LOCO2 Qs Flashcards by patrick ellis

How well did you know this?

Not at all

Perfectly

Which of the following is the glenoid labrum?

A
B
C
D
E

Which of the following is the glenoid labrum?

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Which of the following is the acromion?

A
B
C
D
E

Which of the following is the acromion?

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Which of the following is the scapula?

A
B
C
D
E

Which of the following is the scapula?

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Which of the following is the supraspinatus muscle?

A
B
C
D
E

Which of the following is the supraspinatus muscle?

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Which of the following is the glenoid labrum

A
B
C
D
E

Which of the following is the glenoid labrum

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Which of the following is the glenoid cavity

A
B
C
D
E

Which of the following is the glenoid cavity

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

What is muscle D? [1]

What is bone E? [1]

D: supraspinatus

E: Acromion

How well did you know this?

Not at all

Perfectly

Which of the following is the articular capsule

A
B
C
D
E

Which of the following is the articular capsule

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Which of the following is the articular capsule

A
B
C
D
E

Which of the following is the articular capsule

A
B
C
D
E

How well did you know this?

Not at all

Perfectly

Osteophytes are a hallmark of

Osteomalacia
Osteopenia
Osteosarcoma
Osteoarthiritis
Osteoporosis

Osteophytes are a hallmark of

Osteomalacia
Osteopenia
Osteosarcoma
Osteoarthiritis
Osteoporosis

How well did you know this?

Not at all

Perfectly

This CT is suggestive of a patient with

Osteomalacia
Osteopenia
Osteosarcoma
Osteoarthiritis
Osteoporosis

Osteoporosis - kyphosis present

How well did you know this?

Not at all

Perfectly

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

Bisphosphonates

How well did you know this?

Not at all

Perfectly

Tinnitus may occur with which of the following bone disorders?

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

Tinnitus may occur with which of the following bone disorders?

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

How well did you know this?

Not at all

Perfectly

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

DKK

How well did you know this?

Not at all

Perfectly

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

Neutrophils

How well did you know this?

Not at all

Perfectly

Which of the following is associated with RA?

Heberden’s nodes
Boutonniere deformity
Bouchard’s nodes
Sadness

Boutonniere deformity

How well did you know this?

Not at all

Perfectly

Name this RA symptom [1]

Boutonniere deformity

How well did you know this?

Not at all

Perfectly

Label A-D of RA symptoms

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

How well did you know this?

Not at all

Perfectly

Label A & B

A: swan neck deformity

B: Boutonniere deformity

How well did you know this?

Not at all

Perfectly

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

HLA DRB1 alleles
HLA DRB2 alleles
HLA DRB3 alleles
HLA DRB4 alleles

HLA DRB1 alleles

How well did you know this?

Not at all

Perfectly

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

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

distal interphalangeal (DIP)

How well did you know this?

Not at all

Perfectly

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

Ca2+

How well did you know this?

Not at all

Perfectly

State a key enzyme found in NETosis net:

PAD1
PAD2
PAD3
PAD4
PAD5

PAD4

How well did you know this?

Not at all

Perfectly

Rheumatoid factor is found on which Ig IgG IgA IgM IgD IgE

**IgM**

Rheumatoid factor is found on IgM and binds to Fc portion of IgG IgA IgM IgD IgE

**IgG**

Which molecule has the most sensitivity for RA diagnosis? RF PAD4 ACPA A-CarP

**ACPA**

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

**Osteopenia**

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

**Staphylococcus aureus**

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

**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.

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

**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**.

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

**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.

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

**Gout**

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

**Antinuclear antibody**

Platelet rich plasma (PRP) is a novel treatment process for Osteoporosis Osteomalacia Osteoarthritis Rheumatoid arthritis

**Osteoarthritis**

Adalimumab is a treatment for OA. Which cytokine does it target? IL-1 IL-6 TNF-a IL-17

**TNF-a**

# OA Red arrow highlights - Loss of joint space - Osteophytes - Subarticular sclerosis - Subchondral cysts

**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)**,

# OA Orange arrow highlights - Loss of joint space - Osteophytes - Subarticular sclerosis - Subchondral cysts

**Osteophytes**

# OA Blue arrow highlights - Loss of joint space - Osteophytes - Subarticular sclerosis - Subchondral cysts

Subchondral cysts

Green arrow highlights - Loss of joint space - Osteophytes - Subarticular sclerosis - Subchondral cysts

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

Farmers often have OA in the Knee Spine Hip Hands

**Hip**

A normal Q angle is 10 - 15 degrees 10 - 25 degrees 15 - 20 degrees 15 - 25 degrees

15 - 20 degrees

Erosive OA typically has erosion of cartilage in Thumb DIP Index finger PIP Middle finger DIP 4th finger PIP Little finger DIP

**Middle finger DIP**

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

**Ankylosing spondylitis**

This is a patient with OA. The arrow points to - Loss of joint space - Osteophytes - Subarticular sclerosis - Subchondral cysts

**Subchondral cysts**

Name this symptom of gout [1]

Gout **tophi**

Name this symptom of gout [1]

Podagra

Rat bite erosions would suggest a patient is suffering from Gout Osteoarthritis (OA) Hydroxyapatite deposition disease (HADD) Septic arthritis Pseudo-gout

**Gout**

This histological slide is suggestive of Gout Osteoarthritis (OA) Hydroxyapatite deposition disease (HADD) Septic arthritis Pseudo-gout

**Gout**

This histological slide is suggestive of Gout Osteoarthritis (OA) Hydroxyapatite deposition disease (HADD) Septic arthritis Pseudo-gout

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.

Name the molecule that would be elevated in this patient

Monosodium urate crystal (patient has gout)

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

**Gout**

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

**Inadequate elimination of uric acid via the kidneys**

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

**Big toe**

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

**Use of certain antidepressant medications**

What type of hypersensitivity reaction is rheumatoid arthritis? It isn't a hypersensitivity reaction Type 2 Type 1 Type 3 Type 4

Type 3

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

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

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

**Proximal interphalangeal (PIP) joints**

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

**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.

Which one of the following is used in the management of acute gout? Allopurinol Febuxostat Probenecid Colchicine

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

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

**11mg/dL**

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

DECT: dual-energy CT

Colchicine is first line treatment for Acute Gout Chronic gout Septic arthritis Acute pseudo-gout Chronic pseudo-gout

**Acute Gout**

# Gout Desricbe the role of the enzyme xanthine oxidase

Converts xanthine to urate

Which of the following treatments for chronic gout blocks xanthine oxidase [2] Rasburicase Allopurinol Probenecid Uricosuric Febuxostat

Allopurinol; Febuxostat

Which of the following treatments for chronic gout catalyses conversion of uric acid to allantoin Rasburicase Allopurinol Probenecid Uricosuric Febuxostat

Rasburicase

Name two drugs to treat gout that undertake mechansim A

Allopurinol; Febuxostat

Which is the most commonly affected joint in pseudogout? Elbow Hip Wrist Knee

Knee

Cholesterol crystals are associated with Pseudogout Gout RA OA

**RA**: cholesterol crystals

The crystals are made from Monosodium urate crystals Calcium pyrophoshate Cholesterol Calcium oxalate

**Monosodium urate crystals**

The crystals are made from Monosodium urate crystals Calcium pyrophoshate Cholesterol Calcium oxalate

**Calcium pyrophoshate**: pseudogout

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

**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.

Deposition of which type of crystal is characteristic of gout? Calcium pyrophosphate Monosodium urate Monosodium phosphate Calcium urate Monosodium pyrophosphate

**Monosodium urate**

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

**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.

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

Gout

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

The patient has no morning stiffness

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

**Colchicine**

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

**Furosemide**

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

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

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

Small joints of the hands and/or feet

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

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

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

Needle-shaped crystals **negatively** birefringent under polarised light

Name this sign of RA [1]

**Bakers cyst**: cyst in the popliteal fossa

Name this complication of RA [1]

scleromalacia perforans

Name this complication of RA [1]

Keratoconjunctivitis sicca

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

**episcleritis**

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

**scleritis**

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

**keratoconjunctivitis sicca**

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

scleromalacia perforans

High level of creatine kinase levels are associated with which connective tissue disease? Systemic lupus erythematosus Dermatomyositis Scleroderma Tendinitis

**Dermatomyositis**

Which disease is depicted? Systemic lupus erythematosus Dermatomyositis Scleroderma Tendinitis

Dermatomyositis

Which disease is depicted? Systemic lupus erythematosus Dermatomyositis Scleroderma Tendinitis

**Systemic lupus erythematosus**

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

Miss Johnson is presenting with **systemic lupus erythematosus (SLE).** **Prednisolone** is a first-line treatment for SLE inflammation during acute flares.

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

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.

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

**Dermatomyositis**

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

**HLA-B27 positive**

Which disease is depicted? Systemic lupus erythematosus Dermatomyositis Scleroderma Tendinitis

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

Name this sign of scleroderma [1]

**Telangiectasia**: abnormal dilation of capillary

Name this sign of scleroderma [1]

**Calcinosis**: calcium deposits in the skin

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

**Scleroderma**

This lady presents with puffy eyes. What disease is she most likely to have? Systemic lupus erythematosus Dermatomyositis Scleroderma Tendinitis

**Dermatomyositis**: Periorbital oedema (swelling around the eyes)

This is a radiography of pelvis (AP view) of a patient with ankylosing spondylitits. Which letter shows a dagger sign A B C D

This is a radiography of pelvis (AP view) of a patient with ankylosing spondylitits. Which letter shows a dagger sign **A** B C D

This is a radiography of pelvis (AP view) of a patient with ankylosing spondylitits. Which letter shows the bamboo spine A B C D

**C**: continuous lateral spinal border

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

**dagger spine**

Name this sign [1] What is it a complication of? [1]

**Circinate balanitis**: due to **reactive arthritis**

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

**chlarmydia & reactive arthritis; gonorrhoea & septic arthritis**

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

Classic triad of **urethritis**, **conjunctivitis** and **arthritis** 'Can't see, pee or climb a tree'

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

**Nifedipine** is a pharmacological option for Raynaud's phenomenon

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 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.

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

**Antinuclear antibodies**

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

**Calcium pyrophosphate dihydrate deposition**

The acromioclavicular joint is which type of joint saddle plane hinge condyloid

**plane**: allows gliding movements

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

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

What type of joint is the distal radioulnar joint? Plane Pivot Saddle Condyloid

**Pivot**

Name the ligament A [1]

Annular ligament

Which muscle initates the first 10 degrees of abduction? Subscapularis Deltoid Supraspinatous Trapezius

**Supraspinatous**

Which nerve is at risk here? [1] Musculocutaneous Axillary Median Radial Ulnar

**Median**

Which cell makes type 1 collagen? osteoclasts osteoblasts osteocyte osteoprogenitor

**osteoblasts**

Q Which molecule signals healthy bone structure? RANLK OPG Sclerostin PTH

**Sclerostin**: high levels of sclerostin switches OFF osteoblasts

Which cell is EphrinB2 found on osteoblast osteoprogrenitors osteoclast osteoid osteocyte

**osteoclast**

Which cell is EphB4 found on osteoblast osteoprogrenitors osteoclast osteoid osteocyte

**osteoblast**

Forward signaling through EphB4 stimulates osteoblast osteoprogrenitors osteoclast osteoid osteocyte

Forward signaling through EphB4 stimulates **osteoblast** & bone formation

Label A & B [2]

A: **EphB4** (receptor on osteoblast) B: **EphrinB2** (ligand on osteoclast)

Forward signaling through EphB4 stimulates osteoblast osteoprogrenitors osteoclast osteoid osteocyte

**osteoblast** and bone formation

When ephrinB2 and ephB4 bind, which is switched off? osteoblast osteoprogrenitors osteoclast osteoid osteocyte

**osteoclast**

Which of the following have a receptor for PTH? What effect does this cause? [1] osteoblast osteoprogrenitors osteoclast osteoid osteocyte

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

Which cell type is this? osteoblast osteoprogrenitors osteoclast osteoid osteocyte

Which cell type is this? **osteoclast**

Label A-E

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

Which cell is EphrinB2 found on osteoblast osteoprogrenitors osteoclast osteoid osteocyte

Which cell is EphrinB2 found on osteoblast osteoprogrenitors **osteoclast** osteoid osteocyte

Which cell is ephB4 receptor found on osteoblast osteoprogrenitors osteoclast osteoid osteocyte

Which cell is ephB4 receptor found on **osteoblast** osteoprogrenitors osteoclast osteoid osteocyte

Which of the following is the principal phosphaturic hormone Sclerostin FGF23 PTH RANKL

Which of the following is the principal phosphaturic (excreted in urine) hormone Sclerostin **FGF23** PTH RANKL

The vitamin D receptor is found on which cell? osteoblast osteoprogrenitors osteoclast osteoid osteocyte

The vitamin D receptor is found on which cell? **osteoblast** osteoprogrenitors osteoclast osteoid osteocyte

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

**C: radial layer**

# OA What change has undertaken at A [1]?

**Eburnation** of cartilage: complete loss of cartilage, exposing bone

# OA What change has undergone at the A? [1]

**Eburnation** of cartilage: complete loss of cartilage, exposing bone

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

**Fibrillation**: saw tooth surface irregularity of cartilage

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

A-Fibrillation of the articular cartilage (arrow)

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

Eburnation of articular cartilage

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

**B. Heberden's Nodes**

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

B. Osteophytes C. Sclerosis of the bone

Label A-E

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**

# Articular cartilage Label A-E

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

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

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

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

Which layer is this **A: tangenitial layer** B: transitional layer C: radial layer D: calcified cartilage E: bone

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

Which layer is this A: tangenitial layer **B: transitional layer** C: radial layer D: calcified cartilage E: bone

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

Which layer is this A: tangenitial layer B: transitional layer **C: radial layer** / **deep layer** D: calcified cartilage E: bone

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

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

The main type of collagen in articular cartilage is: Type 1 Type 2 Type 3 Type 4

The main type of collagen in articular cartilage is: Type 1 **Type 2** Type 3 Type 4

Which area of articular cartilage does OA initiate in? A: tangenitial layer B: transitional layer C: radial layer D: calcified cartilage E: bone

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

Which layer do chondrocytes die in? A: tangenitial layer B: transitional layer C: radial layer D: calcified cartilage E: bone

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

The ECM of cartilage is produced by the chondrocytes and contains up to 80% Cartilage Bone Water Aggrecans Hyaluronic acid

The ECM of cartilage is produced by the chondrocytes and contains up to 80% Cartilage Bone **Water** Aggrecans Hyaluronic acid

Label 1-5

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

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

_which of these labels are joining points for muscles? [3]_ - coracoid process - supraspinous fossa - infraspinous fossa

label A-E

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

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

supraspinatus

Which of the following is the glenoid labrum? A B C D E

Which of the following is the glenoid labrum? A B **C** D E

Which of the following is the acromion? A B C D E

Which of the following is the acromion? **A** B C D E

Which of the following is the scapula? A B C D E

Which of the following is the scapula? A B C D **E**

Which of the following is the supraspinatus muscle? A B C D E

Which of the following is the supraspinatus muscle? A B C **D** E

Which of the following is the glenoid labrum A B C D E

Which of the following is the glenoid labrum A B **C** D E

Which of the following is the glenoid cavity A B C D E

Which of the following is the glenoid cavity A **B** C D E

What is muscle D? [1] What is bone E? [1]

D: supraspinatus E: Acromion

Which of the following is the articular capsule A B C D E

Which of the following is the articular capsule **A** B C D E

Which of the following is the articular capsule A B C D E

Which of the following is the articular capsule **A** B C D E

3 main superficial veins of upper arm? [3]

where do each of the following arrive from? - Muscularcutaneous - axillary - median - radial - ulnar nerve

where do each of the following arrive from? - Muscularcutaneous: **C5-C7** - axillary: **C5-C6** - median: **C5-T1** - radial: **C5-T1** - ulnar nerve; **C8-T1**

median nerve

radial nerve

Label A-D

A: **Latissimus dorsi muscle** forming the posterior axillary fold B: **Subscapularis muscle** C:**Deltoid** D: **External abdominal oblique muscle**

Label A-E

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

Label A

Brachioradialis muscle

Label A-C

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

Label 1-5

1: bicep brachii 2: brachialis 3: Pronator teres muscle 4: Brachioradialis muscle 5: Pronator quadratus muscle

Which of the following is the median nerve A B C D E

Which of the following is the median nerve A **B** C D E

Which of the following is the radial nerve A B C D E

Which of the following is the radial nerve **A** B C D E

Which of the following is the brachial artery A B C D E

Which of the following is the brachial artery A B C **D** E

Label E [1]

Pronator teres

Label A [1]

supinator muscle

Which of the following is the radial nerve 1 2 3 4

Which of the following is the radial nerve 1 2 3 **4**

Which of the following is the median nerve 1 2 3 4

Which of the following is the median nerve 1 2 **3** 4

Which of the following is the ulnar artery and nerve 1 2 3 4

Which of the following is the ulnar artery and nerve **1** 2 3 4

Which of the following is the carpal tunnel 1 2 3 4

Which of the following is the carpal tunnel 1 **2** 3 4

Which of the following is the carpal tunnel 1 2 3 4

Which of the following is the carpal tunnel 1 **2** 3 4

Label A-D

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

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

which muscles are used to flex your forarm when: a) pronated b) supinated

**pronated forearm** - brachialis used to flex elbow joint **supinated forarm -** brachiali and bicep brachii flex elbow joints

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

which ligament is commonly torn in young girls? Ulnohumeral joint Radio humeral joint Proximal radioulnar joint why?

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

what are the boundaries of the cubital fossa?

_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.

**median nerve !**

Label 20-22 & A-C

20 Site of humero-ulnar joint 21 Site of humeroradial joint 22 Site of proximal radio-ulnar A = humerus B = radius C = ulna

Label 1-3

1: ulnar collateral ligament 2: olecranon 3: radius

Which of the following is the median nerve A B C D E

Which of the following is the median nerve A B C D **E**

Which of the following is the radial artery A B C D E

Which of the following is the radial artery **A** B C D E

Which of the following is the ulnar nerve A B C D E

Which of the following is the ulnar nerve A B C **D** E

Which of the following is the ulnar artery A B C D E

Which of the following is the ulnar artery A B **C** D E

which superficial forearm muscle is this?

palmaris longus

which tendons are from muscles A & B? which joints of the fingers are these muscles acting on?

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

lumbricals: **flex MCP** dorsal interrossei: abduct fingers **(DAB)** palmar interrossei adduct the fingers (**PAD)**

Label B & C

B = thoracodorsal C = long thoracic

Label A-C

A: Pec major B: serratus anterior C: **long thoracic nerve**

Which nerve is at risk here? [1]

median

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

**Osteoporosis**

Damage occurs from twisting injuries: Posterior cruciate ligament injury Menisical injury Medial collateral ligament injury Lateral collateral ligament injury

Menisical injury

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]

**Osteomalacia**

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

**Osteomalacia**

Which of the following commonly affects the DIP and PIP joints? Paget's disease Osteoathritis Osteoporosis Osteomalacia Rheumatoid arthritis

**Osteoathritis**

Which of the following commonly affects the MCP and PIP joints? Paget's disease Osteoathritis Osteoporosis Osteomalacia Rheumatoid arthritis

Rheumatoid arthritis

X-ray findings include osteophytes forming at joint margins Paget's disease Osteoathritis Osteoporosis Osteomalacia Rheumatoid arthritis

Osteoathritis

Which of the following antibodies is most associated with RA? P-ANCA Anti-dsDNA Anti-Ro Anti ACPA Anti La

Anti ACPA

**SLE**

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]

**Paget's disease**

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

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

**Reactive arthritis**

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**

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

**Hydroxychloroquine**

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**

# 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**

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

**Hydroxychloroquine**

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**

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. DeQuervain's disease**

Transcutaneous electrical nerve stimulation (TENS) is an adjunct used to treat Osteoporosis Osteoarthritis RA Gout Ankylosing spondylititis

**Osteoarthritis**

Which of the following can be grafted as at treatment for OA Osteoblast Osteocyte Chondrocytes Fibroblasts

Chondrocytes

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

**D. Nucleic acids**

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

Dermatomyositis

Ankylosing spondylitis is most associated with which of the following? Aortic stenosis Aortic regurgitation Mitral stenosis Mitral regurgitation

**Aortic regurgitation**

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

Ankylosing spondylitis

Granuloma formation is a which type of hypersensitivity reaction? Type 1 Type 2 Type 3 Type 4

**Type 4**

Duchenne MD patients are likely to suffer from Restrictive cardiomyopathy Dilated cardiomyopathy Arrhythmogenic cardiomyopathy. Hypertrophic obstructive cardiomyopathy

**Dilated cardiomyopathy**

**Fibromyalgia**

# 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