inflamed left hand and forearm with a deforming bilateral polyarthropathy
- The examiners expected that the description would include the features of rheumatoid arthritis shown, the presence of vasculitic lesions on the fingers of the right hand, swelling and erythema of the left hand with a scar/healing wound on the same forearm.
- Tying this together in the interpretation meant this was probably cellulitis and/or joint/bone infection in the setting of rheumatoid arthritis.
- Relative immune compromise related to the disease or its treatment was likely to be a complicating factor.
- Failures were usually due to an inability to interpret this as rheumatoid arthritis.
About Mike Cadogan
