Classic Presentations

Question 1

A 40 year old woman presents with pain and stiffness in the hands and feet that is worse after resting and relieved with movement. It takes at least 30 minutes in the morning for the stiffness to ease up. On examination the joints are soft and warm and the DIP joints are spared.

Answer 1

Rheumatoid arthritis

Question 2

A 30 year old man presents with spinal pain and stiffness that is worse in the morning and improves with exercise

Answer 2

Ankylosing spondylitis

Question 3

A patient presents with an asymmetrical oligoarthritis and arthritis in the small joints of the hands that does not spare the DIP. Their nails are also pitted and have onycholysis

Answer 3

Psoriatic arthritis

Question 4

A patient with IBD presents with pain/stiffness asymmetrically in the knees, ankles, elbows and wrists

Answer 4

Enteropathic arthritis

Question 5

A 30 year old patient presents with fever, fatigue, malaise and arthritis in the knee. A few weeks earlier they were treated for an STI (or had a stomach bug)

Answer 5

Reactive arthritis

Question 6

An immunocompromised patient who you suspect of injecting drugs presents with an acute onset, painful, red, hot, swollen and tender joint with severe pain on any movement

Answer 6

Septic arthritis

Question 7

A 25 year old woman of Asian descent presents with fever, fatigue, weight loss and poor appetite. On her face is a rash that spreads across her cheeks and nose but spares her naso-lablial folds. Antibody tests reveal the presence of ANA and o anti-dsDNA

Answer 7

Lupus

Question 8

A 55 year old woman presents with dry eyes and mouth. She also complains of fatigue, bad teeth and a swelling in her parotid gland. Antibody testing shows the presence of anti-Ro and anti-La

Answer 8

Sjogrens syndrome

Question 9

A patient presents with sclerodactyly and telangiectasia. They also experience Raynaud’s. These symptoms are confined to the face, hands, forearms and feet. Antibody tests show the presence of anti-centromere antibody

Answer 9

Limited systemic sclerosis

Question 10

A patient presents with sclerodactyly and telangiectasia. They also experience Raynaud’s. The cutaneous symptoms are located both centrally and distally. The patient also has pulmonary fibrosis and pulmonary hypertension. Antibody tests show the presence of Anti-Scl-70

Answer 10

Diffuse cutaneous systemic sclerosis

Question 11

A patient presents with chronic myositis, arthrits, Raynauds, sclerodactyly and pulmonary hypertension. Antibody tests show the presence of anti-RNP antibodies

Answer 11

Mixed connective tissue disease

Question 12

A young person experiences multiple unexplained venous and arterial events. Blood tests show o IgM or IgG anticardiolipin antibodies, lupus anticoagulant and o IgM or IgG beta 2 glycoprotein

Answer 12

Anti-phospholipid syndrome

Question 13

An elderly patient complains of pain and stiffness in their neck, shoulders and hips. It’s worse in the morning and takes at least an hour to subside

Answer 13

Polymyalgia rheumatica

Question 14

A 50 year old woman presents with symmetrical, proximal muscle weakness in the upper and lower extremities that has been gradually worsening over months. Antibodies tests show the presence of anti-Jo-1 and CK level is raised

Answer 14

Polymyositis

Question 15

A 50 year old woman presents with symmetrical, proximal muscle weakness in the upper and lower extremities that has been gradually worsening over months. She also has a red rash across her eyes, chest, shoulders and down her fingers

Answer 15

Dermatomyositis

Question 16

A man presents with distal muscle weakness that has gradually been getting worse over the course of years. The weakness is asymmetrical

Answer 16

Inclusion body myositis

Question 17

A 30 year old women complains of widespread pain on both sides of her body that has been present for 3 months. She also reports fatigue, headaches and memory problems

Answer 17

Fibromyalgia

Question 18

An elderly patient complains of headaches and problems with their vision. They have also noticed tenderness in their scalp and intermittent pain in their jaw. On examination, the temporal artery is tender, enlarged and non-pulsatile

Answer 18

Giant cell arteritis

Question 19

A young Asian woman presents with low-grade fever, malaise, night sweats, weight loss, arthralgia and fatigue. She is also experiencing claudicant symptoms in both upper and lower limbs

Answer 19

Takayasu arteritis

Question 20

A 45 year old woman of European descent presents with fever and weight loss, arthralgia, nose bleeds and nasal crusting, mouth ulcers and a cough. Her nose has a ‘saddle nose’ appearance. Antibody tests show cANCA.

Answer 20

Granulomatosis with polyangiitis (GPA/Wegener’s)

Question 21

A patient presents with late onset asthma. They also have paranasal sinusitis, pulmonary infiltrates and polyneuropathy. Blood tests show a high eosinophil count and pANCA

Answer 21

Eosinophilic granulomatosis with polyangiitis (EGPA)/Churg-Strauss

Question 22

A child presents with purpuric rash over the buttocks and lower limbs, abdominal pain and vomiting and joint pain. A few weeks prior they had an URTI.

Answer 22

Henoch-Schonlein purpura