Arthritis Flashcards

Question 1

Q

A 50yr old woman presents to her GP with pain in her joints. She complains that for the past 2 months she has had a lot of difficulty getting dressed in the morning because her hands are always stiff and painful, but this improves as the day goes on. Which investigation is most specific for the most likely diagnosis?

A.X-ray

B.Anti-CCP antibodies

C.Rheumatoid factor

D.MRI

C. c-ANCA antibodies

Question 2

Q

A 50yr old woman presents to her GP with pain in her joints. She complains that for the past 2 months she has had a lot of difficulty getting dressed in the morning because her hands are always stiff and painful, but this improves as the day goes on. What would you be most likely to see on an X-ray of the hand?

A.Joint space narrowing and brown tumours

B.Juxta-articular osteopenia and osteophytes

C.Joint space narrowing and Heberden’s nodes

D.Joint space narrowing and subchondral sclerosis

E.Joint space narrowing and joint erosions

Answer

A

I think it is E BUT NO ANSWERS ON SLIDE

message me if you think differently

Question 3

Q

What are the seronegative spondyloarthropathies?

What are they asssociated with?

Answer

A

PEAR HEADS

Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
Reactive arthritis

Asciated thing

HLA B27
Enthesitis
Asymmetrical oligoarthritis with Axial involvement and extra-articular involvement
Dactylitis
Seronegative

Question 4

Q

Ankylosing spondilitis

Who is affected?

What is the presentation?

What are the investigations?

Answer

A

Who is affected? Affects young men (<40yrs)

What is the presentation?

Articular

Affects spine (enthesitis) and sacroiliac joints (arthritis):
Gradual onset pain and morning stiffness
Eventually bone fusion, and loss of spinal movement
- Question-mark posture: loss of lordosis, kyphosis, neck hyperextension
  - Schober’s test

Extra-articular: the 5 A’s

Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
Amyloidosis
Achilles tendonitis

What are the investigations?

Bloods: ACD, ESR/CRP, albumin

MRI: most sensitive

X-ray:

Mild: sacroilitis
Late: syndesmophytes & bamboo spine

Question 5

Q

What is reactive arthritis?

What does it present as?

Answer

A

What is reactive arthritis?

Sterile inflammation ~2 weeks after extra-articular infection:

GU infection (chlamydia, gonorrhoea)
GI infection (shigella, campylobacter, shigella)

What does it present as?

Arthritis:

Asymmetrical oligoarthritis of lower limbs + spondylitis

Enthesitis:

Dactylitis, Achilles tendonitis, plantar fascitis

Reiter’s syndrome

“Can’t see, can’t pee, can’t climb a tree”
Conjunctivitis, urethritis, arthritis

Question 6

Q

A 28yr old man presents with a 1 month history of lower back pain. When questioned, he mentions it is very difficult for him to get out of bed in the morning, and he struggles to keep his back straight, although this improves over the course of the day. On examination, you note tenderness over the lumbosacral spine and SI joints. Which of the following complications is this man most at risk of?

A.Anterior uveitis

B.Conjunctivitis

C.Aortic aneurysm

D.Urethritis

E. Eczema

Question 7

Q

Septic arthritis

What is the urgency of this problem?

What is the aetiology?

WHat are the risk factors?

What are the presentation?

What are the investigations?

Answer

A

What is the urgency of this problem? - emergency

What is the aetiology?

Inflammation due to infection:

Usually haematogenous spread
Staph. Aureus >30yrs
Neisseria gonorrhoea <30yrs
Direct inoculation

What are the risk factors?

1.Joint damage:

Rheumatoid arthritis; prosthetic joint; gout

2.Infection risk:

Immunosuppression; diabetes; IVDU

What are the presentation?

Acute monoarthritis, usually affecting the knee:

Exquisite pain
Redness and swelling
Restricted ROM
Fever

What are the investigations?

Bloods: ↑ WCC, ↑ CRP
Joint aspirate (before ABx):

Turbid, yellow
Low viscosity
↑ WCC (neutrophils >90%)
MC&S

Question 8

Q

A 32 yr old woman presents to A&E with severe pain in her right knee and an inability to weight bear. An examination of the knee joint reveals a red, tender and swollen knee. Which of the following investigations is most likely to reveal the diagnosis?

A.Serum calcium

B.Serum urate

C.Blood culture

D.Joint aspiration

E.X-ray

Question 9

Q

What is this condition?

What pathogen usually causes it?

What are the different types?

What is the presentation

What are the investigations? What would you find?

What joints are usally affected in adults and children?

Answer

A

What is this condition? osteomylitis

What pathogen usually causes it? staph aureus

What are the different types? haematogenous, contigeus, direct

What is the presentation?

Inflammation (pain & swelling)
Reduced mobility
Fever

What are the investigations? What would you find?

Bloods:

↑ WCC
↑ ESR/CRP
Blood cultures

Imaging:

X-ray
MRI (most sensitive)

What joints are usally affected in adults and children?

Children: Long bones
Adults: Vertebrae - Pott’s disease (TB)

Question 10

Q

A 25yr old man presents to his GP with a 3 day history of pain and stiffness in his right knee and ankle, and pain on passing urine. He has no significant past medical history, however he mentions that he suffered from a “stomach bug” approximately 2 weeks ago. His blood results show:

WCC: 14*109/L (Normal: 4-10)

CRP: 52 (Normal: <5)

What is the most likely diagnosis?

A.Henoch-Schonlein purpura

B.Rheumatoid arthritis

C.Reactive arthritis

D.Systemic lupus erythematosus (SLE)

E.Microscopic polyangiitis

Question 11

Q

A 51 yr old obese man presents to A&E with severe pain in his right toe. The pain came on over the course of an hour and he is now unable to weight bear. He is afebrile. The A&E consultant suspects that this man is suffering from gout, and requests a joint aspirate. Which of the following findings on joint aspiration would support the consultant’s diagnosis?

A.Needle shaped, negatively birefringent crystals

B.Needle shaped, positively birefringent crystals

C.Rhomboid shaped, negatively birefringent crystals

D.Rhomboid shaped, positively birefringent crystals

E.Diamond shaped, negatively birefringent crystals

Question 12

Q

A 63 year old lawyer presents to her GP with a 3 month history of pain in her right thumb. She mentions that the pain is predominantly at the base of her thumb, and it is so severe that at the end of the day that she can no longer type or write with her right hand. Her observations and PMHx are otherwise unremarkable. Which of the following investigations would help to confirm the diagnosis?

A.DEXA scan

B.X-ray

C.Anti-CCP antibodies

D.Rheumatoid factor

E.CT scan