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  • Question 1 - Which joint is usually spared from osteoarthritis? ...

    Correct

    • Which joint is usually spared from osteoarthritis?

      Your Answer: Elbow joint

      Explanation:

      Osteoarthritis in the Hand and Elbow

      Osteoarthritis (OA) is a prevalent form of arthritis that commonly affects the hand, particularly the joints. The joints may exhibit several deformities, including the development of small bone spurs called nodes. These nodes are referred to as Heberden’s nodes when they occur at the joint next to the fingernail and Bouchard’s nodes when they occur at the middle joints. The base of the thumb may also appear squared off, accompanied by swelling and tenderness. Soft tissue laxity can result in instability at the base of the thumb.

      In contrast, elbow OA is relatively uncommon.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 2 - A 65-year-old woman presents with a four-month history of finding it more difficult...

    Incorrect

    • 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?

      Your Answer: Raised creatine kinase

      Correct Answer: Plasma viscosity

      Explanation:

      Diagnostic Markers for Polymyalgia Rheumatica and Temporal arthritis

      Polymyalgia rheumatica and temporal arthritis are inflammatory conditions that can cause significant morbidity if left untreated. Here are some diagnostic markers that can help support or rule out these conditions:

      Plasma viscosity: A raised plasma viscosity can support a diagnosis of polymyalgia rheumatica with temporal arthritis, but it is a nonspecific inflammatory marker.

      Creatine kinase: A raised creatine kinase is not supportive of a diagnosis of polymyalgia rheumatica or temporal arthritis.

      Monospot test: A positive monospot test is supportive of a diagnosis of Epstein–Barr virus (EBV), but not polymyalgia rheumatica or temporal arthritis.

      Whole cell count (WCC): A raised WCC is not supportive of a diagnosis of polymyalgia rheumatica or temporal arthritis.

      Bence Jones proteins: Presence of Bence Jones protein is supportive of a diagnosis of multiple myeloma, but not polymyalgia rheumatica or temporal arthritis.

      If temporal arthritis is suspected, immediate treatment with prednisolone is crucial to prevent permanent loss of vision. A temporal artery biopsy can confirm the diagnosis.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 3 - A 27-year-old male presents with lower back pain and painful feet that feel...

    Incorrect

    • A 27-year-old male presents with lower back pain and painful feet that feel like walking on pebbles. He has been generally healthy, but he recently returned from a trip to Corfu where he had a diarrheal illness. He admits to infrequently taking ecstasy but takes no other medication. On examination, he has limited movement and pain in the sacroiliac joints and soreness in the soles of his feet upon deep palpation. What is the most probable diagnosis?

      Your Answer: Gonococcal arthritis

      Correct Answer: Reactive arthritis

      Explanation:

      After a diarrhoeal illness, the patient may be at risk of developing reactive arthritis, which is a possible diagnosis for both sacroiliitis and plantar fasciitis. However, it is less likely to be related to inflammatory bowel disease (IBD) if there is only one acute episode of diarrhoea.

      Sacroiliitis is a condition that affects the sacroiliac joint, which is located at the base of the spine where it connects to the pelvis. It causes inflammation and pain in the lower back, buttocks, and legs. Plantar fasciitis, on the other hand, is a condition that affects the plantar fascia, a thick band of tissue that runs along the bottom of the foot. It causes pain and stiffness in the heel and arch of the foot.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 4 - A 56-year-old carpenter presents to the general practitioner (GP) with an acutely swollen...

    Incorrect

    • A 56-year-old carpenter presents to the general practitioner (GP) with an acutely swollen and painful left thumb. The pain came on rapidly over the course of 24 hours, without history of trauma or injury. The patient describes the thumb as being extremely painful and particularly tender to touch. The patient is a type 2 diabetic, which is well controlled with metformin. He does not smoke, but drinks around ten pints of beer at weekends.
      Examination reveals a swelling, erythema and tenderness over the first metacarpophalangeal joint. The clinician suspects a possible crystal arthropathy.
      With regard to gout, which of the following statements is true?

      Your Answer: Allopurinol is effective in the treatment of acute gout

      Correct Answer: Gout may be seen in patients with chronic haemolytic anaemia

      Explanation:

      Mythbusting Gout: Clarifying Common Misconceptions

      Gout is a painful and often misunderstood condition. Here are some common misconceptions about gout, and the truth behind them:

      1. Gout may be seen in patients with chronic haemolytic anaemia.
      2. Gout may occur in those with elevated urate levels (although levels may be normal during an acute attack) such as those with haemolytic anaemia.
      3. Gout only affects the first metacarpophalangeal (MCP) joint.
      4. Gout most commonly affects the first metatarsophalangeal joint. However, it is not the only joint affected.
      5. Allopurinol is effective in the treatment of acute gout.
      6. Acute gout is treated with non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or prednisolone, but not allopurinol. Allopurinol is effective in the prevention of gout because it reduces serum urate levels by blocking urate production (xanthine oxidase inhibition).
      7. A diagnosis of gout is made if there are positively birefringent crystals in the joint aspirate.
      8. Gout is an inflammatory arthritis that occurs as a result of deposition of negatively birefringent urate crystals in the joint.
      9. All cases of acute gout have an elevated serum urate.
      10. Although a raised serum urate can be used to support the diagnosis, many will not be raised. Similarly, if a patient has a raised serum urate, they do not automatically have the clinical picture of gout.

      In conclusion, it is important to dispel these common myths about gout in order to properly diagnose and treat this painful condition.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 5 - A 20-year-old woman presents with a painful left hip and groin and is...

    Correct

    • A 20-year-old woman presents with a painful left hip and groin and is struggling to weight-bear. She completed therapy for acute myeloblastic leukaemia some six months earlier.
      On examination, she walks with a limp and there is limitation of hip flexion, internal and external rotation.
      Investigations:
      Investigation Result Normal Value
      Haemoglobin 121 g/l 115–155 g/l
      White cell count (WCC) 6.1 × 109/l 4–11 × 109/l
      Platelets 191 × 109/l 150–400 × 109/l
      Sodium (Na+) 140 mmol/l 135–145 mmol/l
      Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
      Creatinine 130 μmol/l 50–120 µmol/l
      C-reactive protein (CRP) 12 mg/l 0–10 mg/l
      The left hip X-ray shows joint sclerosis with collapse of the femoral head.
      Which one of the following is the most likely diagnosis?

      Your Answer: Avascular necrosis

      Explanation:

      Differentiating Arthritis Types: Avascular Necrosis, Gout, Osteoarthritis, Pseudogout, and Septic Arthritis

      Arthritis is a common condition that affects the joints, causing pain, stiffness, and inflammation. However, there are different types of arthritis, each with its own causes, symptoms, and treatments. Here are some key points to differentiate between avascular necrosis, gout, osteoarthritis, pseudogout, and septic arthritis:

      Avascular necrosis is a condition where the bone tissue dies due to a lack of blood supply. It can be caused by corticosteroid use, malignancy, or trauma. Femoral head collapse is a classic radiographic change in avascular necrosis.

      Gout is a type of crystal arthritis that usually affects peripheral joints, such as the big toe, ankle, or knee. It is caused by the buildup of uric acid crystals in the joint, leading to sudden attacks of pain, redness, and swelling.

      Osteoarthritis is a degenerative joint disease that occurs when the cartilage that cushions the joints wears down over time. It is more common in older adults and can affect any joint, but femoral head collapse does not occur in osteoarthritis.

      Pseudogout is another type of crystal arthritis that usually affects peripheral joints. It is caused by the buildup of calcium pyrophosphate crystals in the joint, leading to similar symptoms as gout.

      Septic arthritis is a bacterial infection of the joint that can cause severe pain, swelling, and fever. It is a medical emergency and requires prompt treatment with antibiotics. While septic arthritis should always be considered in a monoarthritis, it is less likely in cases where there are classic radiographic changes of avascular necrosis, risk factors, and a normal CRP without history of fever.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 6 - A 35-year-old woman presented with fever and joint pain. During her consultation with...

    Correct

    • A 35-year-old woman presented with fever and joint pain. During her consultation with the doctor, the doctor observed a rash on both cheeks. A kidney biopsy sample showed deposits of immunoglobulin, C3, and fibrinogen in the basement membrane. Her serum analysis revealed elevated levels of anti-dsDNA antibody. What is the most probable diagnosis?

      Your Answer: Systemic lupus erythematosus (SLE)

      Explanation:

      Systemic lupus erythematosus (SLE) is an autoimmune disorder that predominantly affects young women. It is characterized by a photosensitive butterfly-shaped rash on the face and joint manifestations. Unlike rheumatoid arthritis, SLE does not cause severe destruction of joints. SLE is a multisystem condition that can affect many systems, including haematological, renal, respiratory, and cardiac systems. The underlying pathological mechanism of damage in SLE is immune complex deposition, which produces antibodies against several nuclear components of the body, especially against double-stranded DNA (dsDNA). Antinuclear antibodies (ANA) and dsDNA are associated with SLE, as is a low C3 and C4. The immunoglobulin, C3 and fibrinogen deposits found in this patient are classic of the immune complex deposition seen in SLE.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 7 - A 32-year-old Afro-Caribbean woman comes to the clinic with concerns about her appearance....

    Correct

    • A 32-year-old Afro-Caribbean woman comes to the clinic with concerns about her appearance. She has noticed hair loss, a rash on her face, and mouth ulcers. Additionally, she has been experiencing joint pain and has been taking paracetamol and ibuprofen to manage it. This is her second visit to the clinic, and the registrar has already sent off some immunology tests. The results show a positive dsDNA antibody. What is the most probable diagnosis?

      Your Answer: Systemic lupus erythematosus (SLE)

      Explanation:

      Systemic lupus erythematosus (SLE) is an autoimmune disease that primarily affects young women. It is caused by the deposition of immune complexes and can have a wide range of clinical effects, including a butterfly-shaped rash on the cheeks and nose, joint pain, and involvement of multiple organ systems such as the kidneys, lungs, and heart. SLE is associated with the presence of ANA and dsDNA antibodies, as well as low levels of C3 and C4 in the blood.

      Mixed connective tissue disease (MCTD) is a syndrome that shares features with several other rheumatological conditions, including SLE, scleroderma, myositis, and rheumatoid arthritis. Common symptoms include fatigue, joint pain, pulmonary involvement, and Raynaud’s phenomenon. MCTD is strongly associated with anti-RNP antibodies.

      Rheumatoid arthritis is an inflammatory arthritis that typically affects middle-aged women and causes symmetrical joint pain and stiffness, particularly in the hands and feet. If left untreated, it can lead to deformities that affect function. Rheumatoid arthritis is associated with the presence of autoantibodies such as rheumatoid factor and anti-CCP.

      Polymyositis is an autoimmune myositis that causes weakness and loss of muscle mass, particularly in the proximal muscles. Other symptoms may include malaise and difficulty swallowing. Polymyositis is associated with anti-Jo1 autoantibodies.

      Systemic sclerosis, also known as diffuse scleroderma, is an autoimmune disease that primarily affects women aged 30-50. It causes collagen accumulation, leading to thickening of the skin and vasculitis affecting small arteries. Systemic sclerosis can affect multiple organ systems, including the skin, lungs, kidneys, and gastrointestinal tract. It is associated with anti-Scl70 antibodies.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 8 - A 50-year-old woman presents with complaints of fatigue. She reports experiencing dysphagia, a...

    Correct

    • A 50-year-old woman presents with complaints of fatigue. She reports experiencing dysphagia, a dry mouth, a gritty feeling in her eyes, and heightened sensitivity to light.
      What is the probable diagnosis?

      Your Answer: Sjögren syndrome

      Explanation:

      Comparison of Symptoms: Sjögren Syndrome, Haemochromatosis, Hepatitis C Virus Infection, Oesophageal Carcinoma, and Polymyositis

      Sjögren syndrome is a condition that causes inflammation and destruction of exocrine glands, resulting in dry and gritty eyes, dry mouth, photosensitivity, fatigue, and joint pain. Patients may also experience excessive watering or deposits of dried mucous in the corner of the eye, recurrent attacks of conjunctivitis, and parotid swelling. On examination, xerostomia can be detected as a diminished salivary pool, a dried fissured tongue, and chronic oral candidiasis.

      Haemochromatosis, on the other hand, is characterized by a pigmented (tanned) appearance and may cause dry mouth and thirst due to diabetes.

      Hepatitis C virus infection can be associated with a secondary Sjögren syndrome, but there is no indication of this in the question.

      Oesophageal carcinoma is unlikely to cause ocular symptoms.

      Polymyositis does not present with any history of muscle weakness.

      In summary, while some symptoms may overlap between these conditions, a thorough examination and medical history are necessary to accurately diagnose and differentiate them.

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      • Rheumatology
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  • Question 9 - A 30-year-old science teacher is diagnosed with tenosynovitis of the fingers of the...

    Correct

    • A 30-year-old science teacher is diagnosed with tenosynovitis of the fingers of the left hand, although she is not experiencing any tenderness or swelling of the affected fingers.
      In which one of the following conditions can tendinitis/tenosynovitis present without being swollen and tender?

      Your Answer: Systemic sclerosis

      Explanation:

      Types of Arthritis and Infections that can Cause Tenosynovitis

      Tenosynovitis is a condition where the tendon sheath becomes inflamed, causing pain and swelling. It can be caused by various types of arthritis and infections. Here are some of the most common causes:

      Systemic Sclerosis: This autoimmune disease causes fibrosis of connective tissue, resulting in hard and thickened skin, swollen digits, and Raynaud’s phenomenon. Tenosynovitis in systemic sclerosis is non-tender and without swelling of the tendons.

      Rheumatoid Arthritis: Tenosynovitis due to rheumatoid arthritis causes pain and swelling of tendons. It usually involves the interphalangeal, metacarpophalangeal, and wrist joints, and can cause deformities such as swan neck and Boutonnière’s deformity.

      Gout: Gout can cause tenosynovitis, which is very painful and presents with redness and swollen tendons. It typically affects the metatarsophalangeal joints.

      Disseminated Gonococcal Infection: This infection can cause acute migratory tenosynovitis, especially in younger adults. Women may be asymptomatic, while men may present with urethral discharge or dysuria.

      Reactive Arthritis: This type of arthritis causes pain and swelling of tendons, commonly affecting the knees or sacrum. It is an acutely inflammatory process and would therefore be swollen and tender.

      In conclusion, tenosynovitis can be caused by various types of arthritis and infections, and it is important to identify the underlying cause in order to provide appropriate treatment.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 10 - A 50-year-old woman visits the Rheumatology Clinic seeking modification of her DMARDs for...

    Correct

    • A 50-year-old woman visits the Rheumatology Clinic seeking modification of her DMARDs for the treatment of her rheumatoid arthritis. She is informed that she will require frequent liver checks and eye exams due to the potential side-effects of these medications. What is the most probable combination of treatment she will receive for her condition?

      Your Answer: Methotrexate plus hydroxychloroquine

      Explanation:

      Medication Combinations for Treating Rheumatoid Arthritis

      When treating rheumatoid arthritis, the first-line medication is a DMARD monotherapy with methotrexate. Short-term steroids may also be used in combination with DMARD monotherapy to induce remission. Hydroxychloroquine is another medication that can be used, but patients should be closely monitored for visual changes as retinopathy and corneal deposits are common side effects.

      Etanercept is not a first-line treatment for rheumatoid arthritis, and methotrexate should not be given in combination with a TNF-alpha inhibitor like etanercept. Methotrexate plus sulfasalazine is an appropriate medication combination for treating rheumatoid arthritis, but regular eye checks are not required as neither medication affects vision.

      If a patient has failed treatment with methotrexate, sulfasalazine plus hydroxychloroquine may be a regimen to consider trialling. However, it is important to note that new-onset rheumatoid arthritis should be treated with a DMARD monotherapy first line, with the addition of another DMARD like methotrexate as the first-line option.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 11 - A 42-year-old known intravenous (iv) drug user presents to her general practitioner with...

    Correct

    • 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?

      Your Answer: Appearance of a silver, scaly rash

      Explanation:

      Differentiating Arthritides: Understanding Clinical and Laboratory Findings

      Arthritis is a common condition that affects the joints, and it can be challenging to distinguish between the various types that exist. However, by considering the patient’s medical history, physical examination, and laboratory findings, clinicians can make an accurate diagnosis.

      For instance, psoriatic arthritis is an inflammatory subtype of arthritis that often affects the DIP joints, sausage digits, and nails. The classic X-ray finding of psoriatic arthritis is the pencil in a cup appearance, although it is not specific to the disease. In contrast, rheumatoid arthritis is characterized by PIP and MCP joint involvement, wrist and cervical spine pain, and positive rheumatoid factor and anti-CCP antibodies.

      Septic arthritis is a medical emergency that usually involves large joints and is associated with high fever, chills, and rapid joint destruction. Synovial fluid analysis may reveal Gram-positive cocci in cases of septic arthritis caused by Staphylococcus aureus.

      Osteoarthritis, on the other hand, is a degenerative joint disease that is associated with subchondral cyst formation, joint space narrowing, and osteophyte formation. It typically affects the DIP and PIP joints and large weight-bearing joints, but it is not an inflammatory arthritis.

      In summary, understanding the clinical and laboratory findings associated with different types of arthritis is crucial for accurate diagnosis and appropriate management.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 12 - In which condition is pseudofracture typically observed? ...

    Correct

    • In which condition is pseudofracture typically observed?

      Your Answer: Osteomalacia

      Explanation:

      Osteomalacia: Causes and Symptoms

      Osteomalacia is a condition that occurs due to a deficiency of vitamin D. This condition can be caused by various factors such as malabsorption, renal disease, chronic renal failure, and anticonvulsant therapy. The most common symptom of osteomalacia is bone pain, which is often accompanied by a proximal myopathy. These symptoms are also known as Looser’s zones.

      Malabsorption, which is the inability of the body to absorb nutrients from food, can lead to osteomalacia. Renal disease, such as familial hypophosphataemic rickets, can also cause this condition. Chronic renal failure, which is the gradual loss of kidney function, can also lead to osteomalacia. Additionally, anticonvulsant therapy, which is used to treat seizures, can cause a deficiency of vitamin D and lead to osteomalacia.

      If you experience bone pain or a proximal myopathy, it is important to seek medical attention. A doctor can diagnose osteomalacia through blood tests and imaging studies. Treatment typically involves vitamin D and calcium supplements, as well as addressing the underlying cause of the deficiency. With proper treatment, the symptoms of osteomalacia can be managed and the condition can be prevented from worsening.

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      • Rheumatology
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  • Question 13 - A 20-year-old student midwife presents with increasing pain and swelling of the ring...

    Correct

    • A 20-year-old student midwife presents with increasing pain and swelling of the ring finger of her left hand. The pain and swelling started two days ago and is now extremely uncomfortable to the point the patient has been avoiding using the left hand altogether. She cannot remember injuring the affected area, and is usually fit and well, without medical conditions to note except an allergy to peanuts.
      On examination, the affected finger is markedly swollen and erythematosus, with tenderness to touch – especially along the flexor aspect of the finger. The patient is holding the finger in slight flexion; attempts at straightening the finger passively causes the patient extreme pain. The patient is diagnosed with tenosynovitis.
      About which one of the following conditions should the presence of acute migratory tenosynovitis in young adults, particularly women aged 20, alert the doctor?

      Your Answer: Disseminated gonococcal infection

      Explanation:

      Migratory tenosynovitis can be caused by disseminated gonococcal infection in younger adults, particularly women. It is important to test for C6-C9 complement deficiency. Rheumatoid arthritis can also cause tenosynovitis, but it is not migratory and is usually found in the interphalangeal, metacarpophalangeal, and wrist joints. Scleroderma can cause tenosynovitis, but it is not migratory either. Fluoroquinolone toxicity may increase the risk of tendinopathy and tendon rupture, but it does not cause migratory tenosynovitis. Reactive arthritis can cause tendinitis, but it is more prevalent in men and is not migratory. It is a rheumatoid factor-seronegative arthritis that can be linked with HLA-B27.

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      • Rheumatology
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  • Question 14 - A 50-year-old woman with a history of rheumatoid arthritis is experiencing shortness of...

    Incorrect

    • A 50-year-old woman with a history of rheumatoid arthritis is experiencing shortness of breath during light activity and has developed a dry cough. Upon testing, her oxygen saturation was found to be 87% while breathing normally. A chest x-ray revealed a diffuse bilateral interstitial infiltrate. Despite an extensive infection screening, no infections were found, leading doctors to believe that her symptoms are a result of a drug she is taking. Which medication is the most likely culprit for this adverse reaction?

      Your Answer: Hydroxychloroquine

      Correct Answer: Methotrexate

      Explanation:

      Potential Side Effects of Common Rheumatoid Arthritis Medications

      Methotrexate, a commonly prescribed medication for rheumatoid arthritis, has been known to cause acute pneumonitis and interstitial lung disease. Although this is a rare complication, it can be fatal and should be closely monitored. Azathioprine, another medication used to treat rheumatoid arthritis, can lead to bone marrow suppression and increase the risk of infection. Cyclosporin, often used in combination with other medications, can cause neurological and visual disturbances. Hydroxychloroquine, while generally well-tolerated, can lead to abdominal pain and visual disturbances in cases of toxicity. Sulfasalazine, another medication used to treat rheumatoid arthritis, can affect liver function tests and cause bone marrow suppression, requiring careful monitoring.

      It is important for patients to be aware of the potential side effects of their medications and to communicate any concerns with their healthcare provider. Regular monitoring and follow-up appointments can help to identify and manage any adverse effects. With proper management, the benefits of these medications can outweigh the risks for many patients with rheumatoid arthritis.

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      • Rheumatology
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  • Question 15 - A 40-year-old homemaker with long-standing psoriasis visits her GP with worsening joint pains...

    Correct

    • A 40-year-old homemaker with long-standing psoriasis visits her GP with worsening joint pains over the past six months. Upon examination, the GP suspects potential psoriatic arthropathy and refers the patient to a rheumatologist. What is a severe manifestation of psoriatic arthropathy?

      Your Answer: Arthritis mutilans

      Explanation:

      Psoriatic Arthritis: Common Presentations and Misconceptions

      Psoriatic arthritis is a type of arthritis that affects some individuals with psoriasis. While it can present in various ways, there are some common misconceptions about its symptoms. Here are some clarifications:

      1. Arthritis mutilans is a severe form of psoriatic arthritis, not a separate condition.

      2. Psoriatic arthritis can have a rheumatoid-like presentation, but not an osteoarthritis-like one.

      3. The most common presentation of psoriatic arthritis is distal interphalangeal joint involvement, not proximal.

      4. Psoriatic spondylitis is a type of psoriatic arthritis that affects the spine, not ankylosing spondylitis.

      5. Asymmetrical oligoarthritis is a common presentation of psoriatic arthritis, not symmetrical oligoarthritis.

      Understanding these presentations can help with early diagnosis and appropriate treatment of psoriatic arthritis.

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      • Rheumatology
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  • Question 16 - A 25-year-old intravenous drug user (ivDU) comes in with a swollen and painful...

    Correct

    • A 25-year-old intravenous drug user (ivDU) comes in with a swollen and painful right knee. Upon examination, there is joint effusion and pyrexia, and frank pus is aspirated. What is the most probable infecting organism?

      Your Answer: Staphylococcus aureus

      Explanation:

      Common Organisms in Septic Arthritis

      Septic arthritis is a serious condition that occurs when a joint becomes infected. The most common organism causing septic arthritis is Staphylococcus aureus. Pseudomonas spp can also cause septic arthritis, but it is less likely than S. aureus, especially in intravenous drug users. Escherichia coli is another pathogen that can cause septic arthritis, but it is less common than S. aureus. In children under the age of two, Haemophilus influenzae is the most common organism causing septic arthritis. Neisseria gonorrhoeae is a common cause of arthritis in the United States, but it is uncommon in Western Europe. It is important to identify the causative organism in order to provide appropriate treatment for septic arthritis.

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      • Rheumatology
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  • Question 17 - A 40-year-old woman presents with pain of the hand, wrist, ankle and knee...

    Correct

    • A 40-year-old woman presents with pain of the hand, wrist, ankle and knee which is asymmetrical and has been going on for the past few months. She has developed a rash on her face and has developed a dry cough and pain on inspiration. She has a child but has had two previous miscarriages (Gravida 3, Para 1). She has no other concurrent medical problems or medications.
      Testing for which one of the following autoantibodies is most likely to reveal the diagnosis in this patient?

      Your Answer: Anti-dsDNA

      Explanation:

      Understanding Autoantibodies: Differentiating Connective Tissue Diseases

      Autoantibodies are antibodies produced by the immune system that mistakenly attack the body’s own tissues. These antibodies can be used as diagnostic markers for various connective tissue diseases. Here, we will discuss the different types of autoantibodies and their association with specific diseases.

      Anti-dsDNA is highly specific for systemic lupus erythematosus (SLE), a multisystem connective tissue disease that can affect the heart, lungs, kidneys, and brain. Patients with SLE may present with a malar rash, polyarthritis, and pleuritis, as well as an increased rate of miscarriage.

      Anti-Jo is associated with myositis, such as polymyositis or dermatomyositis, which present with muscle pain and a rash but no pleuritic pain or an associated history of miscarriage.

      Anti-Ro is associated with Sjögren syndrome, which can have similar features to SLE, including myalgia or polyarthralgia in 50% of patients, as well as skin features of purpura and annular erythema. However, it will not cause pleuritic pain.

      Anti-centromere is associated with limited cutaneous scleroderma, a multisystem autoimmune disease resulting in abnormal growth of connective tissue. It can cause nonspecific musculoskeletal pain but not an associated history of pleuritic and miscarriage.

      Anti-Rh is an antibody to a receptor on blood cells and is not associated with connective tissue disease.

      In conclusion, the presence or absence of autoantibodies does not confirm or exclude a diagnosis of connective tissue disease. A diagnosis is based on a combination of clinical presentation and laboratory tests. Understanding the association between autoantibodies and specific diseases can aid in the diagnosis and management of these complex conditions.

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      • Rheumatology
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  • Question 18 - A 61-year-old man presented to his general practitioner with complaints of pain in...

    Incorrect

    • A 61-year-old man presented to his general practitioner with complaints of pain in his right big toe. He reported experiencing severe pain that disturbed his sleep at night. The patient has a medical history of hypertension and is currently taking thiazide diuretics. He consumes alcohol most nights of the week. During his last visit to the doctor, he was prescribed antibiotics for painful urination. Upon examination, the doctor observed tenderness, redness, and warmth in the right first metatarsophalangeal joint. The doctor decided to perform joint aspiration.
      What is the most probable diagnosis?

      Your Answer: Pseudogout

      Correct Answer: Gout

      Explanation:

      Common Joint Disorders and Infections

      Gout, psoriatic arthritis, pseudogout, septic arthritis, and osteomyelitis are all joint disorders and infections that can cause pain, swelling, and redness in affected joints. Gout is caused by crystal deposition in the joint, most commonly in the big toe, and can be triggered by certain medications, trauma, infection, surgery, and alcohol consumption. Psoriatic arthritis is associated with psoriatic nail disease and can cause sausage-shaped digits, with DIPJs being the most commonly affected joints. Pseudogout occurs due to the deposition of calcium pyrophosphate dehydrate crystals in the joint and usually affects knee joints in patients with previous joint damage. Septic arthritis is caused by joint infection, with gonococci being the most common organism in young patients and Staphylococcus aureus in older patients with pre-existing joint damage. Osteomyelitis is an infection of the bone caused by various organisms and presents with redness, swelling, pain, and tenderness over the affected bone.

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      • Rheumatology
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  • Question 19 - A 30-year-old Afro-Caribbean woman presents with bilateral ankle and wrist pain that has...

    Incorrect

    • A 30-year-old Afro-Caribbean woman presents with bilateral ankle and wrist pain that has been gradually worsening over the past 5 days. She complains of fatigue and feelings of lack of energy. She mentions a dry cough and shortness of breath on exertion, lasting for more than a year. On examination, her vital signs are within normal limits, except for the presence of a mild fever. There are several reddish, painful, and tender lumps on the anterior of the lower legs. A chest X-ray shows bilateral hilar masses of ,1 cm in diameter.
      Which of the following test results is most likely to be found in this patient?

      Your Answer: Elevated cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA)

      Correct Answer: Elevated serum angiotensin-converting enzyme (ACE)

      Explanation:

      Differentiating between Elevated Serum Markers in a Patient with Arthropathy and Hilar Lymphadenopathy

      The presence of arthropathy and hilar lymphadenopathy in a patient can be indicative of various underlying conditions. In this case, the patient’s elevated serum markers can help differentiate between potential diagnoses.

      Elevated serum angiotensin-converting enzyme (ACE) is a common finding in sarcoidosis, which is likely the cause of the patient’s symptoms. Bilateral hilar lymphadenopathy with or without pulmonary fibrosis is the most typical radiological sign of sarcoidosis. Additionally, acute arthropathy in sarcoidosis patients, known as Löfgren syndrome, is associated with erythema nodosum and fever.

      On the other hand, elevated cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) is present in granulomatosis with polyangiitis (GPA), which presents with necrotising granulomatous lesions in the upper and lower respiratory tract and renal glomeruli. It is not typically associated with hilar lymphadenopathy.

      Hyperuricaemia and elevated double-stranded (ds) DNA antibody are not relevant to this case, as they are not associated with the patient’s symptoms. Hyperglycaemia is also not a factor in this case.

      In conclusion, the combination of arthropathy and hilar lymphadenopathy can be indicative of various underlying conditions. Elevated serum markers can help differentiate between potential diagnoses, such as sarcoidosis and GPA.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 20 - What is impacted by Heberden's arthropathy? ...

    Correct

    • What is impacted by Heberden's arthropathy?

      Your Answer: Distal interphalangeal joints

      Explanation:

      Heberden’s Nodules

      Heberden’s nodules are bony growths that form around the joints at the end of the fingers. These nodules are most commonly found on the second and third fingers and are caused by calcification of the cartilage in the joint. This condition is often associated with osteoarthritis and is more common in women. Heberden’s nodules typically develop in middle age.

      Overall, Heberden’s nodules can be a painful and uncomfortable condition for those who experience them. However, the causes and symptoms of this condition can help individuals seek appropriate treatment and manage their symptoms effectively. With proper care and attention, it is possible to minimize the impact of Heberden’s nodules on daily life.

    • This question is part of the following fields:

      • Rheumatology
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