Formative assessment 2 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?
Refer him 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?
Temporal artery biopsy
A 50 year old man attends his GP complaining of swelling of his toes. He has just returned from a holiday to celebrate his birthday. He has high blood pressure and his BMI is 32. This is a picture of his foot.
What test would be most helpful to establish a diagnosis?
Aspirate the joint
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?
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?
Vitamin D status
In Rheumatoid Arthritis which cells are directly responsible for the loss of articular cartilage?
Osteoclasts
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?
Pseudogout
Which autoantibodies are specific for Rheumatoid Arthritis?
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?
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?
MRI of the 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?
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?
Sulfasalazine
