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
Which one of the following drugs has been associated with an increased risk of atypical stress fractures of the proximal femoral shaft?
spironolactone alendronate quetiapine venlafaxine clopidogrel
alendronate
Adverse effects
oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
osteonecrosis of the jaw
increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
Which of the following is not a recognised feature of temporal arteritis?
rapid response to high dose prednisolone
pyrexia
visual disturbance
elevated creatine kinase
elevated creatine kinase
The radiograph below was taken from a patient who presented with pain, swelling and erythema of the right knee
what is the Dx?
OA
Rheumatoid arthritis
pseudogout
gout
pseudogout
A 30-year-old man with a history of mitral valve prolapse, recurrent pneumothorax, lower back pain secondary to scoliosis and pectus excavatum is considering starting a family. Given the likely diagnosis, what is the mode of inheritance of this condition?
X linked recessive
mitochondrial
autosomal dominant
autosomal recessive
autosomal dominant
A 75-year-old female presents to the emergency department with severe pain and swelling in her right knee. She had a right knee arthroplasty two weeks ago and is concerned about infection.
On examination, the joint has boggy swelling and is extremely tender on palpation and movement. The patient is systemically well with normal observations. A joint aspirate is sent off and the results are not yet available, but you noted that the aspirate appeared translucent. On x-ray, chondrocalcinosis is seen in the right knee.
What is the most likely diagnosis?
septic arthritis compartment syndrome gout pseudogout reactive arthritis
pseudogout
Chondrocalcinosis helps to distinguish pseudogout from gout
also not septic as aspirate would have been cloudy
Claire, a 12-year-old girl presents to a paediatric clinic after being referred by her GP. On examination, her height is in the 90th centile for her age. Her fingers seem long and ‘spidery’ and she is able to the wrap her thumb and little finger around her wrist easily. Her father died of an aortic dissection at the age of 40. Given the most likely diagnosis, which of the following features may be found on clinical examination?
talipes equinovarus hallux valgus cleft palate pectus excavatum positive schober's test
pectus excavatum
Pectus excavatum and pes planus are features of Marfan’s syndrome
Hypermobility, tall stature, long fingers are all features of Marfan’s disease, especially given the family history of aortic dissection.
A 32-year-old woman presents with sudden onset hemiparesis affecting the right face, arm and leg. On examination you note right sided hemiparesis, aphasia, and a right homonymous hemianopia. She has a past medical history of recurrent deep vein thrombosis, pulmonary embolisms and recurrent miscarriages. Blood results reveal a prolonged APTT.
What is the most likely cause of the stroke?
von willebrand disease
embolus from AF
antiphospholipid syndrome
SLE
Factor V leiden
antiphospholipid syndrome
The clinical features are suggestive of antiphospholipid syndrome.
A 73-year-old man presents pain in his right thigh. This has been getting progressively worse for the past 9 months despite being otherwise well. An x-ray is reported as follows:
X-ray right femur: Radiolucency of subarticular region suggestive of osteolysis. Some areas of patchy sclerosis
Bloods tests show:
Calcium 2.38 mmol/l (high)
Phosphate 0.85 mmol/l 9 (n)
ALP 544 u/L (n)
Prostate specific antigen 3.4 ng/ml (normal range for age < 4 ng/mol)
What is the most appropriate action?
vit D supplementation
check serum testosterone
referral to urologist
IV bisphosphonates
IV bisphosphonates
This patient has Paget’s disease as evidenced by an isolated rise in ALP and characteristic x-ray changes. As he has bone pain he should be treated with bisphosphonates.
A 30-year-old woman is diagnosed with systemic lupus erythematosus after presenting with lethargy, arthralgia and a facial rash. Her rheumatologists starts her on hydroxychloroquine. Which one of the following is it most important to monitor?
BP blood sugar QT interval on ECG visual acuity PEFR
visual acuity
Hydroxychloroquine - may result in a severe and permanent retinopathy
