Archives: Medical Student Finals

MSFinals-5945

A 50-year-old man presents to the Emergency Department with a painful and swollen left knee that has been bothering him for the past 2 days. He is running a fever. The patient has a history of rheumatoid arthritis, which was recently diagnosed and is being treated with NSAIDs and low-dose oral corticosteroids. He reports that he visited his general practitioner 5 days ago for a painful right ear, and was prescribed antibiotics for an ear infection. Upon examination, the left knee is swollen, red, tender, and slightly flexed, leading to a diagnosis of septic arthritis. What is the most likely causative organism in this case?

MSFinals-5963

A 42-year-old known intravenous (iv) drug user presents to her general practitioner with complaints of fever, morning stiffness, and joint pain. The patient reports a constant, dull pain in the distal interphalangeal (DIP) joints bilaterally, with an intensity of 3/10. Her medical history is unremarkable, but her family history includes a skin condition and rheumatoid arthritis. The patient consumes 15 alcoholic units per week and smokes two packs of cigarettes per day. On physical examination, the patient is febrile with a temperature of 38.1 °C. The DIP joints are warm and swollen, and there is symmetric nail pitting. What is the most likely diagnosis for this patient’s current presentation?

MSFinals-5955

A 35-year-old woman presents with increasing early-morning bilateral knee pain and stiffness and generalised fatigue. On examination, she is noted to have flat erythema over the malar eminences with sparing of the nasolabial folds. Multiple painless oral ulcers are also noted. Examination of the knee joints reveals tenderness and suprapatellar effusions bilaterally.
Which of these is most specific for the underlying condition?

MSFinals-5962

A 65-year-old man visits his General Practitioner (GP) complaining of a swollen and painful first metatarsophalangeal joint that has been bothering him for a week. He reports that the pain became unbearable last night. The patient denies any fever or toe injuries. Upon examination, the joint appears red, swollen, and warm to touch. The patient has a history of gout, peptic ulcer, and is currently taking allopurinol 300 mg once a day for gout prophylaxis. What is the most appropriate next step in management?

MSFinals-5960

A 55-year-old carpet layer presented with acute pain and swelling affecting his left knee. There is no history of trauma. Past medical history includes haemochromatosis for which he receives regular venesection.
Examination reveals a hot, tender, swollen left knee.
Investigations:
Investigation Result Normal value
Haemoglobin 135 g/l 135–175 g/l
White cell count (WCC) 4.0 × 109/l 4–11 × 109/l
Platelets 200 × 109/l 150–400 × 109/l
Erythrocyte sedimentation rate (ESR) 12 mm/h 0–10mm in the 1st hour
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 5.0 mmol/l 3.5–5.0 mmol/l
Creatinine 120 μmol/l 50–120 µmol/l
Knee aspirate: 12 000 white blood cells/ml (majority neutrophils); rhomboid-shaped, weakly positively birefringent crystals. No growth on culture.
Which of the following is the most likely diagnosis in this case?

MSFinals-5959

A 63-year-old woman visits her GP complaining of pain and swelling in her fingers and wrists. The pain has been gradually worsening over the past few months, and she is having difficulty opening jars at home. She reports that her fingers are stiff when she wakes up but gradually loosen throughout the morning.

Upon examination, the GP notes symmetrical swelling of the MCP and PIP joints, which are tender to pressure and have stress pain on passive movement. The patient also has swan neck and boutonnière deformities of the fingers. The GP diagnoses the patient with rheumatoid arthritis and refers her to a rheumatologist. The GP prescribes anti-inflammatory medications and advises the patient to rest her fingers and wrists.

What is the most common ocular extra-articular manifestation of rheumatoid arthritis in a patient who is 63 years old?

MSFinals-5956

A 58-year-old woman has been scheduled for a left total knee replacement in one month’s time. She has a past medical history significant for rheumatoid arthritis (RA), for which she takes methotrexate and hydroxychloroquine.
Which of the following investigations would be most important before the patient’s operation?

MSFinals-5953

What is the most probable diagnosis for a 70-year-old woman who presents with bilateral shoulder pain and stiffness, fatigue, weight loss, and elevated ESR levels?

MSFinals-5949

A 65-year-old woman presents with a four-month history of finding it more difficult to get out of her chair. She also complains of a right-sided temporal headache, which is often triggered when she brushes her hair. A diagnosis of polymyalgia rheumatica with temporal arthritis is suspected.
Which of the following blood tests is most useful in supporting the diagnosis?

MSFinals-5948

In which disease is the distal interphalangeal joint typically impacted?