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  • Question 1 - Osteopetrosis occurs as a result of a defect in: ...

    Correct

    • Osteopetrosis occurs as a result of a defect in:

      Your Answer: Osteoclast function

      Explanation:

      It is a metabolic bone disease caused by defective osteoclastic resorption of immature bone. Osteopetrosis is also known as marble bone disease. Osteoclasts are unable to adequately acidify bone matrix. Impaired bone resorption leads to overly dense bone that is more likely to fracture. It is usually treated with bone marrow transplant and high dose calcitriol.

    • This question is part of the following fields:

      • Rheumatology
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      Seconds
  • Question 2 - Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?...

    Incorrect

    • Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?

      Your Answer:

      Correct Answer: Anti-CCP antibodies

      Explanation:

      Rheumatoid arthritis is both common and chronic, with significant consequences for multiple organ systems. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. However, its sensitivity is low, and a negative result does not exclude disease. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid arthritis. The other factors that are mentioned do not play a key prognostic role.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 3 - A 49 year old female presents to the clinic complaining of pain in...

    Incorrect

    • A 49 year old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?

      Your Answer:

      Correct Answer: Resisted wrist extension with the elbow extended

      Explanation:

      Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 4 - A 22 year old nulliparous female presents with shortness of breath. She has...

    Incorrect

    • A 22 year old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results: Hb: 12.4 g/dl Plt: 137 WBC: 7.5*109/l PT: 14 secs APTT: 46 secs Which of the following would be the most likely diagnosis?

      Your Answer:

      Correct Answer: Antiphospholipid syndrome

      Explanation:

      The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 5 - A 68 year old man presents with acute symptoms of gout on his...

    Incorrect

    • A 68 year old man presents with acute symptoms of gout on his first metatarsophalangeal joint. Which option best explains the underlying mechanism of gout?

      Your Answer:

      Correct Answer: Decreased renal excretion of uric acid

      Explanation:

      Primary gout is related more often to underexcretion of uric acid or overproduction.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 6 - A patient who has recently been diagnosed with SLE undergoes serum testing. A...

    Incorrect

    • A patient who has recently been diagnosed with SLE undergoes serum testing. A rise in which of the following antibodies would indicate severe systemic involvement?

      Your Answer:

      Correct Answer: Anti double-stranded DNA antibodies

      Explanation:

      Anti ds-DNA antibodies are very specific for SLE and their presence most often indicates systemic spread of the disease. These antibodies are present in about 30 percent of the total cases of SLE.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 7 - A 32 year old complains of pain in her hands bilaterally. Which of...

    Incorrect

    • A 32 year old complains of pain in her hands bilaterally. Which of the following symptoms would point towards an inflammatory joint disease such as rheumatoid arthritis?

      Your Answer:

      Correct Answer: Marked stiffness for more than an hour in the mornings

      Explanation:

      In rheumatoid arthritis (RA), clinical symptoms of joint stiffness, pain, and functional disability are commonly most severe in the early morning. These symptoms closely follow the circadian rhythm of the pro-inflammatory cytokine, interleukin (IL)-6. In RA, the increase in nocturnal anti-inflammatory cortisol secretion is insufficient to suppress ongoing inflammation, resulting in the morning symptoms characteristic of RA. Established diagnostic criteria for RA include prolonged morning stiffness that could last up to an hour. Loss of joint mobility, pain, malaise and swelling of finger joints are features that are not specific to rheumatoid arthritis, and are found in many other conditions.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 8 - A 23 year old male patient presents with urethritis for the last 2...

    Incorrect

    • A 23 year old male patient presents with urethritis for the last 2 weeks that has not responded to antibiotics. Lately he has developed an onset of new range of symptoms that are linked to his HLA B27 positivity. Which of the following signs is not related to Reiter's syndrome?

      Your Answer:

      Correct Answer: A mild fever with a generalised macular rash

      Explanation:

      Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. Dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum)

    • This question is part of the following fields:

      • Rheumatology
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  • Question 9 - A 68 year old female is on long term prednisolone therapy for polymyalgia...

    Incorrect

    • A 68 year old female is on long term prednisolone therapy for polymyalgia rheumatica. Which of the following would be the most suitable protection against osteoporosis?

      Your Answer:

      Correct Answer: Oral bisphosphonate

      Explanation:

      Prevention of osteoporosis associated with chronic glucocorticoid therapy is done by administrating bisphosphonates. Oral bisphosphonates are indicated for patients aged above 65 who have been on steroid therapy for over 3 months, so as to reduce the risk of steroid induced osteoporosis. HRT is usually done in post menopausal women who have oestrogen related bone resorption.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 10 - A 34 year old woman presents to the emergency department due to right...

    Incorrect

    • A 34 year old woman presents to the emergency department due to right sided weakness. Past history reveals a DVT following the birth of her daughter, and two miscarriages. Head CT confirms an ischaemic stroke in the territory of left middle cerebral artery. What would be the most likely finding on echocardiography?

      Your Answer:

      Correct Answer: Normal

      Explanation:

      The patient most likely suffers from antiphospholipid syndrome. The clinical criteria consist of vascular thrombosis and pregnancy morbidity. Vascular thrombosis is defined as one or more clinical episodes of arterial, venous, or small-vessel thrombosis in any tissue or organ confirmed by findings from imaging studies, Doppler studies, or histopathology. ASD, VSDs would cause paradoxical emboli and stroke, however the recurrent pregnancy loss in this case is strongly suggestive of antiphospholipid syndrome. The ECG would be normal in most cases associated with anti phospholipid syndrome.

    • This question is part of the following fields:

      • Rheumatology
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Rheumatology (1/1) 100%
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