Formative 4 Flashcards
A 60 year old man falls whilst working in his garden fracturing his left hip. Once he has recovered from the fracture which of the following would be the next step in his management?
a) Reassure him that this was simply bad luck as men his age are not at risk of osteoporosis
b) commence him on bisphosphonate therapy
c) refer for a bone density scan
d) advise him to avoid working in the garden
e) commence calcium and vitamin D supplements
c) refer for a bone density scan
A 75 year old man presents with acute sudden onset unilateral headache, on a background of 2 month history of pain and stiffness of the shoulder girdle. Which of the following investigations would be the most likely to help towards a diagnosis?
a) ESR
b) Rheumatoid factor (RF)
c) CT head
d) temporal artery biopsy
e) anti-neutrophil cytoplasmic antibodies (ANCA)
d) temporal artery biopsy
A 22 year old female patient presents with 3 month history of stiffness and swelling of the hand joints and new onset right sided sharp chest pain on inspiration. Urinalysis shows microscopic haematuria and proteinuria.
Which of the following immunological tests would support your clinical suspicion?
a) Anti-centromere antibodies
b) Anti-CCP antibodies
c) Rheumatoid factor
d) Anti double stranded DNA antibodies
e) Anti smooth muscle antibodies
d) Anti double stranded DNA antibodies
A 35 year old Asian computer programmer presented to his GP with widespread muscle pain and weakness, and difficulty rising from his chair. His alkaline phosphatase is elevated at 2000 and serum calcium is just below the reference range.
Which of the following tests would be diagnostic for the underlying cause of his problems?
a) Creatinine kinase
b) Rheumatoid Factor
c) Ultrasound of his muscles
d) Vitamin D status
e) Isotope bone scan
d) Vitamin D status
In Rheumatoid Arthritis which cells are directly responsible for the loss of articular cartilage?
a) Macrophages
b) Synovial fibroblasts
c) T cells
d) B cells
e) Osteoclasts
b) Synovial fibroblasts
A 78 year old healthy woman on no medications, presents acutely with a hot, swollen left knee. She was previously well with only mild knee pain on coming down stairs. No other joints are involved. She is struggling to weight bear on her knee.
What is the most likely diagnosis?
a) Rheumatoid arthritis
b) Psoriatic arthritis
c) Pseudogout
d) Trauma
e) Osteoarthritis
c) Pseudogout
Which autoantibodies are specific for Rheumatoid Arthritis?
a) ANA
b) ENA
c) Anti-CCP
d) ANCA
e) Rheumatoid factor
c) Anti-CCP
A 50 year old lady attends her GP. She is concerned that she has osteoporosis as her mother has been diagnosed with this. How should her GP proceed?
a) Perform a fracture risk assessment
b) Refer for a bone density scan
c) Explain that she is too young for osteoporosis and ask her to return in 5 years time
d) Commence therapy with HRT
e) Commence calcium and Vitamin D supplements
a) Perform a fracture risk assessment
A 23 year student sees his GP with a several year history back pain and stiffness. The pain is worse at night, first thing in the morning and if he has been sitting for long periods studying. He is otherwise well apart from a previous episode of a red, painful eye for which he received some steroid eye drops. On examination he has a reduced Schobers test and is tender over his right sacroiliac joint.
Which investigation would be most helpful in reaching a diagnosis?
a) CRP
b) HLA B27
c) MRI whole spine
d) Anti-CCP antibody
e) Trial of non-steroidal anti-inflammatory medication
c) MRI whole spine
A 67 year old female patient presents with 3 month history of proximal weakness of the upper and lower limbs. She struggles to lift her arms above the shoulder level and to stand from sitting unaided. Her blood tests show elevated ESR at 80 and raised creatine kinase at 5 times the upper limit of normal range.
What is the most likely diagnosis?
a) Polymyalgia rheumatica
b) Rheumatoid arthritis
c) Osteoarthritis
d) Polymyositis
e) Giant cell arteritis
d) Polymyositis
A 30 year old woman is newly diagnosed with rheumatoid arthritis. She has a two year old daughter and is currently trying for another baby. She has synovitis across the MCPs in both hands and has evidence of erosions and joint damage on X-ray.
Which of the following treatment options would be best in this case?
a) Non steroidal anti-inflammatory
b) Methotrexate
c) Sulfasalazine
d) Leflunomide
e) Paracetamol
c) Sulfasalazine
