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  • Question 1 - A 32 year old female is diagnosed with SLE based on her complaints...

    Incorrect

    • A 32 year old female is diagnosed with SLE based on her complaints of polyarthralgia, mouth ulcers and ANA positivity. Labs reveal normal urinalysis, urea and electrolytes. ESR is 90mm in the first hour. How will you manage this patient?

      Your Answer: Prednisolone 30 mg/day

      Correct Answer: Hydroxychloroquine 200 mg/day

      Explanation:

      Hydroxychloroquine is used in the management of SLE as it prevents disease progression and has relatively mild side effects, for instance headache, nausea etc. Its use reduces the usage of corticosteroids. It is particularly effective when the disease is less severe and there is no organ involvement. Cyclophosphamide and prednisolone are indicated in cases of renal, neurological and lung involvement.

    • This question is part of the following fields:

      • Rheumatology
      15.8
      Seconds
  • Question 2 - A 53 year old female, longstanding case of rheumatoid arthritis comes for a...

    Correct

    • A 53 year old female, longstanding case of rheumatoid arthritis comes for a review. Which of the following features are commonly associated with her condition?

      Your Answer: Proximal interphalangeal joint involvement in the hands

      Explanation:

      Rheumatoid arthritis is a polyarthritis that results in symmetrical pain and swelling of the affected joints (also at rest). It particularly affects the metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs), not the distal interphalangeal joints (DIPs).
      Ulcerative colitis and IBD are associated with seronegative arthritides, not RA. The condition can also cause various extra-articular manifestations such as ocular symptoms, rheumatoid nodules and pulmonary fibrosis. Scleritis, episcleritis and keratoconjunctivitis sicca are more common than uveitis. Early intervention with disease-modifying antirheumatic drugs (DMARDs) plays a decisive role in successful treatment.

    • This question is part of the following fields:

      • Rheumatology
      10
      Seconds
  • Question 3 - A 62 year old man arrives at the clinic with a history of...

    Incorrect

    • A 62 year old man arrives at the clinic with a history of cough and intermittent haemoptysis for the last 3 months. He has a 50 pack year smoking history and is currently waiting for bronchoscopy to assess a left lower lobe collapse. The patient also has a marked muscle weakness and wasting of proximal muscles of his shoulders and pelvic girdle. His wife states that lately he has been unable to eat solids. Which of the following statements would be true regarding this scenario?

      Your Answer: His dysphagia is due to compression by the tumour

      Correct Answer: He may have a photosensitive facial rash

      Explanation:

      The patient has presented with signs of small cell lung cancer. The associated proximal muscle weakness is most probably due to dermatomyositis which occurs as a paraneoplastic syndrome associated with lung carcinoma. In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees or elbows. The rash is patchy and usually a bluish-purple colour. Corticosteroids are helpful in the management of the cutaneous changes and muscle weakness.

    • This question is part of the following fields:

      • Rheumatology
      96.7
      Seconds
  • Question 4 - A 23 year old male patient presents with urethritis for the last 2...

    Correct

    • 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: 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
      8.9
      Seconds
  • Question 5 - A 30 year old female has been started on azathioprine after she was...

    Correct

    • A 30 year old female has been started on azathioprine after she was found to be intolerant of methotrexate. Routine blood monitoring shows the following values: Hb 7.9 g/dL, Plt 97*109/l, WBC 2.7*109/l. Azathioprine toxicity will most likely to occur in the presence of which of the following?

      Your Answer: Thiopurine methyltransferase deficiency

      Explanation:

      Azathioprine therapy can cause acute myelosuppression. Toxicity is in part caused by the incorporation of azathioprine-derived 6-thioguanine nucleotides (6-TGN) into deoxyribonucleic acid (DNA). The enzyme thiopurine methyltransferase (TPMT) plays an important role in azathioprine catabolism.

    • This question is part of the following fields:

      • Rheumatology
      9.4
      Seconds
  • Question 6 - Which of the following cancers is responsible in producing osteoblastic bone metastases instead...

    Correct

    • Which of the following cancers is responsible in producing osteoblastic bone metastases instead of osteolytic?

      Your Answer: Prostate adenocarcinoma

      Explanation:

      Osteoblastic (or sclerotic) bone metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma.

    • This question is part of the following fields:

      • Rheumatology
      3.3
      Seconds
  • Question 7 - A patient who has recently been diagnosed with SLE undergoes serum testing. A...

    Correct

    • 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: 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
      13.6
      Seconds
  • Question 8 - A 28 year old male arrives at the clinic complaining of fever, arthralgia...

    Incorrect

    • A 28 year old male arrives at the clinic complaining of fever, arthralgia and urethritis. On examination, the ankle is swollen and there is a pustular rash on the dorsal foot. What is the most likely diagnosis?

      Your Answer: Reactive arthritis

      Correct Answer: Disseminated gonorrhoea

      Explanation:

      DGI presents as two syndromes: 1) a bacteremic form that includes a triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis and 2) a septic arthritis form characterized as a purulent arthritis without associated skin lesions. Many patients will have overlapping features of both syndromes. Time from infection to clinical manifestations may range from 1 day to 3 months. There is no travel history and the rash of Lyme disease is not purulent. Reactive arthritis presents with conjunctivitis, urethritis and arthritis usually with a red hot tender and swollen joint.

    • This question is part of the following fields:

      • Rheumatology
      10.3
      Seconds
  • Question 9 - A 22 year old man who has recently returned from a trip to...

    Correct

    • A 22 year old man who has recently returned from a trip to Far East presents with sore eyes and symmetrical joint pain in his knees, ankles and feet. Labs reveal an elevated ESR. The synovial fluid aspirate is sterile and has a high neutrophil count. What is the most likely diagnosis?

      Your Answer: Reactive arthropathy

      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. Symmetric lower limb arthropathy and a sterile joint aspirate points towards reactive arthropathy.

    • This question is part of the following fields:

      • Rheumatology
      6.6
      Seconds
  • Question 10 - A 46 year old male, known with Rheumatoid Arthritis presents with a swollen...

    Incorrect

    • A 46 year old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows: Temp: 38.8 BP: 90/60 mmHg Pulse: 110/min. Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?

      Your Answer:

      Correct Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently

      Explanation:

      Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Rheumatology (6/9) 67%
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