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  • Question 1 - A 41 year old woman who has a history of SLE presents with...

    Incorrect

    • A 41 year old woman who has a history of SLE presents with a dry cough, dyspnoea and fever. She is being treated with a monthly dose of IV cyclophosphamide for Grade IV nephropathy. The last cyclophosphamide dose was 10 years ago. Lab investigations are as follows: WCC: 2.3 (lymphocyte count 0.7), Platelets: 81, Hb: 10.5, ESR: 56, CRP: 43, PO2: 7.2 kPa, PCO2: 3.6 kPa after walking out to the toilet. Chest X ray was unremarkable apart from some patchy pulmonary infiltration. What is the likely diagnosis?

      Your Answer: TB

      Correct Answer: Pneumocystis carinii pneumonia (PCP)

      Explanation:

      Pneumocystis carinii pneumonia, is an opportunistic fungal lung infection occurring almost exclusively in immunocompromised individuals. In 50% of cases, PCP is the first manifestation of AIDS (acquired immune deficiency syndrome), but it may be caused by other immunodeficiency disorders. PCP should be suspected in patients with a history of progressive dyspnoea and a dry cough with resistance to standard antibiotic treatment. Signs that support this diagnosis include a CD4 count < 200/μL, an increased beta-D-glucan level, and diffuse bilateral infiltrates on chest x-ray. Management of PCP includes high-dose trimethoprim/sulfamethoxazole (TMP/SMX), treatment of the underlying immunodeficiency disorder, and steroids in the case of severe respiratory insufficiency. TB is less likely to be present in this case as ESR is relatively low and chest x-ray appeared normal.

    • This question is part of the following fields:

      • Rheumatology
      1418.2
      Seconds
  • Question 2 - An 82 year old man arrives at the clinic with painful right upper...

    Incorrect

    • An 82 year old man arrives at the clinic with painful right upper arm that he has been experiencing for the last few months. The pain is gradually worsening and often wakes him up at night. He is a known case of Paget's disease involving his lumbar spine and pelvis and is currently taking oral bisphosphonates. On examination, shoulder movements are intact. Which of the following is the most likely cause of his arm pain?

      Your Answer: Paget's disease

      Correct Answer: Osteosarcoma

      Explanation:

      Paget’s accelerates the remodelling process with old bone breaking down more quickly which disrupts the normal growth process. New bone development eventually adjusts to the faster pace and speeds up on its own. The pace is too fast for healthy bone growth, and the regrowth ends up softer and weaker than normal. The effect of this accelerated process causes bone pain, fractures, and deformities. Since osteosarcoma is a type of bone cancer linked to abnormal bone growth, this makes it a rare but possible complication of Paget’s disease although the chances of developing osteosarcoma are minimal. Fractures are painful and restrict movement whereas this patients pain is gradually developing. Pain associated with osteoarthritis is usually mild to moderate and worsens as the day progresses.

    • This question is part of the following fields:

      • Rheumatology
      27.6
      Seconds
  • Question 3 - A 26 year old male presents with right sided elbow and wrist pain...

    Incorrect

    • A 26 year old male presents with right sided elbow and wrist pain and left sided knee and ankle pain that has persisted for about two weeks. He recently returned from a trip to Thailand that last for two weeks. The patient admits to having unprotected sex while on holiday. Examination reveals swelling and tenderness of tendons around joints but no inflammation of the joints. A vesiculopustular skin rash is also observed. What is the most likely cause?

      Your Answer: Reactive arthritis

      Correct Answer: Gonococcal arthritis

      Explanation:

      Patients with disseminated gonococcal arthritis may present with dermatitis-arthritis syndrome (60%) of with localized septic arthritis. (40%). Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. Gout usually involves a singe joint and does not cause vesicopustular skin rash. Reactive arthritis has ocular symptoms (conjunctivitis), urethritis, and arthritis. Fungal arthritis occurs rarely and it may occur after a surgical infection or fungal spread hematogenously. it presents with tender, red, hot and swollen joint with loss of range of motion.

    • This question is part of the following fields:

      • Rheumatology
      1081.7
      Seconds
  • Question 4 - Which of the following cancers is responsible in producing osteoblastic bone metastases instead...

    Incorrect

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

      Your Answer: Choriocarcinoma in either gender

      Correct 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
      26.2
      Seconds
  • Question 5 - A 74 year old man presents with 12 kg weight loss and persistent...

    Correct

    • A 74 year old man presents with 12 kg weight loss and persistent back pain that is unrelated to activity for the past several months. Laboratory findings show : WCC: 6.7 x 109/l (5.4 neutrophils, 1.2 lymphocytes and 0.2 monocytes), Haemoglobin: 11.2 g/dL, Haematocrit: 33.3%, MCV: 88 fl, Platelet count: 89 x 109/l. The biochemistry shows: sodium 144 mmol/L, potassium 4.5 mmol/L, chloride 100 mmol/L, bicarbonate 26 mmol/L, urea 14 mmol/L, creatinine 90 μmol/L, glucose of 5.4 mmol/l. A CT scan of the spine reveals scattered 0.4 to 1.2 cm bright lesions in the vertebral bodies. Which of the following additional laboratory test findings is he most likely to have?

      Your Answer: Serum prostate specific antigen of 35 microgram/l

      Explanation:

      Old age, persistent backache, weight loss, and osteosclerotic lesions make prostatic adenocarcinoma the most likely diagnosis. The sequelae include severe pain, pathological fractures, hypercalcemia and cord compression. Prostatic adenocarcinoma is detected by elevated levels of prostate specific antigen. Positive serology for borrelia burgdorferi would hint at Lyme disease which does not cause osteosclerotic bone lesions, neither would Neisseria gonorrhoeae have such a presentation.

    • This question is part of the following fields:

      • Rheumatology
      149.2
      Seconds
  • Question 6 - A 43 year old female presents with an array of symptoms including weakness,...

    Incorrect

    • A 43 year old female presents with an array of symptoms including weakness, lethargy, dysphagia, dry mouth, gritty sensation in her eyes and increased photosensitivity. In order to confirm the suspected diagnosis, which of the following tests should be performed?

      Your Answer: Antineutrophil antibodies

      Correct Answer: Labial gland biopsy

      Explanation:

      To confirm the diagnosis, especially in patients with negative anti-Ro or anti-La antibodies, labial gland biopsy is done. In performing a labial biopsy, the surgeon typically makes a shallow 1/2 inch wide incision on either side of the inner lip after numbing the area with a local anaesthetic. Schirmer’s test determines whether the eye produces enough tears to keep it moist. This test can be done for ocular symptoms of Sjogren syndrome but is of no diagnostic importance as it can be positive with many other diseases.

    • This question is part of the following fields:

      • Rheumatology
      27.5
      Seconds
  • Question 7 - A 33 year old female presents with dyspnoea, myalgia, arthralgia and a skin...

    Correct

    • A 33 year old female presents with dyspnoea, myalgia, arthralgia and a skin rash. The presence of which of the following antibodies would be the most specific for SLE?

      Your Answer: Anti-Sm

      Explanation:

      Anti-Sm antibodies are essential for diagnosis of SLE, especially in anti-dsDNA-negative patients. ANA are also found in 95% of the patients with SLE but they may also occur with other conditions like Juvenile inflammatory arthritis, chronic activity hepatitis, and Sjogren’s syndrome. Anti-Ro, although also found with SLE are more characteristic of Sjogren Syndrome. RF is usually associated with rheumatoid arthritis and cANCA with Wegener’s granulomatosis, Churg Strauss, and microscopic polyangiitis.

    • This question is part of the following fields:

      • Rheumatology
      21.2
      Seconds
  • Question 8 - A 64 year old woman who is of Asian descent and is diabetic...

    Incorrect

    • A 64 year old woman who is of Asian descent and is diabetic (controlled by diet) presents with generalized body aches and difficulty rising from sitting for the last few months. Her blood glucose levels are in the normal range. Lab examination reveals normal blood cell count, low serum phosphate, calcium at the lower range, and raised alkaline phosphatase levels. Radiological examination shows which of the following?

      Your Answer: Osteolytic areas with bone destruction

      Correct Answer: Linear areas of low density

      Explanation:

      Osteomalacia is a condition due to defective mineralization of osteoid. Occurs as a result of Vitamin D deficiency secondary to poor dietary intake and sun exposure, malabsorption e.g., inflammatory bowel disease and gastrointestinal bypass surgery. Radiological findings include reduced bone mineral density (a non specific finding), inability to radiologically distinguish vertebral body trabeculae (the film appears poor quality), looser pseudo fractures, fissures, or narrow radiolucent lines (these are the characteristic findings). Osteolytic or punched out lesions may be seen with multiple myeloma and bony metastases. Areas of sclerosis may be observed with conditions like osteosclerosis and Paget disease. A Brodie abscess is a subacute osteomyelitis, which may persist for years before progressing to a chronic, frank osteomyelitis.

    • This question is part of the following fields:

      • Rheumatology
      89
      Seconds
  • Question 9 - Which of the following statements is the most characteristic of primary Raynaud's phenomena?...

    Correct

    • Which of the following statements is the most characteristic of primary Raynaud's phenomena?

      Your Answer: Fingers are symmetrically involved during an attack

      Explanation:

      A typical attack may last less than an hour but can also persist for longer. In primary Raynaud’s, attacks are more likely symmetric, episodic, and without evidence of peripheral vascular disease. Patients more commonly have a negative ANA and normal inflammatory markers. There should be no evidence of tissue gangrene, digital pitting, or tissue injury in primary Raynaud’s. In contrast, patients with secondary Raynaud’s will describe attacks that are more frequent, painful, often asymmetric and may lead to digital ulcerations.

    • This question is part of the following fields:

      • Rheumatology
      19.2
      Seconds
  • Question 10 - A 22 year old nulliparous female presents with shortness of breath. She has...

    Correct

    • 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: 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
      46.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Rheumatology (4/10) 40%
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