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Pleural Effusion
Valvular Disease
Chronic Liver Disease
Hepatomegaly
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Motor Neuron Disease
Multiple Sclerosis
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Peripheral Neuropathy
Ankylosing Spondylitis
Psoriasis
Rheumatoid Arthritis
Systemc Sclerosis
Acromegaly
Cushing's Disease
Goitre
Thyroid Status
Clubbing
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Systemic Sclerosis
Incidental findings
Raynaud's
Signs
Tight, shiny skin fingers, sclerodactyly, calcinosis, telangiectasia
Differential diagnosis
CREST
Function
Hand function
Tests
FBC, CXR
Anticentromere, Anti Scl-70
Extensions
Examine chest for fibrosis, pulmonary hypertension
Assess hand function
Ask patient to open mouth wide
Systemic sclerosis questions
Do you have any difficulty with swallowing
Do your fingers change colour in the cold
Dry eyes/mouth (associated sjogren's)
Raynauds questions
Do your fingers change colour in the cold
What colour do they go, is there a particular sequence (white/blue/red)
How long have you had this problem
What is your job; does it involve vibrating tools
Notes
CREST: Calcinosis, raynauds, esophageal dysmotility, sclerodactyly and telangiectasia. More favourable prognosis than systemic sclerosis; anti-centromere antibody.
Limited cutaneous scleroderma = only extremities (10y survival 71%), diffuse cutaneous scleroderma = trunk and extremities (10y survival 21%).
Rx: symptomatic / immunosupression (cyclophosphamide, methotrexate). No role for steroids.
Copyright PassMED, 2008.
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