WBR0407

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::27 year old male presents to the office with several day history of multiple joint pains. He says he has been having pain for the past 4 months and it is progressively getting worse. His pains are more prominent on shoulders, elbows and lower back with no improvement on rest but feels better with exercise. His past medical history is significant for a motor vehicle accident, but did not have any serious complications except for abrasions at back. He is a chronic smoker and alcoholic. He is sexually active and does not use condoms. He has no recent travel outside the country and has no allergies. Physical examinations show mild swelling in the both shoulder and elbow joints. Mild shoulder and hip joint tenderness is present. Shoulder movements are restricted. Forward flexing movements of spine is restricted but lateral flexion is normal. No rash is present. Which of the following is the patient more prone to develop?]]
Answer A	AnswerA::Acute unilateral eye pain
Answer A Explanation	[[AnswerAExp::Correct : Unilateral uveitis is the most common extraarticular complication of AS, occurring in 25 to 40 percent of patients. There is no correlation between the activity and severity of the eye disease and those of the articular disease. Uveitis presents as acute unilateral pain, photophobia, and blurring of vision. Patients should be immediately referred to an ophthalmologist to verify the diagnosis by slit lamp examination and to receive treatment to prevent complications.]]
Answer B	AnswerB::Impotence
Answer B Explanation	[[AnswerBExp::Incorrect : The cauda equina syndrome is a rare complication reported in patients with longstanding disease who have marked ankylosis of the spine. The symptoms are those of damage to the lumbosacral nerve roots, probably caused by arachnoiditis. Patients may complain of abnormalities in cutaneous sensation and motor function and impotence.]]
Answer C	AnswerC::Loss of bowel and bladder control
Answer C Explanation	[[AnswerCExp::Incorrect : The cauda equina syndrome is a rare complication reported in patients with longstanding disease who have marked ankylosis of the spine. The symptoms are those of damage to the lumbosacral nerve roots causing loss of bowel and bladder control.]]
Answer D	AnswerD::Abdominal pain and bloody stools
Answer D Explanation	[[AnswerDExp::Incorrect : Ileal and colonic mucosal ulcerations, which are almost always asymptomatic, can be detected by endoscopy in 50 to 60 percent of patients with AS. Very rarely they progress to clinically apparent inflammatory bowel disease (ulcerative colitis or Crohn's disease) causing abdominal pain and bloody diarrhea.]]
Answer E	AnswerE::Breathing difficulty
Answer E Explanation	AnswerEExp::'''Incorrect''' : Many patients with AS have restrictions in chest expansion due to costovertebral rigidity. Due to lung fibrosis, chest X-rays may show apical fibrosis while pulmonary function testing may reveal a restrictive lung defect.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Ankylosing spondylitis is a chronic, painful, degenerative inflammatory arthritis primarily affecting the spine and sacroiliac joints, causing eventual fusion of the spine. It is a member of the group of the autoimmune spondyloarthropathies with a probable genetic predisposition. Complete fusion results in a condition known as bamboo spine, which is a complete rigidity of the spine. It characteristically affects young adults with a peak age of onset between 20 and 30 years. Although classically thought of as a spinal disease, however hips, shoulders, peripheral joints, and even the temporomandibular joints can be involved. In addition, extra-articular organs, such as the eyes, lungs, and heart, can be affected. Organs affected by AS, other than the axial spine and other joints, are commonly the heart, lungs, colon, and kidney. Other complications are aortic regurgitation, Achilles tendinitis, AV node block and amyloidosis. Educational Objective: References: ]]
Approved	Approved::Yes
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