3

Question 1

Felty syndrome is?

Answer 1

Triad of

• rheumatoid arthritis (severe, rheumatoid nodules and vasculitis sxs like necrotizing skin lesions can b seen)
• neutropenia
• splenomegaly

Question 2

A 55yr old women presented with left shoulder stiffness of 2months duration. She helps her disabled husband with his daily activities. She has dm, htn. P/E- markedly decreased active n passive abduction, flexion, rotation at the left shoulder. The remainder of the physical examination is unremarkable.
Dx

Answer 2

Adhesive capsulitis( frozen shoulder)

Question 3

49yr old female came with difficulty swallowing, dry eyes, wt loss. P/E - oral trash, dental caries, bilateral firm submandibular nodules
Dx?
Diagnostic tests (3)

Answer 3

Sjögren syndrome
Schimer test - to check for dry eyes
- antibodies to Ro/SSA & LA/SSB

Question 4

A 13yr old boy came with a limp. He has had left hip pain for several wks. BMI is 31kg/m2. Lt leg is 🚩rotated externally🚩. There’s decreased range of motion and pain with interna rotation
Dx?
Diagnostic test?
Rx

Answer 4

Slipped capital femoral epiphysis
Frog leg lateral view
Surgical pinning of the slipped epiphysis
Can also occur in tall, thin individuals during accelerated growth

Question 5

A sharp forefoot pain involving the metatarsals in a thin female runner is most likely due to?
Mx?

Answer 5

Stress fracture
Remember the female athlete triad- oligomenorrhea, low caloric intake, low bone density
Mx- rest n analgesics but 5th metatarsal n tibial #s need more aggressive Rx

Question 6

In a suspected SLE, which marker should b tested 1st?

Answer 6

ANA

If positive, other more specific tests will b done

Question 7

The most common pulmonary complication in systemic scleroderma?

Answer 7

Interstitial fibrosis

Pulmonary hypertension is also there but less common

Question 8

A 5 yr old boy came with hip pain, limping. He has had a runny nose and congestion for the past 3 days. P/E - lt hip is flexed, slightly abducted, n externally rotated. He’s not febrile, not ill looking. Lab tests including CBC n X-ray r normal
Dx?
It occurs following?
Hip ultrasound may reveal?

Answer 8

Transient synovitis
Usually occurs in boys3-8yrs of age
Usually follows viral infections but can also be post traumatic (eg. Gymnastics) and may present as referred pain in the knee.
- hip U/S :- unilateral or bilateral hip effusion even when sxs r confined to one hip

Question 9

Vertebral compression Vs lumbosacral strain

Answer 9

VCF- point tenderness can b elicited pain typically increases with standing, walking n lying on the back. Risk factors like osteoporosis r present

Question 10

A middle aged adult, presenting with unilateral hip pain especially when pressure is applied, as when sleeping, and with external rotation or resisted abduction
Dx?

Answer 10

Trochanteric bursitis ( bursa at the insertion of gluteus mediums

Question 11

An adolescent presented with anterior knee pain. There is edema n tenderness over the tibial tubercle. Pain can b reproduced by extending the knee against resistance.
Dx?

Answer 11

Osgood-schlatter disease

Question 12

Juvenile idiopathic arthritis is the most common cause of arthritis in children

• Polyarticular subtype of JIA is cxd by? Rx?
• oligoarticular subtype?
• these two r complicated by?

Answer 12

-Most commonly diagnosed in toddler n adolescent girls
- >=5joints within 6months of disease onset (symmetric involvement of wrists, elbows, knees, ankles is common)
- typically have joint pain n stiffness that is worse in the morning and improves over the course of the day
Rx- NSAIDs
Oligo- <=4joint involvement, otherwise similar to polyarticular.
- both can b complicated by uveitis