LOCO revision 7 Flashcards
State which disease causes A-C
A: RA
B: OA
C: gout
Saw tooth erosion is associated with which type of OA? [1]
Erosive OA
A 30-year-old female presents to a clinic with worsening joint pains, low-grade fever and tiredness for the past 5 months. She also has chest pain that increases when breathing in. On examination, there are painless ulcers in her oral cavity. There is a reddish butterfly-patterned rash on her cheeks. She mentions that the rash worsens when she goes out into the sun. Her blood tests show:
Hb 98 g/L Male: (135-180)
Female: (115 - 160)
Platelets 95 * 109/L (150 - 400)
WBC 3.2 * 109/L (4.0 - 11.0)
ESR 90 mm/hr (0 - 20)
Urinalysis reveals proteinuria and red cell casts. Investigations for autoantibodies are sent for the patient.
Which of the following has the highest sensitivity for the condition this patient is most likely to have?
Anti-La antibodies
Anti-Ro antibodies
Anti-Smith antibodies
Anti-dsDNA antibodies
Antinuclear antibodies (ANA)
Antinuclear antibodies (ANA)
Which of the following is true regarding rheumatoid factor?
It is usually an IgM molecule reacting against patient’s own IgG
High titres are not associated with severe disease
Rose-Waaler test involves agglutination of IgG coated latex particles
80% of SLE patients are RF positive
90% of patients with Sjogren’s syndrome are RF positiv
It is usually an IgM molecule reacting against patient’s own IgG
Which one of the following confers the least risk of developing osteoporosis?
Obesity
Long term unfractionated heparin therapy
Gastrectomy
Osteogenesis imperfecta
Diabetes
Obesity: Low BMI increases the risk of OP
A 34-year-old male is asked to grasp a piece of paper between his thumb and index finger. He is unable to do this.
Which other action is the patient most likely to be struggle with?
Abduction of the thumb
Adduction of his fingers
Extension of his wrist
Pronation of the wrist
Supination of the wrist
Adduction of his fingers: nerve palsy
Question 28 of 152
A 23-year-old woman suffers from recurrent anterior dislocations of her left shoulder. A CT scan reveals a Bankart lesion. This is a lesion of the anterior glenoid labrum. Which rotator cuff muscle tendon is found at the anterior aspect of the shoulder capsule?
Teres minor
Supraspinatus tendon
Teres major
Subscapularis tendon
Infraspinatus tendon
Subscapularis tendon
What is the pathophysiological process causing rickets?
Excessive activity of receptor activator of nuclear factor kappa-Β ligand (RANKL)
Excessive mineralised osteoid
Excessive non-mineralised osteoid
Excessive osteoclast activity
Inadequate osteoclast activity
Excessive non-mineralised osteoid
A 34-year-old man presents to the emergency department complaining of pain in his right hand after a fall 5 days ago. The pain is on the dorsum of the hand, at the base of his thumb. He explains that he fell forwards whilst playing football but managed to catch himself with his right hand before his head hit the floor.
On examination, there is marked tenderness on palpation of the base of the first metacarpal on the dorsum of his hand. There is also swelling in this area.
What type of fracture is the patient most likely to have sustained?
Boxer’s fracture
Colles’ fracture
Galeazzi fracture
Scaphoid fracture
Smith’s fracture
Falling onto an outstretched hand (FOOSH) is the most common mechanism causing a scaphoid fracture
A 61-year-old female presents to the rheumatology clinic with a new diagnosis of rheumatoid arthritis. She is started on a short course of steroids and a disease modifying anti-rheumatic drug. What type of joint is primarily affected in rheumatoid arthritis?
Synovial
Fibrous
Cartilaginous
Synostosis
Hyaline
Synovial
A 52-year-old woman with muscle aches presents to the general practice. She has been experiencing this for well over a year and it affects her chest and back more so than her limbs. On questioning, she alludes to having bouts on average every 3 months of becoming short of breath. She lives a very healthy lifestyle remaining abstinent from drinking and smoking.
On examination, she has a flat erythematous rash on her torso and purple discolouration bilaterally around the eyelids which she explains she has had for a long time.
Which antibody is associated with the patient’s condition?
Anti-Jo-1
Anti-Scl-70
Anti-smooth muscle
Anti-histone
C-ANCA
Anti-Jo-1
Dermatomyositis is associated with the anti-Jo-1 antibody
A 70-year-old woman who has a strong family history of fragility fractures secondary to osteoporosis presents as she is concerned about her own risk. What is the most appropriate way to assess her risk?
Order an x-ray of her hips and lumbar spine
Assess her using the Birmingham Hip Score tool
Order a MRI of her hips and lumbar spine
Check her calcium and phosphate levels
Assess her using the FRAX tool
Assess her using the FRAX tool
A 27-year-old male attends his general practitioner with lower back pain. He reports that the back pain has been present for the past year and has minimal improvement with oral ibuprofen and paracetamol. He has found that it is worse in the morning and swimming helps alleviate his symptoms. He has no history of trauma and works as a tax analyst, preferring to run for exercise than perform heavy lifting routines. He has no past medical history of note and no drug allergies.
What is the most likely radiological finding in this patient?
‘Pencil in cup’ deformity
Bamboo spine
Osteophytes
Sacroiliitis
Vertebral collapse
Sacroiliitis (Bamboo spine is a sign of late stage AS)
An 84-year-old gentleman presents to GP with stiffness and swelling of the joints on his right hand. On inspection, you see uniform swellings predominantly affecting the distal interphalangeal (DIP) joints, which are non-tender and hard on palpation. He is otherwise systemically well and no other joints are affected. There is no relevant past medical history.
What is the most likely clinical sign described?
Boutonniere deformity
Bouchard’s nodes
Rheumatoid nodules
Heberden’s nodes
Calcinosis cutis
Heberden’s nodes
RA
Methotrexate and Rituximab would be
First line treatment
Second line treatment
Third line treatment
Fourth line treatment
Third line treatment
RA
Methotrexate and a 2nd line DMARD would be
First line treatment
Second line treatment
Third line treatment
Fourth line treatment
First line treatment
RA
Methotrexate & a TNF-inhibitor would be
First line treatment
Second line treatment
Third line treatment
Fourth line treatment
Second line treatment
Methotrexate inhibits which enzyme? [1]
dihydrofolate reductase
RA
Sulfasalazine is a prodrug for [1]
5-ASA
RA Treatment:
Hydroxychloroquine blocks:
TLR7
TLR8
TLR9
TLR10
TLR11
TLR9
RA
Leflunomide inhibits which enzyme? [1]
What is the effect of this? [2]
Dihydroorotate dehydrogenase (DHODH): stops pyrimidine synthesis & therefore reduces pro-inflammatory cytokines: IL-1, TNF-A and IL-6; Blocks T cell proliferation
Which is the staple treatment for RA?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Which is the staple treatment for RA?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Which treatment for RA inhibits dihydrofolate reductase?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Which treatment for RA inhibits dihydrofolate reductase?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Which treatment for RA reduces purine synthesis?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Methotrexate
Which treatment for RA reduces pyrimidine synthesis?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Leflunomide
Which treatment for RA is safe for pregnant people?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Sulfasalazine
Which treatment for RA is prodrug that operates in large intestine?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Which treatment for RA is prodrug that operates in large intestine?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Which treatment for RA that targets TLR-9?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Hydroxychloroquine
Which treatment for RA that reduces dendritic cell activation?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Hydroxychloroquine
Which is a treatment for RA that inhibits dihydro-orotate dehydrogenase?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Leflunomide
Which treatment for RA requires folate to be given alongside?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Methotrexate
Which treatment for RA is a tumor necrosis factor-alpha (TNF-alpha) inhibitor?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Infliximab
Which treatment for RA is a monoclonal antibody?
Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab
Infliximab
Which treatment for RA is an anti-CD20 monoclonal antibody?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Rituximab
Which treatment for RA causes B cell depletion?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Rituximab
Which treatment for RA leads to decreased T-cell proliferation and cytokine production?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Abatacept
Which treatment for RA is an IL-1 antagonist?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Anakinra
Which treatment for RA targets IL-6?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Tolizumab
Which treatment for RA targets upregulates CTLA-4, which switches T cell off?
Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab
Tolizumab
Which one of the following adverse effects is most characteristically associated with hydroxychloroquine?
Liver impairment
Interstitial lung disease
Hypertension
Liver impairment
Interstitial lung disease
Hypertension
Retinopathy
Hepatoxicity
This image shows which type of fracture?
Hangman fracture
Colles fracture
Smith fracture
Wedge fracture
Colles fracture
A garden spade deformity arises from a
Hangman fracture
Colles fracture
Smith fracture
Wedge fracture
Smith fracture
This shows what type of deformity? [1]
What type of fracture would this have arisen from? [1]
Garden spade; due to Smith fracture
This shows a
Hangman fracture
Colles fracture
Smith fracture
Wedge fracture
Wedge fracture
hyperflexion injuries to the vertebral body resulting from axial loading
This best describes a
Hangman fracture
Colles fracture
Smith fracture
Wedge fracture
Wedge fracture
Dinner fork deformity arises from improper healing of a
Hangman fracture
Colles fracture
Smith fracture
Wedge fracture
Colles fracture
What is the name for this type of fracture? [1]
Jefferson fracture
What is impingement syndrome
Compression of the musculocutaneous nerve
Compression of the long thoracic nerve
Inflammation of the long head of the biceps brachii
Inflammation of the supraspinatus tendon
Compression of the axillary artery
Inflammation of the supraspinatus tendon
Patient fractures their medial epicodondyle of the humerus, how do they present clinically?
Claw hand
Hand of benediction
Thumb wasting
Wrist drop
Basically normal
Basically normal: proximal ulnar damage
