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LOCO2 Qs Flashcards

1
Q
A
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2
Q

Which of the following is the glenoid labrum?

A
B
C
D
E

A

Which of the following is the glenoid labrum?

A
B
C
D
E

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3
Q

Which of the following is the acromion?

A
B
C
D
E

A

Which of the following is the acromion?

A
B
C
D
E

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4
Q

Which of the following is the scapula?

A
B
C
D
E

A

Which of the following is the scapula?

A
B
C
D
E

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5
Q

Which of the following is the supraspinatus muscle?

A
B
C
D
E

A

Which of the following is the supraspinatus muscle?

A
B
C
D
E

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6
Q

Which of the following is the glenoid labrum

A
B
C
D
E

A

Which of the following is the glenoid labrum

A
B
C
D
E

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7
Q

Which of the following is the glenoid cavity

A
B
C
D
E

A

Which of the following is the glenoid cavity

A
B
C
D
E

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8
Q

What is muscle D? [1]

What is bone E? [1]

A

D: supraspinatus

E: Acromion

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9
Q

Which of the following is the articular capsule

A
B
C
D
E

A

Which of the following is the articular capsule

A
B
C
D
E

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10
Q

Which of the following is the articular capsule

A
B
C
D
E

A

Which of the following is the articular capsule

A
B
C
D
E

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11
Q

Osteophytes are a hallmark of

Osteomalacia
Osteopenia
Osteosarcoma
Osteoarthiritis
Osteoporosis

A

Osteophytes are a hallmark of

Osteomalacia
Osteopenia
Osteosarcoma
Osteoarthiritis
Osteoporosis

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12
Q

This CT is suggestive of a patient with

Osteomalacia
Osteopenia
Osteosarcoma
Osteoarthiritis
Osteoporosis

A

Osteoporosis - kyphosis present

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13
Q

Giant osteoclasts are associated with long term treatment of which drug class? [1]

A

Bisphosphonates

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14
Q

Tinnitus may occur with which of the following bone disorders?

A. Rheumatoid arthritis
B. Paget disease
C. Multiple myeloma
D. Gout

A

Tinnitus may occur with which of the following bone disorders?

A. Rheumatoid arthritis
B. Paget disease
C. Multiple myeloma
D. Gout

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15
Q

RA

Which molecule induces sclerostin within the pathophysiological process? [1]

A

DKK

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16
Q

Which cell type breaks down hyaluronic acid in RA pathophysiology? [1]

A

Neutrophils

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17
Q

Which of the following is associated with RA?

  • Heberden’s nodes
  • Boutonniere deformity
  • Bouchard’s nodes
  • Sadness
A

Boutonniere deformity

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18
Q

Name this RA symptom [1]

A

Boutonniere deformity

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19
Q

Label A-D of RA symptoms

A

A: ulnar deviation
B: z-deformity
C: swan neck
D: Boutonniere deformity

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20
Q

RA

Label A & B

A

A: swan neck deformity

B: Boutonniere deformity

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21
Q

Seropostive (ACPA positive) RA is more likely in people with which HLA

  • HLA DRB1 alleles
  • HLA DRB2 alleles
  • HLA DRB3 alleles
  • HLA DRB4 alleles
A

HLA DRB1 alleles

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22
Q

Which of these joints would you least likely see swollen & painful joints in RA?

metacarpophalangeal (MCP)
Metatarsophalangeal (MTP)
proximal interphalangeal (PIP)
distal interphalangeal (DIP)

A

distal interphalangeal (DIP)

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23
Q

RA

NETosis is a key pathophysiological process of RA.
Which ion needs to be present for it to occur? [1]

A

Ca2+

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24
Q

State a key enzyme found in NETosis net:

PAD1
PAD2
PAD3
PAD4
PAD5

A

PAD4

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25
Q

Rheumatoid factor is found on which Ig

IgG
IgA
IgM
IgD
IgE

A

IgM

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26
Q

Rheumatoid factor is found on IgM and binds to Fc portion of

IgG
IgA
IgM
IgD
IgE

A

IgG

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27
Q

Which molecule has the most sensitivity for RA diagnosis?

RF
PAD4
ACPA
A-CarP

A

ACPA

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28
Q

A 58 year old woman is seen by her GP after a left wrist fracture. She was standing on a chair to change a lightbulb, lost her balance and feel off onto her outstretched hand. She was seen in A&E, where a cast was applied. She was followed up in the fracture clinic, where the cast was removed and she was discharged. The discharge letter requested that her GP review her risk of future fractures. She says she leads a healthy lifestyle, with a balanced diet and regular exercise. She does not smoke or drink alcohol and has no significant ongoing medical problems.

A DEXA scan is arranged, which shows a T-Score at the hip of -2.1.

What term best describes her bone mineral density?

Osteopenia
Osteosclerosis
Normal
Osteoporosis
Osteomalacia

A

Osteopenia

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29
Q

A 64 year old man is under the care of the diabetic foot clinic for a deep ulcer on the plantar aspect of the foot in the area of the second metatarsal. He is admitted to hospital with a low-grade fever of 37.9°C, lethargy and loss of appetite. He is started on IV antibiotics.

An MRI scan of his foot confirms osteomyelitis.

What is the most likely causative organism?

Pseudomonas aeruginosa
Group A streptococcus
Staphylococcus aureus
Escherichia coli
Anaerobic bacteria

A

Staphylococcus aureus

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30
Q

A 58-year-old male presents with severe pain in his left knee. This came on suddenly this morning and is not relieved by paracetamol. He is systemically well and has no significant past medical history, except for a BMI of 31. He was assessed by colleagues in the emergency department, with joint aspiration showing positively birefringent, rhomboid-shaped crystals.

What is the most likely diagnosis?

Osteomyelitis
Septic arthritis
Gout
Psoriatic arthritis
Pseudogout

A

Pseudogout

Pseudogout presents with positively birefringent crystals, often described as “rhomboid” in shape. In comparison, gout crystals are negatively birefringent crystals, often described as “needle” in shape.

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31
Q

A 58-year-old woman goes to see her GP complaining of enlarging nodules around the olecranon processes of both elbows. She originally noticed them a year ago, but has attended today as they have been getting slowly larger, more unsightly and tender. She reports no longer being able to rest on her elbows.

She is known to be under a Rheumatologist for a chronic inflammatory arthropathy and has been taking Methotrexate for the last eight months.

An image of her elbow is provided below.

What disease is her rheumatologist treating her for?

Source: Dr J.Atkins
Ankylosing Spondylitis
Gout
Psoriatic Arthritis
Seropositive Rheumatoid Arthritis
Seronegative Rheumatoid Arthritis

A

Seropositive Rheumatoid Arthritis

This is a typical rheumatoid nodule. They can occur in any tissue, but the commonest sites where they are clinically apparent are the olecranon area of the elbow and the extensor surfaces of the fingers/wrists. They are only found in seropositive rheumatoid arthritis.

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32
Q

Which one of the following diseases are the findings on this spinal X-ray consistent with?

Prostate cancer
Gout
Vitamin D deficiency
Ankylosing spondylitis
Discitis

A

Ankylosing spondylitis

The X-ray shows the typical appearances of ankylosing spondylitis including:

Squaring of the vertebral bodies
Vertebral body fusion
Ossification of spinal ligaments
The combination of these radiographic features is referred to as a bamboo spine.

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33
Q

A 40-year-old man presents to the emergency department with an acutely swollen and extremely painful left knee. This started suddenly and woke him from sleep. He has no past medical history and takes no regular medication. The man is overweight and admits to having at least 4 pints of beer a night for as long as he can remember.

On examination, he has a temperature of 37.6°C, but observations are otherwise normal. He is systemically well. The left knee appears erythematous and tender to touch. Urine dipstick is normal.

Synovial fluid is aspirated from the left knee, and microscopy is performed and demonstrated below.

Euthman. License [CC BY 2.0].
What is the most likely diagnosis?

Gout
Osteoarthritis (OA)
Hydroxyapatite deposition disease (HADD)
Septic arthritis
Pseudo-gout

A

Gout

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34
Q

A 35-year-old Asian woman is being treated for pleural effusion as an inpatient. During the ward round your consultant points out that she appears to have a rash over her cheeks, Upon further questioning, the patient tells you that she noticed the rash a few months ago and that she has been feeling very fatigued recently.

She claims to have no past medical history, family history and is not on any medication.

You are suspicious that this patient could have systemic lupus erythematosus (SLE). Which of the following autoantibody tests would be the most sensitive?

Anti-smooth muscle antibody
Rheumatoid factor
Antinuclear antibody
Anti-double-stranded DNA
Anti-Ro antibody

A

Antinuclear antibody

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35
Q

Platelet rich plasma (PRP) is a novel treatment process for

Osteoporosis
Osteomalacia
Osteoarthritis
Rheumatoid arthritis

A

Osteoarthritis

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36
Q

Adalimumab is a treatment for OA. Which cytokine does it target?

IL-1
IL-6
TNF-a
IL-17

A

TNF-a

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37
Q

OA

Red arrow highlights

  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • Subchondral cysts
A

symmetric joint space narrowing (because it is harder to see what is not there, this is best appreciated by mentally contrasting with the NORMAL joint space, shown by red arrow on the figure to the left),

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38
Q

OA

Orange arrow highlights

  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • Subchondral cysts
A

Osteophytes

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39
Q

OA

Blue arrow highlights

  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • Subchondral cysts
A

Subchondral cysts

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40
Q

Green arrow highlights

  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • Subchondral cysts
A

subchondral sclerosis (the white line at the surface green arrow),

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41
Q

Farmers often have OA in the

Knee
Spine
Hip
Hands

A

Hip

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42
Q

A normal Q angle is

10 - 15 degrees
10 - 25 degrees
15 - 20 degrees
15 - 25 degrees

A

15 - 20 degrees

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43
Q

Erosive OA typically has erosion of cartilage in

Thumb DIP
Index finger PIP
Middle finger DIP
4th finger PIP
Little finger DIP

A

Middle finger DIP

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44
Q

A 21-year-old man presents to the general practitioner with a 3-month history of lower back pain that radiates to the buttocks. This is worst in the morning, improves with exercise and occasionally wakes him at night.

Which of the following is the most likely diagnosis?

Ankylosing spondylitis

Intervertebral disc herniation

Reactive arthritis

Rheumatoid arthritis

Spinal stenosis

A

Ankylosing spondylitis

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45
Q

This is a patient with OA. The arrow points to

  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • Subchondral cysts
A

Subchondral cysts

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46
Q

Name this symptom of gout [1]

A

Gout tophi

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47
Q

Name this symptom of gout [1]

A

Podagra

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48
Q

Rat bite erosions would suggest a patient is suffering from

Gout
Osteoarthritis (OA)
Hydroxyapatite deposition disease (HADD)
Septic arthritis
Pseudo-gout

A

Gout

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49
Q

This histological slide is suggestive of

Gout
Osteoarthritis (OA)
Hydroxyapatite deposition disease (HADD)
Septic arthritis
Pseudo-gout

A

Gout

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50
Q

This histological slide is suggestive of

Gout
Osteoarthritis (OA)
Hydroxyapatite deposition disease (HADD)
Septic arthritis
Pseudo-gout

A

Gout

Figure 1. Typical granuloma in gout. The central part is formed by urate crystals. The inflammatory cells surrounding the area of crystals typical include macrophages, lymphocytes, plasma cells and giant cells. This is typical morphology within tophi. No histologic morphology of a coexisting rheumatoid arthritis was present. Fixation: formalin. H&E: amplification, × 20.

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51
Q

Name the molecule that would be elevated in this patient

A

Monosodium urate crystal

(patient has gout)

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52
Q

A patient has synovial fluid extracted and it looks like this. What is the patient most likely suffering from

Gout
Osteoarthritis (OA)
Hydroxyapatite deposition disease (HADD)
Septic arthritis
Pseudo-gout

A

Gout

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53
Q

Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid?

Consumption of too much alcohol

Inadequate elimination of uric acid via the kidneys

Infection causing build-up of uric acid

Production of too much uric acid in the body

A

Inadequate elimination of uric acid via the kidneys

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54
Q

Which of the following joints is most commonly affected by uric acid crystal accumulation and gout attacks?

A.
Big toe
B.
Fingers
C.
Hip
D.
Shoulder

A

Big toe

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55
Q

Sudden gout flare-ups (attacks) can occur without warning. Which of the following is NOT a known trigger of a sudden gout flare-up?

Illness
.
Injury

Use of certain antidepressant medications

Use of certain blood pressure medications

A

Use of certain antidepressant medications

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56
Q

What type of hypersensitivity reaction is rheumatoid arthritis?

It isn’t a hypersensitivity reaction
Type 2
Type 1
Type 3
Type 4

A

Type 3

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57
Q

You are assessing a referral report for one of your patients which mentions that the HLA DR1 gene has been identified.

What disease is this indicative of?

Sjogrens
SLE
Rheumatoid arthritis
Scleroderma
Polymyositis

A

Rheumatoid arthritis
Rheumatoid arthritis is associated with the following antibodies: HLA DR1, HLA DR4, Anti CCP, ACPA (can be positive or negative).

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58
Q

A patient with diagnosed osteoarthritis visits his GP about some swellings that have developed in his hands. The GP explains that the swellings the patient is concerned about are called Bouchard’s nodes.

Where are Bouchard’s nodes located?

Metacarpophalangeal (MCP) joints
Proximal interphalangeal (PIP) joints
Carpometacarpal (CMC) joints
Distal interphalangeal (DIP) joints
Base of the thumb

A

Proximal interphalangeal (PIP) joints

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59
Q

Jamie Tan, a 14-year old girl who immigrated to the UK from Singapore, presents to her GP with polyarthritis. She has a history of childhood chorea. On examination, a mid-diastolic rumbling murmur is heard, loudest in the 5th intercostal space in the mid-clavicular line.

What is the most likely diagnosis?

Aortic regurgitation
Mitral stenosis
Aortic stenosis
Mitral regurgitation
Mitral valve prolapse

A

Mitral stenosis

It is most likely caused by a previous episode of rheumatic fever. This is a systemic inflammatory condition that may develop 2-6 weeks post-pharyngeal infection e.g. with Streptococcus pyogenes. It causes antibodies to be produced that cross-react with self-tissues, e.g. in the heart, joints and skin. Left untreated it can also cause latent Sydenham’s chorea and mitral valve stenosis (most common cause) in later life. It is treated with 1 dose of intramuscular benzylpenicillin.

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60
Q

Which one of the following is used in the management of acute gout?

Allopurinol
Febuxostat
Probenecid
Colchicine

A

Colchicine: inhibits microtubule polymerisation by binding tubulin. This impairs neutrophil chemotaxis and degranulation

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61
Q

High uric acid levels are common. Above what level uric acid would indicate gout & therefore should be treated ?

9 mg/dL
10 mg/dL
11mg/dL
12mg/dL
13 mg/dL

A

11mg/dL

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62
Q

What is the name of this gout imaging? [1]

A

DECT: dual-energy CT

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63
Q

Colchicine is first line treatment for

Acute Gout
Chronic gout
Septic arthritis
Acute pseudo-gout
Chronic pseudo-gout

A

Acute Gout

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64
Q

Gout

Desricbe the role of the enzyme xanthine oxidase

A

Converts xanthine to urate

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65
Q

Which of the following treatments for chronic gout blocks xanthine oxidase [2]

Rasburicase
Allopurinol
Probenecid
Uricosuric
Febuxostat

A

Allopurinol; Febuxostat

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66
Q

Which of the following treatments for chronic gout catalyses conversion of uric acid to allantoin

Rasburicase
Allopurinol
Probenecid
Uricosuric
Febuxostat

A

Rasburicase

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67
Q

Name two drugs to treat gout that undertake mechansim A

A

Allopurinol; Febuxostat

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68
Q

Which is the most commonly affected joint in pseudogout?

Elbow
Hip
Wrist
Knee

A

Knee

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69
Q

Cholesterol crystals are associated with

Pseudogout
Gout
RA
OA

A

RA: cholesterol crystals

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70
Q

The crystals are made from

Monosodium urate crystals
Calcium pyrophoshate
Cholesterol
Calcium oxalate

A

Monosodium urate crystals

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71
Q

The crystals are made from

Monosodium urate crystals
Calcium pyrophoshate
Cholesterol
Calcium oxalate

A

Calcium pyrophoshate: pseudogout

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72
Q

A 27-year-old man presents to his GP with a swollen, painful knee that has developed over the last 3 days. He feels generally unwell and since this morning he has noticed that his eyes are sore. He has never experienced anything like this before and he has no significant past medical history. He had a few days of bloody diarrhoea which he did not seek medical review for. On examination, you note slight redness of the conjunctiva, but no discharge. The right knee is noticeably swollen and warm to palpation. Patella tap test is positive and there is a limited range of movement due to pain. His vital signs are all within normal limits.

What is the most likely diagnosis?

Psoriatic arthritis
Reactive arthritis
Septic arthritis
Gout
Rheumatoid arthritis

A

Reactive arthritis

The most likely diagnosis is reactive arthritis which typically presents 2-4 weeks after a urinary tract or gastrointestinal infection. A single lower limb joint is typically affected and there is often systemic symptoms of malaise and fever. Conjunctivitis and urethritis can also be present and are referred to as Reiter’s triad. The common causative organisms include C. trachomatis, Campylobacter, Salmonella and Shigella. In this case, the episode of bloody diarrhoea most likely represents a Campylobacteriosis.

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73
Q

Deposition of which type of crystal is characteristic of gout?

Calcium pyrophosphate
Monosodium urate
Monosodium phosphate
Calcium urate
Monosodium pyrophosphate

A

Monosodium urate

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74
Q

A 54-year-old male presents to the GP with severe pain in one of his toes which started yesterday. He has no significant past medical history and has not experienced anything like this in the past. On examination, there is erythema and exquisite tenderness over the right first metatarsophalangeal joint (MTP). Vital signs are all within normal limits and there is nothing else to note on examination.

Given the likely diagnosis, which of the following would be the most appropriate first-line treatment?

NSAIDs
Intra-articular corticosteroids
Canakinumab
Oral corticosteroids
Paracetamol

A

NSAIDs

The gentleman is presenting with the typical symptoms of gout, with 70% of first attacks involving the first metatarsophalangeal joint (MTP). The first-line pharmacological treatment options for gout are NSAIDs or Colchicine (unless contraindicated due to gastric issues/heart failure etc) and the sooner they are started the more rapid the response will be.

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75
Q

A 55-year-old man presents to the emergency department with acute knee pain. There is no history of fever or trauma. He has a past medical history of hypertension.

On examination, he is afebrile. His left knee looks swollen and erythematous; there is a positive patellar tap and restricted passive and active joint movement.

His left-knee X-ray is normal, with no acute pathology seen.

The results of his joint aspiration are shown below.

What is the most likely diagnosis?

Pseudogout
Psoriatic arthritis
Gout
Rheumatoid arthritis
Septic arthritis

A

Gout

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76
Q

Which of the following statements does not fit with a diagnosis of rheumatoid arthritis?

There are radiographic changes that show erosion of the affected joints
The arthritis is symmetrical in nature
The patient has no morning stiffness
The small joints of the hands/feet are affected

A

The patient has no morning stiffness

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77
Q

A 53-year-old male is diagnosed with a first episode of acute gout.

His past medical history is significant for peptic ulcer disease, essential hypertension and type 2 diabetes mellitus. He takes esomeprazole 40 mg daily PO, ramipril 5 mg daily PO, and metformin 1 g BD PO. He has no allergies.

Based on the above, which of the following would be the most appropriate treatment option?

Prednisolone
Allopurinol
Febuxostat
cA 53-year-old male is diagnosed with a first episode of acute gout.

His past medical history is significant for peptic ulcer disease, essential hypertension and type 2 diabetes mellitus. He takes esomeprazole 40 mg daily PO, ramipril 5 mg daily PO, and metformin 1 g BD PO. He has no allergies.

Based on the above, which of the following would be the most appropriate treatment option?

Prednisolone
Allopurinol
Febuxostat
Colchine
Naproxen

A

Colchicine

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78
Q

Synovial fluid analysis:

Colour: Yellow
Clarity: Cloudy
Viscosity: Decreased
WBC: 5000 cells/mm3 (Reference range: < 200 cells/mm3)
Neutrophils: 55 % (Reference range: < 25%)
Gram stain: Negative
Crystals: Needle-shaped, negatively birefringent crystals

Given the likely diagnosis, the recent introduction of which medication may have precipitated this pathology?

Atenolol
Bisoprolol
Furosemide
Amlodipine
Lisinopril

A

Furosemide

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79
Q

Mrs Smith is a 68-year-old lady who visits her GP presenting with right knee pain which worsens on exertion (e.g. walking up the stairs). The pain is particularly bad at the end of the day. She has tried regular paracetamol but it did not help. She has no morning stiffness. She has also noted some bony swelling in her right knee. Mrs Smith has no previous history of joint problems. The GP says her symptoms are due to osteoarthritis. He advises her to take up exercises which may help.

Of the other management options provided, which is most suitable in this case?

Prescribe Paracetamol
Arthroscopy
Prescribe an NSAID
Prescribe Tramadol
Book Mrs Smith for corticosteroid injections into her knee

A

NSAIDs should be prescribed as Mrs Smith has tried paracetamol - the usual first drug to be prescribed - which has not helped.

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80
Q

Which of the following joints are most commonly affected by rheumatoid arthritis?

Sacroiliac joint
Gleno-humeral
Knee and elbow joints
Small joints of the hands and/or feet
Sterno-clavicular

A

Small joints of the hands and/or feet

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81
Q

A 67-year-old female was recently discharged from the coronary care unit with a diagnosis of heart failure. She arrives at her outpatient appointment and complains she has developed severe pain and swelling in the base of her right big toe. The doctor reviews her medication and decides to remove one of her regular medications.

Which of the following was most likely stopped?

Amlodipine
Nitrates
Bendroflumethiazide
Atorvastatin
Rosuvastatin

A

Bendroflumethiazide: Ptx has gout; Thiazide diuretics, low-dose aspirin block uric acid secretion, hence increases its blood level.

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82
Q

A 65-year-old presents to the emergency department with a very painful right wrist.

This started 12 hours ago, there is no history of trauma and he has been well recently. He experienced something similar in his left big toe last month but did not seek medical attention and it resolved over a few days.

On assessment, his heart rate is 95 beats per minute but other observations are within normal limits. His right wrist is red and swollen and a joint aspiration is performed.

What is most likely to be found on analysis of the joint aspiration?

Multiple gram-negative cocci
Multiple gram-positive cocci
Needle-shaped crystals negatively birefringent under polarised light
Needle-shaped crystals positively birefringent under polarised light
Rhomboid-shaped crystals positively birefringent under polarised light

A

Needle-shaped crystals negatively birefringent under polarised light

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83
Q

Name this sign of RA [1]

A

Bakers cyst: cyst in the popliteal fossa

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84
Q

Name this complication of RA [1]

A

scleromalacia perforans

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85
Q

Name this complication of RA [1]

A

Keratoconjunctivitis sicca

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86
Q

State the complication of RA depicted

scleritis
keratoconjunctivitis sicca
episcleritis
scleromalacia perforans

A

episcleritis

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87
Q

State the complication of RA depicted

scleritis
keratoconjunctivitis sicca
episcleritis
scleromalacia perforans

A

scleritis

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88
Q

State the complication of RA depicted
​
scleritis
keratoconjunctivitis sicca
episcleritis
scleromalacia perforans

A

keratoconjunctivitis sicca

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89
Q

State the complication of RA depicted
​
scleritis
keratoconjunctivitis sicca
episcleritis
scleromalacia perforans

A

scleromalacia perforans

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90
Q

High level of creatine kinase levels are associated with which connective tissue disease?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Dermatomyositis

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91
Q

Which disease is depicted?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Dermatomyositis

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92
Q

Which disease is depicted?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Systemic lupus erythematosus

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93
Q

Miss Johnson (27) recently presented to you with fatigue, unintentional weight loss and myalgia following a second consecutive miscarriage. During your examination, you notice lymphadenopathy and a slight red rash across both cheeks. When questioned about her facial rash, she tells you that it becomes worse if she is outside on a sunny day. You order some investigations which show:

ANA antibodies
RBC of 3.5 x1012
Raised CRP and ESR levels
What first-line treatment would you prescribe for Miss Johnson to use during acute flares?

Ciclosporin
Paracetamol
Prednisolone
Rituximab
Methotrexate

A

Miss Johnson is presenting with systemic lupus erythematosus (SLE).

Prednisolone is a first-line treatment for SLE inflammation during acute flares.

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94
Q

A 55-year-old lady presents with a 3-month history of progressive muscle weakness and facial rash. She describes difficulty climbing the stairs and even combing her hair. On examination, you note a purple rash on her upper eyelids, with some oedema surrounding her eyes. She has significant proximal muscle weakness on assessment and tenderness in the proximal muscle groups. Basic laboratory investigations reveal a raised creatine kinase.

What is the most likely diagnosis?

Dermatomyositis
Polymyositis
X-linked muscular dystrophy
Rheumatoid arthritis
Hyperthyroidism

A

The patient has dermatomyositis which is an inflammatory connective tissue disorder affecting skeletal muscle and the skin.

It is twice as common in women and the peak age of onset is 50 years of age. The history of progressive proximal muscle weakness with a facial rash, in addition to the findings of muscle tenderness and a raised creatinine kinase, fit with a diagnosis of dermatomyositis. Further investigations to confirm the diagnosis would include autoantibodies (ANA / Anti-Mi-2 / Anti-Jo-1) and muscle biopsy.

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95
Q

Mrs Jones lives alone and is currently in remission from breast cancer. She presents to her GP with progressive muscle pain, fatigue and weakness in her shoulders over the past few weeks. Upon examination, you notice periorbital oedema, a purple rash on her eyelids and erythematous patches on her elbows which you suspected to be Gottron lesions.

In order to confirm your suspicions, you order several investigations which show:

Anti-nuclear antibodies positive
Anti-Mi-2 antibodies positive
Elevated creatine kinase levels

What would be your diagnosis?

Dermatomyositis
Polymyositis
X-linked muscular dystrophy
Rheumatoid arthritis
Hyperthyroidism

A

Dermatomyositis

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96
Q

Which of the following would you most expect to see on investigation of a patient with ankylosing spondylitis?

HLA-B27 positive
Neutropenia
Calcium pyrophosphate crystals in synovial fluid
Narrowing of the joint space and osteophytes
Anti-Ro and Anti-La

A

HLA-B27 positive

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97
Q

Which disease is depicted?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Scleroderma: Perioral skin tightening with decreased oral opening: gives rise to a ‘pursed-string’ appearance

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98
Q

Name this sign of scleroderma [1]

A

Telangiectasia: abnormal dilation of capillary

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99
Q

Name this sign of scleroderma [1]

A

Calcinosis: calcium deposits in the skin

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100
Q

Raynaud phenomenon is when skin colour changes that occur in the fingers and toes from vasospasm.

Which pathology is it most likely seen in ?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Scleroderma

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101
Q

This lady presents with puffy eyes. What disease is she most likely to have?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

A

Dermatomyositis: Periorbital oedema (swelling around the eyes)

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102
Q

This is a radiography of pelvis (AP view) of a patient with ankylosing spondylitits.

Which letter shows a dagger sign

A
B
C
D

A

This is a radiography of pelvis (AP view) of a patient with ankylosing spondylitits.

Which letter shows a dagger sign

A
B
C
D

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103
Q

This is a radiography of pelvis (AP view) of a patient with ankylosing spondylitits.

Which letter shows the bamboo spine

A
B
C
D

A

C: continuous lateral spinal border

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104
Q

This is a patient with AS. What are the arrows pointing to? [1]

A

dagger spine

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105
Q

Name this sign [1]

What is it a complication of? [1]

A

Circinate balanitis: due to reactive arthritis

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106
Q

Chlamydia is the most common sexually transmitted cause of reactive arthritis.
Gonorrhoea commonly causes a gonococcal septic arthritis

gonorrhoea & reactive arthritis; chlarmydia & septic arthritis
gonorrhoea, reactive arthritis & septic arthritis
chlarmydia & reactive arthritis; gonorrhoea & septic arthritis
chlarmydia, reactive arthritis & septic arthritis

A

chlarmydia & reactive arthritis; gonorrhoea & septic arthritis

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107
Q

Reactive arthritis has a triad of which 3 symptoms? [3]

A

Classic triad of urethritis, conjunctivitis and arthritis

‘Can’t see, pee or climb a tree’

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108
Q

A 54-year-old woman, who is known to have systemic sclerosis, complains that her hands change colour in the cold. This is associated with severe pain. She asks if there is any medication you can prescribe.

Which of the following is a suitable first line option?

Amlodipine

Atenolol

Amitriptyline

Bisoprolol

Nifedipine

A

Nifedipine is a pharmacological option for Raynaud’s phenomenon

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109
Q

A 27-year-old man was brought to the hospital after he complained of a sudden-onset chest pain while playing football. He said that this is the first time he is having such a pain. He remembers that one of his uncles had a similar pain when he was young and he died early due to a heart problem. On examination, he has a pulse rate of 87 beats per minute, a respiratory rate of 22 breaths per minute and blood pressure of 101/74 mmHg. The doctor also notices that his fingers are longer than normal and that his little finger and thumb overlapped each when the man was asked to hold the opposite wrist. He has no significant past medical and surgical history and is not currently taking any regular medications. He denies any illicit drug use but smokes about half a pack of cigarette a day since he was 17 years old. Which of the following best explains disease mechanism in this man?

Decrease in the production of collagen
Impaired hydroxylation of lysine and proline amino acids on collagen
A defect of the glycoprotein structure which usually wraps around elastin
Copper deficiency affecting the normal function of lysyl oxidase enzyme
Overactive elastase enzyme leading to an excessive breakdown of collagen

A

A defect of the glycoprotein structure which usually wraps around elastin

This condition is known as Marfan syndrome and is inherited in an autosomal dominant pattern.

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110
Q

Nevertheless, she remains anxious and is requesting another blood test to confirm that she does not have lupus herself.

Which is the most appropriate blood test to perform in this instance?

C-reactive protein
Erythrocyte sedimentation rate
Antinuclear antibodies
Anti-double stranded DNA
Anti-cyclic citrullinated peptide

A

Antinuclear antibodies

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111
Q

A 64-year-old female presents to the emergency department with a two-week history of gradual-onset left knee pain. She has a known history of hyperparathyroidism, but is not on any regular medications.

On examination, there are no visible changes to the joint. The temperature over the knee is normal. She has tenderness over passive and active movement, but no restriction of joint movement.

A joint radiograph demonstrates no fracture but chondrocalcinosis. A joint aspiration under polarised light reveals positively birefringent rhomboid-shaped crystals.

Given the likely diagnosis, what is the underlying pathology?

Calcium pyrophosphate dihydrate deposition
Patellar fracture
Immune-mediated synovial damage
Joint infection
Uric acid deposition

A

Calcium pyrophosphate dihydrate deposition

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112
Q

The acromioclavicular joint is which type of joint

saddle
plane
hinge
condyloid

A

plane: allows gliding movements

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113
Q

Label the nerves that supply sesnory innervation to A-C [3]

A

A: ulnar nerve
B: radial nerve
C: median nerve

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114
Q

What type of joint is the distal radioulnar joint?

Plane

Pivot

Saddle

Condyloid

A

Pivot

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115
Q

Name the ligament A [1]

A

Annular ligament

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116
Q

Which muscle initates the first 10 degrees of abduction?

Subscapularis
Deltoid
Supraspinatous
Trapezius

A

Supraspinatous

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117
Q

Which nerve is at risk here? [1]

Musculocutaneous
Axillary
Median
Radial
Ulnar

A

Median

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118
Q

Which cell makes type 1 collagen?

osteoclasts
osteoblasts
osteocyte
osteoprogenitor

A

osteoblasts

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119
Q

Q
Which molecule signals healthy bone structure?

RANLK
OPG
Sclerostin
PTH

A

Sclerostin: high levels of sclerostin switches OFF osteoblasts

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120
Q

Which cell is EphrinB2 found on

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

osteoclast

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121
Q

Which cell is EphB4 found on

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

osteoblast

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122
Q

Forward signaling through EphB4 stimulates

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

Forward signaling through EphB4 stimulates

osteoblast & bone formation

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123
Q

Label A & B [2]

A

A: EphB4 (receptor on osteoblast)

B: EphrinB2 (ligand on osteoclast)

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124
Q

Forward signaling through EphB4 stimulates

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

osteoblast and bone formation

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125
Q

When ephrinB2 and ephB4 bind, which is switched off?

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

osteoclast

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126
Q

Which of the following have a receptor for PTH?

What effect does this cause? [1]

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

osteoblast: causes production of RANKL - causes more osteoclast activity & number

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127
Q

Which cell type is this?

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

Which cell type is this?

osteoclast

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128
Q

Label A-E

A

A: osteoblast
B: osteoclast
C: osteoid
D: cement line
E: mineralized bone

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129
Q

Which cell is EphrinB2 found on

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

Which cell is EphrinB2 found on

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

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130
Q

Which cell is ephB4 receptor found on

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

Which cell is ephB4 receptor found on

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

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131
Q

Which of the following is the principal phosphaturic hormone

Sclerostin
FGF23
PTH
RANKL

A

Which of the following is the principal phosphaturic (excreted in urine) hormone

Sclerostin
FGF23
PTH
RANKL

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132
Q

The vitamin D receptor is found on which cell?

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

A

The vitamin D receptor is found on which cell?

osteoblast
osteoprogrenitors
osteoclast
osteoid
osteocyte

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133
Q

which layer in articular cartilage do chondrocytes hypertrophy and form columns

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

C: radial layer

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134
Q

OA

What change has undertaken at A [1]?

A

Eburnation of cartilage: complete loss of cartilage, exposing bone

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135
Q

OA

What change has undergone at the A? [1]

A

Eburnation of cartilage: complete loss of cartilage, exposing bone

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136
Q

OA

Name the change that the arrow is pointing to [1]

A

Fibrillation: saw tooth surface irregularity of cartilage

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137
Q

OA

Name the change that the arrow is pointing to [1]

A

A-Fibrillation of the articular cartilage (arrow)

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138
Q

OA

Name the change that the arrow is pointing to [1]

A

Eburnation of articular cartilage

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139
Q

During a head-to-toe assessment of a patient with osteoarthritis, you note bony outgrowths on the distal interphalangeal joints. You document these findings as:

A. Bouchard’s Nodes
B. Heberden’s Nodes
C. Neurofibromatosis
D. Dermatofibromas

A

B. Heberden’s Nodes

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140
Q

You receive your patient back from radiology. The patient had an x-ray of the hips and knees for the evaluation of possible osteoarthritis. What findings would appear on the x-ray if osteoarthritis was present? Select-all-that-apply

A. Increased joint space
B. Osteophytes
C. Sclerosis of the bone
D. Abnormal sites of hyaline cartilage

A

B. Osteophytes
C. Sclerosis of the bone

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141
Q

Label A-E

A

A: calcified cartilage
B: chondrocytes
C: tide line
D: hyaline cartilage
E: articular surface

Hyaline cartilage: non-calcified
Deeper layers of cartilage are calcified: darker
Seperated via a tide mark

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142
Q

Articular cartilage

Label A-E

A

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

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143
Q

which layer in articular cartilage do chondrocytes hypertrophy and form columns

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

which layer in articular cartilage do chondrocytes hypertrophy and form columns

A: tangenitial layer
B: transitional layer
C: radial layer / deep layer
D: calcified cartilage
E: bone

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144
Q

Which layer is this

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

Which layer is this

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

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145
Q

Which layer is this

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

Which layer is this

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

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146
Q

Which layer is this

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

Which layer is this

A: tangenitial layer
B: transitional layer
C: radial layer / deep layer
D: calcified cartilage
E: bone

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147
Q

Which layer of articular cartilage are ER and golgi apparatus prominent in chondrocytes

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

Which layer of articular cartilage are ER and golgi apparatus prominent in chondrocytes

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

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148
Q

The main type of collagen in articular cartilage is:

Type 1
Type 2
Type 3
Type 4

A

The main type of collagen in articular cartilage is:

Type 1
Type 2
Type 3
Type 4

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149
Q

Which area of articular cartilage does OA initiate in?

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

Which area of articular cartilage does OA initiate in?

A: tangenitial layer / superifical layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

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150
Q

Which layer do chondrocytes die in?

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage
E: bone

A

Which layer do chondrocytes die in?

A: tangenitial layer
B: transitional layer
C: radial layer
D: calcified cartilage

Leave an empty hole, releasing their extracellular contents into the matrix which triggers calcification. Calcified cartilage is eventually digested by osteoclasts and replaced with bone

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151
Q

The ECM of cartilage is produced by the chondrocytes and contains up to 80%

Cartilage
Bone
Water
Aggrecans
Hyaluronic acid

A

The ECM of cartilage is produced by the chondrocytes and contains up to 80%

Cartilage
Bone
Water
Aggrecans
Hyaluronic acid

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152
Q

Label 1-5

A
  1. Pec major
  2. Pec minor
  3. Axillary vein
  4. Thoracodorsal
  5. Long thoracic
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153
Q

label these xox

which of these labels are joining points for muscles? [3]

A

which of these labels are joining points for muscles? [3]

  • coracoid process
  • supraspinous fossa
  • infraspinous fossa
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154
Q

label A-E

A

A: acromioclavicular joint
B: corocoid process
C: clavicle
D: acromion
E: glenoid fossa

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155
Q

Which muscle initates the first 10 degrees of abduction? [1]

A

supraspinatus

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156
Q
A
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157
Q

Which of the following is the glenoid labrum?

A
B
C
D
E

A

Which of the following is the glenoid labrum?

A
B
C
D
E

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158
Q

Which of the following is the acromion?

A
B
C
D
E

A

Which of the following is the acromion?

A
B
C
D
E

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159
Q

Which of the following is the scapula?

A
B
C
D
E

A

Which of the following is the scapula?

A
B
C
D
E

160
Q

Which of the following is the supraspinatus muscle?

A
B
C
D
E

A

Which of the following is the supraspinatus muscle?

A
B
C
D
E

161
Q

Which of the following is the glenoid labrum

A
B
C
D
E

A

Which of the following is the glenoid labrum

A
B
C
D
E

162
Q

Which of the following is the glenoid cavity

A
B
C
D
E

A

Which of the following is the glenoid cavity

A
B
C
D
E

163
Q

What is muscle D? [1]

What is bone E? [1]

A

D: supraspinatus

E: Acromion

164
Q

Which of the following is the articular capsule

A
B
C
D
E

A

Which of the following is the articular capsule

A
B
C
D
E

165
Q

Which of the following is the articular capsule

A
B
C
D
E

A

Which of the following is the articular capsule

A
B
C
D
E

166
Q

3 main superficial veins of upper arm? [3]

A
167
Q
A
168
Q

where do each of the following arrive from?

  • Muscularcutaneous
  • axillary
  • median
  • radial
  • ulnar nerve
A

where do each of the following arrive from?

  • Muscularcutaneous: C5-C7
  • axillary: C5-C6
  • median: C5-T1
  • radial: C5-T1
  • ulnar nerve; C8-T1
169
Q
A
170
Q
A

median nerve

171
Q
A
172
Q
A
173
Q
A

radial nerve

174
Q

Label A-D

A

A: Latissimus dorsi muscle forming the posterior axillary fold

B: Subscapularis muscle

C:Deltoid

D: External abdominal oblique muscle

175
Q

Label A-E

A

A: bicep brachii
B: triceps brachii
C: brachioradialis
D: subscapularis
E: Axillary artery

176
Q

Label A

A

Brachioradialis muscle

177
Q

Label A-C

A

A: Coracobrachialis muscle
B: Teres major
C: Medial head of triceps brachii muscle

178
Q

Label 1-5

A

1: bicep brachii

2: brachialis

3: Pronator teres muscle

4: Brachioradialis muscle

5: Pronator quadratus muscle

179
Q

Which of the following is the median nerve

A
B
C
D
E

A

Which of the following is the median nerve

A
B
C
D
E

180
Q

Which of the following is the radial nerve

A
B
C
D
E

A

Which of the following is the radial nerve

A
B
C
D
E

181
Q

Which of the following is the brachial artery

A
B
C
D
E

A

Which of the following is the brachial artery

A
B
C
D
E

182
Q

Label E [1]

A

Pronator teres

183
Q

Label A [1]

A

supinator muscle

184
Q

Which of the following is the radial nerve

1
2
3
4

A

Which of the following is the radial nerve

1
2
3
4

185
Q

Which of the following is the median nerve

1
2
3
4

A

Which of the following is the median nerve

1
2
3
4

186
Q

Which of the following is the ulnar artery and nerve

1
2
3
4

A

Which of the following is the ulnar artery and nerve

1
2
3
4

187
Q

Which of the following is the carpal tunnel

1
2
3
4

A

Which of the following is the carpal tunnel

1
2
3
4

188
Q

Which of the following is the carpal tunnel

1
2
3
4

A

Which of the following is the carpal tunnel

1
2
3
4

189
Q

Label A-D

A

A: radial artery
B: ulnar artery
C: Anterior interosseous
arteries
D: ulnar artery

190
Q
A

A - musculocutaneous nerve
B - median nerve
C - axillary nerve
D - ulnar nerve

191
Q

which muscles are used to flex your forarm when:

a) pronated
b) supinated

A

pronated forearm - brachialis used to flex elbow joint

supinated forarm - brachiali and bicep brachii flex elbow joints

192
Q
A

A: short head of bicep brachii
B: radial nerve
C: brachial artery
D: tricep (long head)
E: musculocutaneous nerve

193
Q
A
194
Q
A
195
Q

which ligament is commonly torn in young girls?

Ulnohumeral joint
Radio humeral joint
Proximal radioulnar joint

why?

A

which ligament is commonly torn in young girls?

Ulnohumeral joint
Radio humeral joint
Proximal radioulnar joint

bc annular ligament if loosely attached to the ulnar in infants

196
Q

what are the boundaries of the cubital fossa?

A

Boundaries of the cubital fossa:

  • superior border: line from the lateral to the medial epicondyle
  • flexor muscles of the forearm and the bracioradialias acting as borders also.
197
Q
A
198
Q
A
199
Q
A

median nerve !

200
Q

Label 20-22 & A-C

A

20 Site of humero-ulnar joint
21 Site of humeroradial joint
22 Site of proximal radio-ulnar

A = humerus
B = radius
C = ulna

201
Q

Label 1-3

A

1: ulnar collateral ligament
2: olecranon
3: radius

202
Q

Which of the following is the median nerve

A
B
C
D
E

A

Which of the following is the median nerve

A
B
C
D
E

203
Q

Which of the following is the radial artery

A
B
C
D
E

A

Which of the following is the radial artery

A
B
C
D
E

204
Q

Which of the following is the ulnar nerve

A
B
C
D
E

A

Which of the following is the ulnar nerve

A
B
C
D
E

205
Q

Which of the following is the ulnar artery

A
B
C
D
E

A

Which of the following is the ulnar artery

A
B
C
D
E

206
Q

which superficial forearm muscle is this?

A

palmaris longus

207
Q

which tendons are from muscles A & B?

which joints of the fingers are these muscles acting on?

A 
A= **flexor digitorum profundus:** all the way to distal phalanx. **PIP &** **DIP flex**
B = **flexor digitorum superficialis:** middle phalanx. **PIP flex**
208
Q
A

lumbricals: flex MCP

dorsal interrossei: abduct fingers (DAB)
palmar interrossei adduct the fingers (PAD)

209
Q
A
210
Q

Label B & C

A

B = thoracodorsal
C = long thoracic

211
Q

Label A-C

A

A: Pec major

B: serratus anterior

C: long thoracic nerve

212
Q

Which nerve is at risk here? [1]

A

median

213
Q

Ptx has normal serum calcium, phosphate, ALP & PTH. Which condition are they most likely to have?

Paget’s disease
Chronic kidney disease
Primary hyperparathyroidism
Osteoporosis
Osteomalacia

A

Osteoporosis

214
Q

Damage occurs from twisting injuries:

Posterior cruciate ligament injury
Menisical injury
Medial collateral ligament injury
Lateral collateral ligament injury

A

Menisical injury

215
Q

A female immigrant from the Indian subcontinent presents with ‘bone pain’, muscle weakness and anorexia. Bloods show a decreased calcium and phosphate level is a stereotypical history of ? [1]

A

Osteomalacia

216
Q

A patient is found to have the following results: low serum calcium, low serum phosphate, raised ALP and raised PTH. Which condition are these findings most consistent with?

Paget’s disease
Chronic kidney disease
Primary hyperparathyroidism
Osteoporosis
Osteomalacia

A

Osteomalacia

217
Q

Which of the following commonly affects the DIP and PIP joints?

Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis

A

Osteoathritis

218
Q

Which of the following commonly affects the MCP and PIP joints?

Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis

A

Rheumatoid arthritis

219
Q

X-ray findings include osteophytes forming at joint margins

Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis

A

Osteoathritis

220
Q

Which of the following antibodies is most associated with RA?

P-ANCA
Anti-dsDNA
Anti-Ro
Anti ACPA
Anti La

A

Anti ACPA

221
Q
A

SLE

222
Q
A

SLE

223
Q

An elderly man is investigated for ‘bone pains’. He is known to be deaf. Bloods show a raised ALP and a skull x-ray shows a thickened vault is a stereotypical history of? [1]

A

Paget’s disease

224
Q
A

Colchicine - inhibits microtubule polymerization by binding to tubulin, interfering with mitosis. Also inhibits neutrophil motility and activity

225
Q

STI –> arthritis, urethritis, conjunctivitis in a question is most likely to indicate ? [1]

A

Reactive arthritis

226
Q

State which disease causes A-C

A

A: RA
B: OA
C: gout

227
Q

Saw tooth erosion is associated with which type of OA? [1]

A

Erosive OA

228
Q

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)

A

Antinuclear antibodies (ANA)

229
Q

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

A

It is usually an IgM molecule reacting against patient’s own IgG

230
Q

Which one of the following confers the least risk of developing osteoporosis?

Obesity

Long term unfractionated heparin therapy

Gastrectomy

Osteogenesis imperfecta

Diabetes

A

Obesity: Low BMI increases the risk of OP

231
Q

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

A

Adduction of his fingers: nerve palsy

232
Q

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

A

Subscapularis tendon

233
Q

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

A

Excessive non-mineralised osteoid

234
Q

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

A

Falling onto an outstretched hand (FOOSH) is the most common mechanism causing a scaphoid fracture

235
Q

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

A

Synovial

236
Q

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

A

Anti-Jo-1

Dermatomyositis is associated with the anti-Jo-1 antibody

237
Q

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

A

Assess her using the FRAX tool

238
Q

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

A

Sacroiliitis (Bamboo spine is a sign of late stage AS)

239
Q

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

A

Heberden’s nodes

240
Q

RA

Methotrexate and Rituximab would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

Third line treatment

241
Q

RA

Methotrexate and a 2nd line DMARD would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

First line treatment

242
Q

RA

Methotrexate & a TNF-inhibitor would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

Second line treatment

243
Q

Methotrexate inhibits which enzyme? [1]

A

dihydrofolate reductase

244
Q

RA

Sulfasalazine is a prodrug for [1]

A

5-ASA

245
Q

Hydroxychloroquine blocks:

TLR7
TLR8
TLR9
TLR10
TLR11

A

TLR9

246
Q

RA

Leflunomide inhibits which enzyme? [1]

What is the effect of this? [2]

A

Dihydroorotate dehydrogenase (DHODH): stops pyrimidine synthesis & therefore reduces pro-inflammatory cytokines: IL-1, TNF-A and IL-6; Blocks T cell proliferation

247
Q

Which is the staple treatment for RA?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Which is the staple treatment for RA?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

248
Q

Which treatment for RA inhibits dihydrofolate reductase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Which treatment for RA inhibits dihydrofolate reductase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

249
Q

Which treatment for RA reduces purine synthesis?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Methotrexate

250
Q

Which treatment for RA reduces pyrimidine synthesis?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Leflunomide

251
Q

Which treatment for RA is safe for pregnant people?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Sulfasalazine

252
Q

Which treatment for RA is prodrug that operates in large intestine?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Which treatment for RA is prodrug that operates in large intestine?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

253
Q

Which treatment for RA that targets TLR-9?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

254
Q

Which treatment for RA that reduces dendritic cell activation?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

255
Q

Which is a treatment for RA that inhibits dihydro-orotate dehydrogenase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

256
Q

Which treatment for RA requires folate to be given alongside?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Methotrexate

257
Q

Which treatment for RA is a tumor necrosis factor-alpha (TNF-alpha) inhibitor?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Infliximab

258
Q

Which treatment for RA is a monoclonal antibody?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Infliximab

259
Q

Which treatment for RA is an anti-CD20 monoclonal antibody?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Rituximab

260
Q

Which treatment for RA causes B cell depletion?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Rituximab

261
Q

Which treatment for RA leads to decreased T-cell proliferation and cytokine production?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Abatacept

262
Q

Which treatment for RA is an IL-1 antagonist?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Anakinra

263
Q

Which treatment for RA targets IL-6?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Tolizumab

264
Q

Which treatment for RA targets upregulates CTLA-4, which switches T cell off?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Tolizumab

265
Q

RA

Methotrexate and Rituximab would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

Third line treatment

266
Q

RA

Methotrexate and a 2nd line DMARD would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

First line treatment

267
Q

RA

Methotrexate & a TNF-inhibitor would be

First line treatment
Second line treatment
Third line treatment
Fourth line treatment

A

Second line treatment

268
Q

Methotrexate inhibits which enzyme? [1]

A

dihydrofolate reductase

269
Q

RA

Sulfasalazine is a prodrug for [1]

A

5-ASA

270
Q

Hydroxychloroquine blocks:

TLR7
TLR8
TLR9
TLR10
TLR11

A

TLR9

271
Q

RA

Leflunomide inhibits which enzyme? [1]

What is the effect of this? [2]

A

Dihydroorotate dehydrogenase (DHODH): stops pyrimidine synthesis & therefore reduces pro-inflammatory cytokines: IL-1, TNF-A and IL-6; Blocks T cell proliferation

272
Q

Which is the staple treatment for RA?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Which is the staple treatment for RA?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

273
Q

Which treatment for RA inhibits dihydrofolate reductase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Which treatment for RA inhibits dihydrofolate reductase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

274
Q

Which treatment for RA reduces purine synthesis?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Methotrexate

275
Q

Which treatment for RA reduces pyrimidine synthesis?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Leflunomide

276
Q

Which treatment for RA is safe for pregnant people?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Sulfasalazine

277
Q

Which treatment for RA is prodrug that operates in large intestine?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Which treatment for RA is prodrug that operates in large intestine?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

278
Q

Which treatment for RA that targets TLR-9?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

279
Q

Which treatment for RA that reduces dendritic cell activation?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

280
Q

Which is a treatment for RA that inhibits dihydro-orotate dehydrogenase?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Hydroxychloroquine

281
Q

Which treatment for RA requires folate to be given alongside?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Methotrexate

282
Q

Which treatment for RA is a tumor necrosis factor-alpha (TNF-alpha) inhibitor?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Infliximab

283
Q

Which treatment for RA is a monoclonal antibody?

Methotrexate
Sulfasalazine
Hydroxychloroquine
Leflunomide
Infliximab

A

Infliximab

284
Q

Which treatment for RA is an anti-CD20 monoclonal antibody?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Rituximab

285
Q

Which treatment for RA causes B cell depletion?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Rituximab

286
Q

Which treatment for RA leads to decreased T-cell proliferation and cytokine production?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Abatacept

287
Q

Which treatment for RA is an IL-1 antagonist?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Anakinra

288
Q

Which treatment for RA targets IL-6?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Tolizumab

289
Q

Which treatment for RA targets upregulates CTLA-4, which switches T cell off?

Etanercept
Adalimumab
Anakinra
Rituximab
Abatacept
Tolizumab

A

Tolizumab

290
Q

A 27-year-old woman comes to the clinician with complaints of pain in her wrists bilaterally from the past few weeks. The pain exacerbates upon the movement of thumbs and wrists. She has no significant past medical history and gave birth to a healthy boy 8 months back. On examination, flexion of the thumb across the palm and deviating the wrist towards the ulna elicits sharp pain at the radial styloid tip. This examination finding is pathognomic for which of the following condition?
A. DeQuervain’s disease
B. Carpal tunnel syndrome
C. Thoracic outlet syndrome
D. Arthritis

A

A. DeQuervain’s disease

291
Q

Transcutaneous electrical nerve stimulation (TENS) is an adjunct used to treat

Osteoporosis
Osteoarthritis
RA
Gout
Ankylosing spondylititis

A

Osteoarthritis

292
Q

Which of the following can be grafted as at treatment for OA

Osteoblast
Osteocyte
Chondrocytes
Fibroblasts

A

Chondrocytes

293
Q

A 65-year-old man with a history of hyperuricemia and alcohol use disorder presents with acute right-toe pain. He reports that last night he went to a party where he binged on alcohol and appetizers, including liver pate, caviar, and sweetbreads. This morning he woke up to pain, redness, and swelling of his right great toe. He has no other significant past medical history and does not take any medication. His vital signs are within normal limits. His physical examination is significant for redness, swelling, and tenderness in his right first metatarsophalangeal joint. Other than the alcohol consumption, which of the following is the most likely etiology of his presentation?

A. Cholesterol
B. Triglycerides
C. Carbohydrates
D. Nucleic acids

A

D. Nucleic acids

294
Q

Gottron sign is an indication of which disease? [1]

A

Dermatomyositis

295
Q

Ankylosing spondylitis is most associated with which of the following?

Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation

A

Aortic regurgitation

296
Q

State an autoimmune disease that can cause AVN block [1]

A

Ankylosing spondylitis

297
Q

Granuloma formation is a which type of hypersensitivity reaction?

Type 1
Type 2
Type 3
Type 4

A

Type 4

298
Q

Duchenne MD patients are likely to suffer from

Restrictive cardiomyopathy
Dilated cardiomyopathy
Arrhythmogenic cardiomyopathy.
Hypertrophic obstructive cardiomyopathy

A

Dilated cardiomyopathy

299
Q
A

Fibromyalgia

300
Q

IBM

Which of the following statements is true regarding the skeletal muscle biopsy image shown above?

CD20+ B cells are the predominant inflammatory component
CD8+ T cells are the predominant inflammatory component
Histologic findings are classic for dermatomyositis
IVIG is the first line therapy
Presence of rimmed vacuoles favors polymyositis

A

B. CD8+ T cells are the predominant inflammatory component

301
Q
A

Infantile myopathy: Most fibres are small and round with a few massively hypertrophic fibres

302
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Myositis - CD8 cell infiltration

303
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Myositis

304
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Body inclusion myositis: Congo red stain - amyloid plaques

305
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Body inclusion myositis: empty vacuole

306
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Body inclusion myositis

307
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Duchenne MD (early)

*Fibre size variability
*Endomysial fibrosis
*Degenerating muscle fibres undergoing myophagocytosis

308
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD (early)
Duchenne MD (late)
Myositis
Infantile myopathy
Fibromyalgia

A

Duchenne MD: Endomysial connective tissue: Increased between muscle fibers

309
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Infantile myopathy
Fibromyalgia

A

Duchenne MD: Dystrophin staining (Below): Muscle fibers in preserved fascicle are revertants with dystrophin present around their rim
Some revertant muscle fibers are present in myopathic regions as well.

310
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Infantile myopathy
Fibromyalgia

A

Duchenne MD:

Later loss of muscle
Atrophy of fibres and death of fibres
Replaced with fibrotic material and fat

311
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Infantile myopathy
Fibromyalgia

A

Duchenne MD:
Later loss of muscle
Atrophy of fibres and death of fibres
Replaced with fibrotic material and fat

312
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Infantile myopathy
Fibromyalgia

A

BMI

313
Q

This histological slide supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Infantile myopathy
Fibromyalgia

A

Body inclusion myositis

314
Q

This imaging supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia

A

Body inclusion myositis

315
Q

This imaging supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia

A

Body inclusion myositis

316
Q

This imaging supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia

A

Body inclusion myositis

317
Q

This imaging supports a diagnosis of

Body inclusion myositis
Duchenne MD
Myositis
Sarcopenia
Fibromyalgia

A

Dermatomyositis / Myositis: calcification

318
Q

What disease is most likely shown?

A

Sarcopenia

319
Q

This imaging supports a diagnosis of? [1]

A

Infantile myopathic hypotonia

320
Q

Which of the following type of T cell is responsible if IgE production?

Th1
Th2
Th17
IT reg

A

Which of the following type of T cell is responsible if IgE production?

Th1
Th2 - produces IL-4 & IL-5 which are both involved in IgE pathway
Th17
IT reg

321
Q

Which of the following type of T cell is responsible if TNF-a and IFN-y production?

Th1
Th2
Th17
IT reg

A

Which of the following type of T cell is responsible if TNF-a and IFN-y production?

Th1
Th2
Th17
IT reg

322
Q

Which of the following type of T cell is responsible for chronic inflammation?

Th1
Th2
Th17
IT reg

A

Which of the following type of T cell is responsible for chronic inflammation?

Th1
Th2
Th17
IT reg

323
Q

Which of the following type of T cell is responsible for autoimmunity?

Th1
Th2
Th17
IT reg

A

Which of the following type of T cell is responsible for autoimmunity?

Th1
Th2
Th17
IT reg

324
Q

Which of the following type of T cell is responsible for autoimmunity?

Th1
Th2
Th17
IT reg

A
325
Q

A culture that that has staphyloxanthin found in it indicates an infection from which pathogen? [1]

A

Staph. aureus

326
Q

Label A & B of chronic osteomyelitis [2]

A

A: Involucrum
B: sequestrum

327
Q

Label the arrows

A

white arrow Involucrum
blue arrow sequestrum

328
Q

This line is:

Hilgenreiner’s Line
Shenton’s Line
Kline’s Line

A

Hilgenreiner’s Line

329
Q

State the effect of:

Barlow test [1]
Ortalini test [1]

What are positive results for each test? [2]

A

Barlow test:
* dislocates / subluxes the hip
* Positive if the hip can be popped out of the socket with this maneuver.

Ortalini test:
* if the hip was dislocated, a distinctive clunk will be heard as the hip relocates.

330
Q

Name this apparatus being used [1]

What pathology is it treating? [1]

What ages would this be used for? [1]

A

Pavlik harness: treats CDH for newborns - 6 months

331
Q

Name this apparatus being used [1]

What pathology is it treating? [1]

What ages would this be used for? [1]

A

Von Rosen splint: CDH between newborn - 6 months

332
Q

Which of the following is a fibrous ligament

achilles ligament
deltoid ligament
spring ligament
patella ligament

A

spring ligament

333
Q

Which of the following is associated with enthesitis

RA
OA
Ankylosing sponditlitis
Gout

A

Which of the following is associated with enthesitis

RA
OA
Ankylosing sponditlitis
Gout

334
Q

Unloading by temporary paralysis is most beneficial for which type of tendons?

Long tendons that undergo tendon-bone healing
Short tendons that undergo tendon-bone healing
Long tendons that undergo flexor tendon healing
Short tendons that undergo flexor tendon healing

A

Short tendons that undergo tendon-bone healing

335
Q

Which IL is specifically associated with enthesitis?

IL-1
IL-6
IL-8
IL-10
IL-23

A

IL-23

336
Q

Vincular arteries supply

Ligaments
Enthesis
Tendons
Perimysium

A

Tendons

337
Q

Name the condition for pain at the tendon at the arrow [1]

A

De Quervain’s tenosynovitis

338
Q

Name the condition for this tendon condition [1]

A

Trigger finger

339
Q

Which drug class is used for ankylosing spondylitis enthesitis? [1]

Anti-TNF treatment
Corticosteroid injection
Sulfasalazine
Methotrexate

A

Anti-TNF treatment

340
Q

Discoid lesions are assoicated with

Ankylosing spondylitis
Systemic lupus erythematosus
Dermatomyositis
Scleroderma

A

SLE

341
Q

Jaccoud arthropathy is a deforming non-erosive arthropathy characterized by ulnar deviation of the 2nd to 5th fingers with metacarpophalangeal joint subluxation.

Which of the following is it associated with

A
342
Q

Belimubab inhibits BAFF (B cell activating factor). It is used to treat

Ankylosing spondylitis
Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Rheumatoid arthritis

A

Systemic lupus erythematosus

343
Q

A characterisitic of [] arthritis is that it can be moved back into the correct position. What is this arthritis called? [1]

A

Jaccoud arthritis

344
Q

What pathology is depicted here? [1]

A

Trigger finger

Superficial and deep flexor tendons with local tenosynovitis at the metacarpal head subsequently develop localised nodal formation on the tendon, distal to the pulley (Fig. 1). The A1 pulley is the most frequently involved ligament in trigger finger.

345
Q

Which of the following is most commonly involved ligament in trigger finger?

A1 pulley
A2 pulley
A3 pulley
A4 pulley
A5 pulley

A

A1 pulley

346
Q

Omalizumab works by reducing which molecule? [1]

A

IgE

347
Q

Pemphigus Vulgaris occurs due to autoantibodies directed at a cadherin-type epithelial cell adhesion molecule called what? [1]§

A

Desmoglein 3

348
Q

Oral steroids; mycophenolate mofetil or azathioprine and / or Rituximab would be used to treat which skin condition? [1]

A

Pemphis vulgaris

349
Q

Allergic contact dermatitis is caused by an Th1 response causing an increase in:

neutrophils
lymphocytes
macrophages
killer cells

A

macrophages

350
Q

Allergic contact dermatitis is caused by which type of response

Th1
Th2
Th17
Th5

A

Allergic contact dermatitis is caused by which type of response

Th1

351
Q

Granuloma formation is a which type of hypersensitivity reaction?

Type 1
Type 2
Type 3
Type 4

A

Type 4

352
Q

This person with a tattoo has an adverse reaction. This occurs due to

Mast cell-mediated inflammation
Antibody-mediated inflammation
Immune complex mediated inflammation
Delayed hypersensitivity
Automimmunity

A

Immune complex mediated inflammation

353
Q

Ruxolitinib is a JAK inhibitor used to treat

Vitiligo
Phemphis vulgaris
Leukocytoclastic vulgaris
Urticaria

A

Ruxolitinib is a JAK inhibitor used to treat

Vitiligo
Phemphis vulgaris
Leukocytoclastic vulgaris
Urticaria

354
Q

Omalizumab is used to treat

Vitiligo
Phemphis vulgaris
Leukocytoclastic vulgaris
Urticaria

A

Urticaria

355
Q

Granuloma formation is caused by which type of response

Th1
Th2
Th17
Th5

A

Th1

356
Q

What type of NSAID is indomethacin

Acetic acid derivative
Propoinic acid derivative
Selective COX-2 inhibitros
Salicylates

A

What type of NSAID is indomethacin

Acetic acid derivative
Propoinic acid derivative
Selctive COX-2 inhibitros
Salicylates

do more

357
Q

Which prostaglandin causes the most bronchoconstriction in asthma patients?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

PGD2

358
Q

What type of NSAID is diclofenac

Acetic acid derivative
Propoinic acid derivative
Selective COX-2 inhibitor
Salicylates

A

What type of NSAID is diclofenac

Acetic acid derivative
Propoinic acid derivative
Selctive COX-2 inhibitros
Salicylates

359
Q

What type of NSAID is aspirin

Acetic acid derivative
Propoinic acid derivative
Selective COX-2 inhibitor
Salicylates

A

What type of NSAID is aspirin

Acetic acid derivative
Propoinic acid derivative
Selctive COX-2 inhibitros
Salicylates

360
Q

What type of NSAID is ibuprofen

Acetic acid derivative
Propoinic acid derivative
Selective COX-2 inhibitor
Salicylates

A

Propoinic acid derivative

361
Q

What type of NSAID is naproxen

Acetic acid derivative
Propoinic acid derivative
Selctive COX-2 inhibitor
Salicylates

A

Propoinic acid derivative

362
Q

What type of NSAID is celecoxib

Acetic acid derivative
Propoinic acid derivative
Selective COX-2 inhibitor
Salicylates

A

Selective COX-2 inhibitor

363
Q

Which prostaglandin causes has mixed vascular effects (constriction and dilation)?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

PGF2α

364
Q

Which prostaglandins cause uterine contraction? [2]

PGE2
PGD2
PGI2
PGF2α
TXA2

A

PGF2α;
TXA2

365
Q

Which prostaglandin causes uterine relaxation?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

Which prostaglandin causes uterine relaxation?

PGE2
PGD2
PGI2
PGF2α
TXA2

366
Q

Which prostaglandin causes inhibits platelet aggregation?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

PGI2

367
Q

Which prostaglandin causes induces platelet aggregation?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

TXA2

368
Q

Which prostaglandin suppresses lymphocytes?

PGE2
PGD2
PGI2
PGF2α
TXA2

A

PGE2

369
Q

What type of fracture occurs from an object dropping on you and breaking the bone

burst fracture
transverse fracture
impacted fracture
spiral fracture
greenstick fracture

A

transverse fracture

370
Q

What type of fracture occurs if somone jumps off a building and lands on their legs

burst fracture
transverse fracture
impacted fracture
spiral fracture
greenstick fracture

A

burst fracture

371
Q

the red arrow points to a

burst fracture
transverse fracture
spiral fracture
greenstick fracture

A

burst fracture

372
Q

Which bone in the foot is common for an avulsion fracture to occur in? [1]

A

The fifth metatarsal in the foot, which is the bone at the base of the little toe, can be vulnerable to avulsion fractures. Dancers often experience this type of injury

373
Q

What type of fracture is highlighted? [1]

A

subluxion

374
Q

A colles fracture is what type of fracture? [1]

burst fracture
transverse fracture
impacted fracture
spiral fracture
greenstick fracture

A

A colles fracture is what type of fracture? [1]

burst fracture
transverse fracture
impacted fracture
spiral fracture
greenstick fracture

375
Q

Name this type of fracture [1]

A

Torus fracture (aka buckle fracture)

376
Q

Ponsenti method treats which growth abnormality? [1]

A

Club foot / Tapes equinovarus

377
Q

This image shows

Perthe’s disease
CDH
SUFE
Pes planus
Talipes equinovarus

A

CDH

378
Q

Name this sign [1]

A

Galeazzi sign

379
Q

Which angle is used to detect CDH via ultrasound

alpha-angle
beta-angle
delta-angle
gamma-angle

A

alpha-angle

The alpha angle is formed by the acetabular roof to the vertical cortex of the ilium. This is a similar measurement to that of the acetabular angle (see below). The normal value is greater than or equal to 60º.

380
Q

A normal alpha angle is greater than [] degrees? [1]

A

60

381
Q

What stage of Perthes disease is this image?

Stage 1
Stage 2
Stage 3
Stage 4

A

Stage 1: avascular necrosis

382
Q

What stage of Perthes disease is this image?

Stage 1
Stage 2
Stage 3
Stage 4

A

Stage 4: reossification

383
Q

What stage of Perthes disease is this image?

Stage 1
Stage 2
Stage 3
Stage 4

A

Stage 3: remodelling

384
Q

What stage of Perthes disease is this image?

Stage 1
Stage 2
Stage 3
Stage 4

A

Stage 2 fragmentation

385
Q

SUFE is which type of Salter-Harris fracture

Type 1
Type 2
Type 3
Type 3

A

Type 1

386
Q

This shows

osgood-schlatter
blounts disease
SUFE
Perthes
CDH

A

blounts disease

387
Q

irreversible tibia varus is the pathophysiology behind

osgood-schlatter
blounts disease
SUFE
Perthes
CDH

A

blounts disease

388
Q

the arrow is pointing to:

osgood-schlatter
blounts disease
SUFE
Perthes
CDH

A

SUFE

389
Q

the arrow is pointing to:

osgood-schlatter
blounts disease
SUFE
Perthes
CDH

A

osgood schlatter

390
Q

the arrow is pointing to:

osgood-schlatter
blounts disease
SUFE
Perthes
CDH

A

osgood-schlatter

391
Q

Which of the following drug treatment causes muscle damage by creating lysosomes in muscle tissue

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

A

Hydroxychloroquine

392
Q

Which of the following drug treatment causes dose dependent type 2 atrophy

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

A

Corticosteroids

393
Q

Which of the following is treatment for DMD

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

A

Which of the following is treatment for DMD

Statins
Hydroxychloroquine
Corticosteroids
Prednisilone

394
Q

This sign tests which nerve

Radial
Median
Axillary
Ulnar

A

Median

395
Q

Jefferson Fracture occurs at

C1
C2
C3
C4
C5

A

C1

LOCO2 (58 decks)

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