Rheumatology Flashcards
Old lady with jaw pain when eating, headache, blurry vision. Ophthalmoscopy show pale retina and cotton wool spots. What medication should be commenced
a) NSAIDs
b) Prednisone
c) Carbamazepine
Temporal arteritis, GCA
Prednisone HIGH DOSE
Female with polymyalgia rheumatica gets scalp tenderness. Diagnosis?
a) GCA
b) Tension headache
c) Dermatitis
GCA
65 year old man with unilateral hemi-knee arthritis not currently taking any medications. Pain is worse on activity and wakes him at night. No swelling, erythema etc. X-ray shows signs of moderate osteoarthritis. The other knee is less painful. Management option?
a) Regular NSAID
b) Regular paracetamol
c) Short term oral corticosteroid d) Intra-articular steroid injection
e) Surgery
Osteoarthritis.
Not currently taking anything - try regular paracetamol
Oral NSAIDs produce greater improvement in pain, joint function and stiffness than
paracetamol, but have a higher risk of adverse effects and may not be suitable for some
patients.. add this on if paracetamol does not work.
65yo lady, bilateral knee pain. On examination both knees very swollen with minor effusion on the left. Xray showed minimal joint space narrowing. What medication to prescribe?
a) Celecoxib
b) Ibuprofen
c) Paracetamol
d) Aspirin
Paracetamol
Man, with ankle injury 15 years ago now pain on movement of some joints. Dx?
a) Gout
b) Rheumatoid arthritis
c) Osteoarthritis
OA
Asian 35 year old lady with pain in joints. Morning stiffness lasting longer than an hour and swelling on and off. Fatigue and 5 kg weight loss over this time. On examination no redness, swelling or deformity. Tenderness in joint pains in MCP, MTP, and PIP. No mouth ulcers. No skin changes. Diagnosis?
a) OA
b) RA
c) Psoriatic arthritis
d) SLE
e) Fibromyalgia
RA
35 year old shop assistant with fatigue, not sleeping well and had tenderness around shoulder girdle muscles. Specific “tender points” over chest and shoulders. Dx?
a) Fibromyalgia
b) Chronic fatigue
c) Polymyalgia rheumatica
d) Somatisation
Fibromyalgia
PMR not really under 50 years of age
Woman comes in with a painful wrist. She had a past history of pain in the MTP which went away over 3 weeks. Hand was swollen over wrist but no obvious deformities or skin changes. What is the most likely diagnosis?
a) RA
b) Psoriatic arthritis
c) Reactive (Reiters syndrome)
d) Gouty arthritis
Gouty
Lady with buttock pain and sausage like toes. Dx?
a) RA
b) Psoriatic arthritis
c) Herniated disc
Psoriatic arthritis
Lady who is 68 years old with osteoarthritis who is on something and celecoxib for it. She goes tramping for 1 day. Later she had pain over the greater trochanter and lateral side of the thigh. Leg moves in all directions fine. Has osteoporosis. What’s this?
a) Intertrochanteric fracture
b) Greater trochanteric pain syndrome
c) Meralgia paresthetica
Greater trochanteric pain syndrome (GTPS) = common cause of lateral hip pain
- More common in females 40-60 years
- Tendinopathy of the gluteus medius and/or minimus with or without coexisting bursal
pathology
0 year old woman presents with pruritis and jaundice. She complains of dry eyes and dry mouth. Xanthelasma and hepatosplenomegaly present. Investigation.
a) Mitochondrial antibody (AMA)
b) Anti ro and anti La (SSA, SSB)
c) Antibodies against nuclei and actin
d) LFTs
AMA - FOR PRIMARY BILIARY CHOLANGITIS
70 year old lady with worsening knee pain over 4 days. Tender swollen knee. Red skin on top, can move though. Tense effusion. Not out of alignment. Dx?
a) Gout
b) Pseudogout
c) OA
d) Reactive arthritis
e) Rheumatoid arthritis
Pseudogout
Diagnosis of pseudo gout.
a) Joint aspiration with light bifringement
b) Bone x-ray
c) Clinical exam
Joint aspiration with light bifringement
Lady with rash over nose and both cheeks. Joint and chest pain. Urinalysis shows blood. What investigation will best confirm the dx?
a) ANA
b) Anti dsDNA
c) Anti-histone
d) Anti-SSA/B
e) Anti-Smith
Anti dsDNA
dont confuse ANA for this (sensitive) and AMA for primary cholangitis
Skin thickening and Reynauds. Which diagnostic marker? a) Anti-centromere
b) Anti-histone
c) Anti-SSA/B d) Anti-Smith
Scleroderma
do ANA
ANTI-CENTROMERE
