Rheumatology

Question 1

The most common cause of isolated asymptomatic of alkaline phosphatase in an elderly patient

Answer 1

Paget disease ( osteitis deformans)
Most accurate nuclear bone scan ( focal increase)
Trt bisphonate

Question 2

Non traumatic vertebral fracture

Answer 2

Most commonly due to osteoporosis

Question 3

Non traumatic vertebral fracture

Answer 3

Most commonly due to osteoporosis

Question 4

Dupuytren contracture

Answer 4

Hyperplasia of the palmar fascia leading to nodule formation
Fourth and fifth fingers
Inability to extend their fingers
Collagenase trt

Question 5

Median nerve under the flexor retinaculum
Carpal tunnel syndrome
Thenar eminence atrophies but sensation spared

Answer 5

Tinel sign : tapping the median nerve
Phalen sign: flexiion of the wrist 90 degrees
Trt: splint to immobilize in position to relieve the pressure

Question 6

Bechet disease

Answer 6

Arthritis and painful ulcers oral and genital with erythema nodosum like lesions
Uveitis
Corticosteroids

Question 7

Takayasu arteritis
Large artery ( aortic arch)

Answer 7

Young Asian female and diminished pulse
And neurological symptoms
Steroid

Question 8

Giant cell arteritis

Answer 8

Headache- scalp tenderness pain with combing
- jaw claudication ( chewing)
Visual symptoms: anterior ischemic optic neuropathy
Polymyalgia rheumatica

Question 9

Polymyalgia rheumatica

Answer 9

Pain and morning stiffness in shoulder
Difficulty combing hair
Elevated esr
Muscle pain and no lab findings for muscle destruction

Question 10

Fibromyalgia

Answer 10

Young women and musclosketal pain and tenderness with trigger points
- impaired attention
- psychiatric disturbances
For three months

Question 11

Antiphosphlipid syndromes

Answer 11

Lupus anticoagulant
Anticardiolipin
Anti beta glycoprotein
Thrombotic event and pregnancy morbidity ( aPTT) elevated