color atlas 2000 - medfreecon.files.wordpress.com · b1. cushing’s syndrome note moon face,...

COLOUR ATLASGolyar Keyhan and Sophie Sun, editors

Deborah Cheng, associate editor

SECTION A: DERMATOLOGY . . . . . . . . . . . . . . . . . . 2Stasis Dermatitis Contact DermatitisAtopic Dermatitis Seborrheic DermatitisAcne Vulgaris Acne Rosacea Psoriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Seborrheic KeratosisOnychomycosis Tinea CapitisEpidermal Cyst Alopecia AreataVitiligo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Toxic Epidermal Necrolysis Erythema Nodosum Erythema MultiformeSquamous Cell CarcinomaKeratoacanthomaActinic Keratosis. . . . . . . . . . Kaposi's Sarcoma . . . . 5Basal Cell Carcinoma Benign Compound Nevus Malignant MelanomaSECTION B: ENDOCRINOLOGY . . . . . . . . . . . . . . . . 6Cushing’s Syndrome Grave’s DiseasePretibial Myxedema AcromegalyNecrobiosis LipoidicaSECTION C: GASTROENTEROLOGY . . . . . . . . . . . . 7Small Bowel Obstruction Bowel PerforationDiverticular Disease Crohn's Disease Ulcerative Colitis Colon CarcinomaPancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Esophageal Varices Peptic Ulcer DiseaseColon CarcinomaSECTION D: GYNECOLOGYEndometriosis Ovarian Teratoma. . . . . . . . . . .Adenomyosis . . . . . . . 9Leiomyoma Cervical LesionCondyloma Acuminata EctropionSECTION E: HEMATOLOGY. . . . . . . . . . . . . . . . . . . . 10Iron Deficiency Anemia Hemolytic Anemia Megaloblastic AnemiaAutoimmune Hemolytic AnemiaSickle Cell AnemiaMicroangiopathic Hemolytic AnemiaAcute Myelogenous Leukemia . . . . . . . . . . . . . . . . . .11Chronic Lymphocytic LeukemiaChronic Myelogenous LeukemiaPlasma Cell MyelomaAcute Lymphocytic LeukemiaMultiple Myeloma (Bone Marrow)Hodgkin's Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . .12MyelofibrosisMononucleosis Hereditary SpherocytosisSECTION F: INFECTIOUS DISEASES. . . . . . . . . . . 12Meningococcemia ScabiesMolluscum Contagiosum . . . . Verruca Vulgaris . . . . .13Impetigo Pityriasis RoseaPityriasis Versicolor ErysipelasHerpes Zoster . . . . . . . . . . . . Candidiasis . . . . . . . .14Primary Syphilis Herpes SimplexSecondary Syphilis Tinea Corporis

MCCQE 2000 Review Notes and Lecture Series Colour Atlas 1

SECTION G: NEUROLOGY. . . . . . . . . . . . . . . . . . . . . . 15Hydrocephalus Intracranial MassEpidural Hemorrhage Subarachnoid HemorrhageAcute Subdural Hemorrhage Chronic Subdural HemorrhageSECTION H: OPHTHALMOLOGY . . . . . . . . . . . . . . 16Dacryocystitis Corneal LacerationHerpes Simplex IritisForeign Body Endophthalmitis Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17PterygiumCentral Retinal Artery OcclusionCentral Retinal Vein OcclusionPapilledema Optic AtrophyProliferative Diabetic Retinopathy . . . . . . . . . . . . . . . 18Retinal Detachment Cytomegalovirus RetinitisGlaucomaSECTION I: OTOLARYNGOLOGYBell’s Palsy Exudative TonsillitisThyroglossal Duct Cyst . . . . . . . . . . . . . . . . . . . . . . . . 19Branchial Cleft CystAcute Otitis Media Serous Otitis Media Cholesteatoma Perforated Tympanic MembraneMaxillary Sinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Tympanostomy TubeSECTION J: PEDIATRICSChicken Pox RoseolaCroup EpiglottitisScarlet Fever . . . . . . . . . . . . . Foreign Body . . . . . . . . 21SECTION K: RESPIROLOGYInterstitial Disease Airspace DiseaseCongestive Heart Failure (PA and Lateral)Wegener's Granulomatosis . . . . . . . . . . . . . . . . . . . . . 22Active Tuberculosis Bronchial CarcinomaPneumothorax Pneumocystis carinii Pneumonia Bacterial PneumoniaEmphysema (PA and Lateral). . . . . . . . . . . . . . . . . . . . 23SECTION L: RHEUMATOLOGYSystemic Lupus ErythematosusDermatomyositis (Face) Discoid Lupus ErythematosusDermatomyositis (Hands)Acute Gouty Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . 24Acute Gout: Monosodium Urate CrystalsVasculitis Scleroderma (Hands)SECTION M: UROLOGYUreteric CalculusUreteric Obstruction

Colour Atlas 2 MCCQE 2000 Review Notes and Lecture Series

SECTION A: DERMATOLOGY

A2. ContactDermatitis

Sharply demarcated,weeping and crustingpapules and vesicles.

A1. Stasis DermatitisErythematous scalingpatches on lower legs. Maysee hyperpigmentation,swelling, and ulceration. (Courtesy Dr. L. From)

A4. SeborrheicDermatitis

Diffuse withinscalp margin,

greasy yellow-white

scales and underlyingerythema.

A3. Atopic Dermatitis Excoriated, lichenified plaques with erythema,dryness, and crusting.

A6. Acne RosaceaProminent facial erythema, telangiectasia, rhinophyma, and scattered papules.(Courtesy Dr. L. From)

A5. Acne VulgarisInflammatory papules, pustules, and open comedones.


SECTION A: DERMATOLOGY . . . CONT.

A7. PsoriasisDry, well-circumscribed, silvery scaling papules andplaques. (Courtesy Dr. L. From)

A9. OnychomycosisDistal onycholysis, nail pitting, and subungual hyperkeratosis.

A10. Tinea CapitisDiffuse area of mild scaling and hair loss with folliclespresent and occasionally erythema and pyoderma.

A8. Seborrheic KeratosisWell-demarcated, waxy, brownish-black or tanpapules/plaques; warty and "stuck-on" appearance.

A11. Epidermal CystRound, firm, yellow/flesh coloured, mobile nodule; mayobserve a follicular punctum on the overlying epidermalsurface.

A12.Alopecia

AreataSharply

demarcatedcircular patch

of scalp completely

devoid of hair.



A13. VitiligoTypical acral distributionshowing cutaneous depigmentation due to an acquired loss ofmelanocytes.

A15. Erythema NodosumTender, poorly demarcated, deep-seated nodules and plaques usually on lower extremities. (Courtesy Dr. M. Mian)

A16. Erythema MultiformeMacules/papules with central concentric rings. (Courtesy of Women’sCollege Hospital Slide Library, Toronto)

A14. ToxicEpidermalNecrolysis Widespread

necrosis withpainful blisteringand denuding of

epidermis.

A18. KeratoacanthomaBenign squamous

exophytic nodule with central keratin-filled crater.

A17. Squamous CellCarcinomaIndurated erythematousnodule or plaque withhyperkeratotic surfacescale/crust and ulceration.



A19. Actinic KeratosisHyperkeratotic, erythematous, slightly elevated, flat-surfaced papules and patches on sun-exposedskin. (Courtesy Dr. C. Forrest)

A20. Kaposi’s SarcomaBluish-red cutaneous nodules on the lower extremity. (Courtesy Dr. J. Murray)

A21. Basal Cell CarcinomaSkin-coloured papule or plaque with rolled, translucent/pearly,telangiectatic outer border.

A22. Benign Compound NevusProliferation of nevomelanocytes characterizedby hyperpigmented macules or papules of regular shape and uniform colour.

A23. Malignant Melanoma Superficial spreading lesion characterized byasymmetrical irregular border, variegated colour,and diameter greater than 0.6 mm.


SECTION B: ENDOCRINOLOGY

B1. Cushing’s SyndromeNote moon face, plethora, truncalobesity, and thinning of extremeties.(Courtesy Dr. W. Singer)

B3. Pretibial MyxedemaWaxy infiltrative plaques and edema, consistentwith infiltrative dermopathy of Grave’s disease.(Courtesy Dr. W. Singer)

B4. AcromegalyBroad nose, thick skin, deep skincreases, skin tags, and generalcoarse features.(Courtesy Dr. W. Singer)

B5. NecrobiosisLipoidicaErythematous papulesor nodules formingshiny/waxy, yellow-redplaques covered withtelangectatic vesselswith scaly, atrophic,and depressed centre.(Courtesy The Hospital forSick Children SlideLibrary, Toronto)

B2. Grave’s DiseaseProptosis and lid lag.(Courtesy Dr. W. Singer)


SECTION C: GASTROENTEROLOGY

C1. Small Bowel ObstructionGas in distended loops of smallbowel (note plicae circularae), ladder pattern, air-fluid levels, andcolon devoid of gas.

C2. Bowel PerforationUpright chest film showing subdiaphragmatic free air abovethe liver. (Courtesy Dr. G. Olscamp)

C3. Diverticular DiseaseMucosal and submucosal herniations though muscularlayer of bowel. (Courtesy Dr. G. Olscamp)

C6. Colon CarcinomaClassic "apple core" malignantlesion in transverse colon.(Courtesy Dr. G. Olscamp)

C5. Ulcerative ColitisColon appears like a smoothtube due to loss of haustrations;ileocecal valve widely patentwith involvement of terminalileum.

C4. Crohn's DiseaseTerminal ileitis and narrowing ofthe lumen due to mucosal ulceration, extensive thickeningand rigidity of the bowel wall.


SECTION C: GASTROENTEROLOGY . . . CONT.

ENDOSCOPY

SECTION D: GYNECOLOGY

D1. EndometriosisUterus with hemorrhagic fibrovascular adhesions on itsserosal surface. (Courtesy Dr. I. Zbeiranowski, Women’sCollege Hospital, Toronto)

D2. Endometriosis Laporoscopic viewBrownish-black implant on the uterosacral ligament.(Courtesy Dr. R. Pittini)

C9. Peptic Ulcer Disease(Courtesy Dr. G. Kandel)

C10. Colon Carcinoma (Courtesy Dr. G. Kandel)

C8. Esophageal Varices (Courtesy Dr. G. Kandel)

C7. PancreatitisMottled calcification in left upperquadrant suggestive of chronicpancreatitis. Note right-sidedpleural effusion.


SECTION D: GYNECOLOGY . . . CONT.

D3. Ovarian TeratomaGross appearance of an ovary witha mature cystic teratoma. (CourtesyDr. I. Zbeiranowski, Women’s CollegeHospital, Toronto)

D4. AdenomyosisMicroscopic endometrial stromaand glands present deep withinmyometrium. (Courtesy Dr. I. Zbeiranowski, Women’s College Hospital, Toronto)

D5. LeiomyomaTop: Uterus with multiple leiomyomas. Bottom: Microscopicview showing proliferative smoothmuscle cells. (Courtesy Dr. I. Zbeiranowski, Women’sCollege Hospital, Toronto)

D6. Cervical LesionTop: Low-grade squamous intra-epithelial lesion stained withacetic acid. Bottom: Invasive cervical cancer. (Courtesy Dr. G. Likrish)

D7. Condyloma Acuminata(“genital warts”) View of thecervix. Range from pinheadpapules to soft cauliflower-like, skin coloured masses in clusters;associated with HPV.(Courtesy Dr. W. Chapman)

D8. EctropionEversion of cervical canal, withcolumnar epithelium farther outsidethe external os of the cervix.(Courtesy Dr. G. Likrish)


SECTION E: HEMATOLOGY

E1. Iron Deficiency AnemiaMicrocytosis and hypochromia of red blood cells. Note increased area of central pallor.

E3A. MegaloblasticAnemiaOval macrocytes.

E3B. Hypersegmented

Neutrophils

E5. Sickle Cell AnemiaElongated, crescent-shaped and sickle red blood cells.Also note target cells and Howell-Jolly body (both due toautosplenectomy secondary to repeated splenic infarcts).(Courtesy Dr. M. Reis)

E2. Hemolytic AnemiaMacrocytes and microspherocytes with polychromasia(purplish tinge).

E4. Autoimmune Hemolytic AnemiaAgglutination of red blood cells.

E6. Microangiopathic Hemolytic AnemiaFragmented red blood cells (schistocytes). Note helmet cell and triangle-shaped cell in bottomright field.


SECTION E: HEMATOLOGY . . . CONT.

HAEMATOLOGIC MALIGNANCIES

E7. Acute Myelogenous LeukemiaNote blast cell with Auer rod.

E8. Chronic Lymphocytic LeukemiaIncreased number of small, well-differentiated lymphocytes. Note "smudge cells."

E9. Chronic Myelogenous LeukemiaIncreased numbers of granulocytes and their precursors. Note most WBCs are band forms or segmented granulocytes.

E10. Plasma Cell MyelomaNote "rouleaux."

E11. Acute Lymphoblastic LeukemiaRound or convoluted nuclei, absence of cytoplasmic granules, and high nuclear:cytoplasmic ratio. (Courtesy Dr. D. Sutton)

E12. Multiple Myeloma (Bone Marrow)Plasma cells in marrow. Note binucleate malignantplasma cell right of center field.


SECTION F: INFECTIOUS DISEASES

F2. ScabiesSmall crusted papules, eczematous plaques, intensepruritus and excoriations, and superficial linear burrows.

F1. MeningococcemiaHemorrhagic papules or petechia with purpuric centresin acral distribution.(Courtesy The Hospital for Sick Children Slide Library, Toronto)

E13. Hodgkin's Lymphoma (Lymph Node)Reed-Sternberg cell is large and bilobed or binucleate. Prominent within the mirror-image nucleiare giant inclusion-like nucleoli ("owl's eyes").

E15. Infectious MononucleosisReactive large, cytoplasmic lymphocytes. Noteindented cytoplasm and eccentrically placed nucleus.

E14. MyelofibrosisTear drop red blood cells (poikilocytes) in the center field. (Courtesy Dr. D. Sutton)

E16. Hereditary SpherocytosisSmall, round, densely staining red blood cells withno central area of pallor.

SECTION E: HEMATOLOGY . . . CONT.


SECTION F: INFECTIOUS DISEASES . . . CONT.

F3. Molluscum ContagiosumDiscrete, umbilicated pearly whitepapules.

F4. Verruca Vulgaris ("common warts")Multiple hyperkeratotic, elevated,discrete epithelial growths withpapillated surface.

F5. ImpetigoHoney-coloured, "stuck-on" crusts,and erythematous weeping erosions.

F6. Pityriasis RoseaMultiple round to oval erythematous patches with finecentral scale. (Courtesy Dr. L. From)

F7. Pityriasis VersicolorBrownish-white scaling macules ontrunk.

F8. ErysipelasStreptococcal infection of the superficial dermis consisting ofsharply delineated edematousplaques with raised margins.(Courtesy Dr. M. Mian)


SECTION F: INFECTIOUS DISEASES . . . CONT.

F9. Herpes ZosterHemorrhagic vesicles and pustuleson an erythematous base limited toa dermatome. (Courtesy Dr. L. From)

F10. CandidiasisMacerated or eroded erythematouspatches; often studded withpapules, pustules, and "satellite"lesions.

F11. Primary SyphilisSingle, erythematous, painlessround chancre on penis.

F13. Secondary Syphilis Commonly affecting palms andsoles with oval, flat-topped, scaling, non-pruritic, red-brownpapules.

F14. Tinea CorporisPruritic, scaly, round/oval plaque with central clearing on the clavicle. (Courtesy Dr. L. From)

F12. HerpesSimplexGrouped vesic-ular eruption (herpetiformarrangement)on an erythematousbase of skin.


SECTION G: NEUROLOGY

G1. HydrocephalusVentricular enlargement, periventricular lucency, narrow orabsent sulci +/– fourth ventricularenlargement.

G2. Intracranial MassLarge glioma with midlineshift and compression ofsulci. (Courtesy Dr. G. Olscamp)

G3. Epidural HemorrhageRight high density biconvex mass,usually uniform density and sharpmargins.

G5. Acute SubduralHemorrhageLeft increased density, concavemass usually less uniform, lessdense, and more diffuse thanepidural hemorrhage. Note compression of ventriclesand midline shift.

G6. Chronic SubduralHemorrhageBilateral hypodense areas representing old blood, masseffect.

G4. SubarachnoidHemorrhageCT without contrast showing bloodin basal and suprasellar cisterns,interhemispheric and sylvian fissures.


SECTION H: OPHTHALMOLOGY

H1. Dacryocystitis Erythematous inflammation of the lacrimal sac.

H2. Corneal Laceration

H3. Herpes SimplexIrregular dendritic (branch-like) lesion of corneal epithelium stained with fluorescein.

H4. IritisCiliary flush and constricted pupil.

H5. Foreign BodyPresence of rust ring on cornea after removal ofmetallic foreign body.

H6. Endophthalmitis with HypopyonProminent layer of purulent material in inferioraspect of anterior chamber. Note corneal edema and conjunctival injection.


SECTION H: OPHTHALMOLOGY . . . CONT.

H7. CataractNuclear sclerosis with opacified lens.

H8. Pterygium Wedge-shaped growth of vascularized conjunctivaextending onto cornea.

H9. Central Retinal Artery OcclusionCherry red spot at fovea, constricted vessels, pale retina and disc.

H10. Central Retinal Vein OcclusionSwollen, blurred disc margin, red congested retinawith flame-shaped hemorrhages. "Blood and thunder" appearance.

H12. Optic AtrophyPallor of optic disc with sharp margins; attenuated vessels.

H11. PapilledemaElevated congested disc with indistinct margins, flame-shaped hemorrhages, and dilated tortuous vessels.

FUNDOSCOPY


SECTION H: OPHTHALMOLOGY . . . CONT.

SECTION I: OTOLARYNG0LOGY

I2. Exudative TonsillitisEnlarged and inflamed tonsils with purulent exudate in apatient with mononucleosis. (Courtesy Dr. A. Waitzman)

I1. Bell's PalsyUnilateral right facial nerve paralysis. Note patientsmiling with mouth droop and loss of nasolabial fold.(Courtesy Dr. A. Waitzman)

H15. Cytomegalovirus RetinitisWhite exudate surrounding hemorrhages and areas ofnecrosis. Distinct border between diseased and normalretina.

H16. GlaucomaAsymmetrical increase of cup:disc ratio (0.8).Cupping seen where vessels disappear over theedge of the attenuated rim.

H13. Proliferative Diabetic RetinopathyFan-shaped network of new blood vessels branching onto optic disc (neovascularization). Also note dot hemorrhages and microaneurysms.

H14. Retinal DetachmentBullous retinal detachment with retinal folds on temporal aspect.


I3. ThyroglossalDuct CystFirm midline mass thatmoves up and downwith swallowing.

SECTION I: OTOLARYNG0LOGY . . . CONT.

I4. Branchial Cleft CystPersistence of branchial cleftremnant as firm cystic mass

in lateral neck.

I5. Acute Otitis MediaBulging, hyperemic tympanic membrane with indistinctlandmarks.

I6. Serous Otitis MediaAir bubbles and serous fluid behind retracted ambertympanic membrane. (Courtesy Dr. M. Hawke)

I7. CholesteatomaCyst-like mass lined with keratinized squamousepithelium and filled with desquamating debris in themiddle ear. Progressive enlargement may lead tobony/soft tissue destruction. (Courtesy Dr. M. Hawke)

I8. Perforated Tympanic Membrane(Courtesy Dr. M. Hawke)


SECTION I: OTOLARYNG0LOGY . . . CONT.

SECTION J: PEDIATRICS

I9. Maxillary Sinusitis (CT scan)Air-fluid level in left maxillary sinus. (Courtesy Dr. A. Waitzman)

I10. Tympanostomy TubePlastic tube placed in inferior portion of tympanic membrane. (Courtesy Dr. M. Hawke)

J1. Chicken PoxMaculopapular rash on trunk progressing to vesicles and to crusts. (Courtesy Dr. M. Mian)

J2. RoseolaDiffuse maculopapular rash. (Courtesy The Hospital for SickChildren Slide Library, Toronto)

J3. Croup“Steeple sign” showing inflammation of tissues in narrow subglottic space. (Courtesy Dr. M. Mian)

J4. Epiglottitis“Thumb sign” showing a swollen epiglottis seen just atlevel of hyoid bone. (Courtesy Dr. M. Mian)


SECTION J: PEDIATRICS . . . CONT.

SECTION K: RESPIROLOGY

J5. Scarlet FeverStrawberry tongue. (Courtesy Dr. M. Mian)

K1. Interstitial DiseaseDiffuse reticulonodular markings prominent in the lowerlung zones; linear strands and spherical densities.

(Courtesy Dr. M. Hutcheon)

K2. Airspace Disease Ill-defined fluffy structures with confluences +/– airbronchograms. (Courtesy Dr. M. Hutcheon)

K3. Congestive Heart Failure (PA film)Cardiomegaly, pulmonary congestion, blunting of costophrenic angles, and loculated pleural effusion.

K4. Congestive Heart Failure (Lateral film)Post-treatment for CHF. Note scant effusion within fissure lines.

J6. Foreign BodyCoin lodged in esophagus. (Courtesy Dr. A. Waitzman)


SECTION K: RESPIROLOGY . . . CONT.

K7. BronchogenicCarcinomaIll-defined infiltratinglesion in left hilar region.

K9. Pneumocystis carinii Pneumonia Bilateral interstitial and alveolar infiltrateswith typical sparing of apices. Arrow showingpneumothorax.

K10. Bacterial Pneumonia“Silhouette sign”. Unilateral localized infiltrate involving lingula and obliterating left heart border.

K8. PneumothoraxSeparation of visceral

and parietal pleura.Note hyperlucent lung

field and small, deflated lung on right

with lack of peripherallung markings.

(Courtesy Dr. G. Olscamp)

K6. ActiveTuberculosis

Cavitation in apicalregions and posterior

segments of upper lobe± calcification. (Courtesy

Dr. M. Hutcheon)

K5. Wegener'sGranulomatosisPatchy alveolar infiltrates, widely distributed multiple irregular masses± pleural effusion and± thick-walled cavities.(Courtesy Dr. M. Hutcheon)

➜


SECTION K: RESPIROLOGY . . . CONT.

SECTION L: RHEUMATOLOGY

K11. Emphysema(PA film)Hyperinflation,darkened lung fields, vascular redistribution.

K12. Emphysema(Lateral film)

Large retrosternal airspace,increased AP diameter

“barrel chest", flattened hemi-diaphragms.

L1. Systemic Lupus Erythematosus Prominent scaly fixed erythema, flat or raised over malar eminences, tending to spare nasolabial folds ("butterfly rash").

L4. Dermatomyositis (Hands) Erythematous flat-topped scaling papules over theknuckles showing Gottron’s papules and periungal telangiectasia. (Courtesy The Hospital for Sick ChildrenSlide Library, Toronto)

L3. Discoid LupusErythematosusViolaceous, hyperpigmented,atrophic plaques; keratotic scale with follicular plugging and scarring.(Courtesy Dr. L. From)

L2. DermatomyositisClassic heliotrope rash ofperiorbital and perinasalviolaceous erythema.(Courtesy Dr. M. Urowitz)


SECTION L: RHEUMATOLOGY . . . CONT.

SECTION M: UROLOLGY

M1. UretericCalculusSmall stone seen atright pelvic brim.

M2. Ureteric ObstructionIntravenous pyelogram (1 hour

post-dye injection) showing right hydronephrosis,

hydroureter, dilated renalpelvis and calyx.

L7. VasculitisNote purpuric papules. (Courtesy Dr. A. Fam)

L6. Acute Gout: Monosodium Urate CrystalsPolarized light microscopy showing monosodium uratecrystals. Note the negative birefringence (yellow) ofneedle-shaped crystals versus the rhomboid-shapedand positively birefringent (blue) crystals of CPPD.(Courtesy Dr. A. Fam)

L5. Acute Gouty ArthritisClassic inflammation resembling cellulitis of the firstmetatasophalangeal (MTP) joint, referred to as poda-gra. The first MTP is the most common site of initialinvolvement. (Courtesy Dr. A. Fam)

L8. Scleroderma Sclerodactyly showing bilateral swelling, a shiny wax-like appearance, and tapering of the fingers. Mayalso note digital ulcers, nailfold telangiectasia, andperiarticular calcinosis. Flexion contractures presentin advanced disease. (Courtesy Dr. A. Fam)

➜

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