Clinical exam skills: A handy sign

A 32 year old woman presented with an eight month history of being “out of sorts.” Five months before she had had an elective ear, nose, and throat procedure in a district hospital. In the months after her admission she had regularly visited her general practitioner with a number of symptoms, which included tiredness, joint pains, facial pains, and a recurrent stuffy nose. At the time of admission to hospital in addition to the above she complained of sore red eyes. On examination, there was evidence of bilateral conjunctival injection. She had tender small joints in the hands, knees, ankles, and elbows. Nail fold infarcts were also noted (fig 1). Fig 1 Nail fold infarcts 1. Describe the findings in the hands and give differential diagnoses for their cause. Computed tomography imaging taken before the previous ear, nose, and throat surgery was retrieved from the district hospital (fig 2). 2. Outline any abnormalities seen in this image. After a consultation with an ophthalmologist, anterior uveitis was confirmed. Her initial blood results (reference range) were …