extra rheumatology questions Flashcards
behcet’s syndrome: classic triad of ?
more common in which background?
what % have a +ve family history?
What dermatological finding is Behcet’s syndrome associated with?
anterior uveitis
oral ulcers
genital ulcers
more common in the eastern Mediterranean (e.g. Turkey)
around 30% of patients have a positive family history
Behcet’s syndrome is associated with erythema nodosum
A 29-year-old woman who has just been diagnosed with rheumatoid arthritis presents for review. Her rheumatologist has started methotrexate to help control her symptoms. She currently has no children but is planning to start a family in the next two years. What is the BNF advice regarding methotrexate and pregnancy?
she should wait at least 3 months after stopping MTX before trying to concieve
she should wait at least 6 months after stopping MTX before trying to concieve
she should wait at least 9 months after stopping MTX before trying to concieve
she should wait at least 3 months after stopping MTX before trying to concieve
Patients using methotrexate require effective contraception during and for at least 3 months after treatment in men or women
You review a 48-year-old woman who is taking methotrexate for rheumatoid arthritis. Concurrent prescription of which other medication should be avoided?
erythromycin trimethoprim sumatriptan lansoprazole sodium valproate
trimethoprim
A 25-year-old man presents complaining of dysuria and pain in his left knee. Three weeks previously he had suffered a severe bout of diarrhoea. What is the most likely diagnosis?
reactive arthritis
behcet’s syndrome
UC
Rheumatoid arthritis
reactive arthritis
Urethritis + arthritis + conjunctivitis = reactive arthritis
A 33-year-old Afro-Caribbean woman comes to see you reporting that she has noticed that her hands feel very cold and painful in the winter. In the morning they often change colour to become pale, then blue and red.
She has tried wearing gloves in the winter and using hand warmers both of which have helped her symptoms a little. She is keen to try medications to see if they would help improve things further.
Given the likely diagnosis, which one of the following medications should be prescribed?
propanolol
nifedipine
ibuprofen
amitriptylline
nifedipine
This patient has Raynaud’s syndrome. Patients with Raynaud’s should be advised to keep their hands warm and stop smoking. Nifedipine is the first line drug treatment
what is marfan’s syndrome?
features?
autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1
tall stature with arm span to height ratio > 1.05
high-arched palate
arachnodactyly
pectus excavatum
A 78-year-old man presents with unilateral deafness which has been present for the past 3 months. On examination Webers test localises to the contralateral side and a CT scan of his head shows a thickened calvarium with areas of sclerosis and radiolucency. His blood tests show an elevated alkaline phosphatase, normal serum calcium and normal PTH levels. Which of the following is the most likely underlying diagnosis?
osteoporosis
paget’s disease w/ skull involvement
lung cancer w/ mets
multiple myeloma
paget’s disease w/ skull involvement
A 78-year-old man presents with symptoms of headaches and deteriorating vision. He notices that there is marked pain on the right hand side of his face when he combs his hair.
A. Wegeners granulomatosis B. Polyarteritis nodosa C. Giant cell arteritis D. Takayasu's arteritis E. Buergers disease
Giant cell arteritis
A 20-year-old lady is referred to the vascular clinic. She has been feeling generally unwell for the past six weeks. She works as a typist and has noticed increasing pain in her forearms whilst working. On examination she has absent upper limb pulses. Her ESR is measured and mildly elevated.
A. Wegeners granulomatosis B. Polyarteritis nodosa C. Giant cell arteritis D. Takayasu's arteritis E. Buergers disease
Takayasu’s arteritis
A 32-year-old man presents to the vascular clinic with symptoms of foot pain during exertion. He is a heavy smoker and has recently tried to stop smoking. On examination he has normal pulses to the level of the popliteal. However, foot pulses are absent. A diagnostic angiogram is performed which shows an abrupt cut off at the level of the anterior tibial artery, together with the formation of corkscrew shaped collateral vessels distally.
A. Wegeners granulomatosis B. Polyarteritis nodosa C. Giant cell arteritis D. Takayasu's arteritis E. Buergers disease
Buergers disease
A 56-year-old woman has hardened skin on her face and below her elbows. The skin on her above her elbows is normal. She is also known to have a long-standing history of Raynaud’s phenomenon.
What is the most likely diagnosis?
psoriasis limited cutaneous ss dermatomyositis sclerodactyly SLE
limited cutaneous ss
A 57-year-old man, with a background history of acromegaly, presents with a red, hot, painful and swollen right knee. He says this occurred over the last 3 days, he is apyrexial. He was fit and well before this occurred. His past medical history includes acromegaly which he takes octreotide monthly. He does not take any diuretics. A joint aspirate is performed and an x-ray is taken. The X-ray shows chondrocalcinosis. What would you expect to find on joint fluid microscopy?
weakly +ve rhomboid shaped crystals
chondrocalcinosis is a feature of pseudogout
A 72-year-old female known to have osteoporosis is started on alendronate. Which one of the following side-effects is it most important to warn her about?
sore throat heartburn headache diarrhoea palpitations
heartburn
Bisphosphonates can cause a variety of oesophageal problems
Which of the following findings is not typical in a patient with antiphospholipid syndrome?
prolonged APTT thrombocytosis recurrent venous thrombosis recurrent arterial thrombosis livedo reticularis
thrombocytosis
Antiphospholipid syndrome: arterial/venous thrombosis, miscarriage, livedo reticularis
A 27-year-old woman presents with painful genital ulceration. She has had recurrent attacks for the past four years. Oral aciclovir has had little effect on the duration of her symptoms. She has also noticed for the past year almost weekly attacks of mouth ulcers which again are slow to heal. Her only past medical history of note is being treated for thrombophlebitis two years ago. What is the most likely diagnosis?
behcet’s syndrome
sarcoidosis
herpes simplex virus type 2
SLE
behcet’s syndrome
