rheumatology SAB question notes Flashcards
36 y/o two month history of stiff hands and wrists.
pain particularly bad for first few hours after waking up.
metacarpophalangeal joints and proximal interphalangeal joints are swollen and warm.
likely diagnosis?
Rheumatoid arthritis
- chronic
- systemic
- symmetrical
what is the most specific investigation for rheumatoid arthritis?
anti-CCP antibodies
55 y/o 2 week history of hand pain. particularly RHS hand. brown discolouration of the nails with oncycholosis is noted. distal interphalangeal joints are tender on palpation.
likely diagnosis
psoriatic arthritis
Herbeden’s nodes found on
DIPs
Bouchards nodes found on
PIPs
main features of osteoarthritis on XR
- reduced joint space
- subchondral sclerosis
- bone cysts
- osteophytes
76 y/o male. pain in knees worse in RHS knee, worse in evening post exertion.
bony nodules on DIPs, RHS knee swollen, reduced range of active movement.
XR show reduction in joint space, subchondral sclerosis and osteophyte formation
osteoarthritis
most common cause of septic arthritis
staph aureus
septic arthritis presents as
- hot
- red
- swollen joints
joint aspiration and blood cultures should be taken.
30 y/o 1 week history of painful, swollen knees and painful RHS heel. burning pains while urinating.
eyes have become red and itchy.
likely diagnosis
septic arthritis
70 y/o female, sudden onset pain and swelling in RHS knee. PMH includes hypertension, hypercholesterolaemia.
pyrexial, RHS knee swollen, reduced range of movement in knee due to swelling and pain.
XR of RHS knee shows chonedrocalcinosis
most likely diagnosis
psuedogout
- rhomboidal, weakly positively bifringent crystals.
chonedrocalcinosis
calcification of hyaline cartilage
asymetric polyarthritis of the lower limbs
reactive arthritis
32 y/o back pain. pain shooting down LHS leg, cannot walk without support. not passed urine.
lower limbs, tone and power cannot be assessed due to pain.
reduced ankle reflexes and sacral anaesthesia
patient most likely has
cauda equina syndrome
20 y/o sudden onset RHS eye pain, with blurred vision and discomfort when gazing at lights.
history of back pain and recently been diagnosed with ankylosing spondylosis.
most common cause of his eye pain?
anterior uveitis associated with ankylosing spondylosis.
70 y/o unilateral headache LHS head. severe bilateral shoulder and neck pains. lethargic.
LHS of scalp painful to touch.
likely diagnosis
giant cell arteritis
- severe unilateral headaches
- scalp tenderness
- jaw claudication on eating
60 y/o two month history of lethargy, weakness. finding it increasingly difficult to climb stairs and do housework.
wasting and weakness of prox muscles in upper and lower limbs.
likely diagnosis
polymyositis
- inflammation of striated muscle
30 y/o afro-carribean woman. increasing shortness of breath, hands have become painful and stiff.
recurrent mouth ulcers, XR show bilateral pleural effusions and blood work shows raised ESR and normal CRP.
what’s the diagnosis ?
- systemic lupus erythematosus
- anti-double stranded DNA antibodies found
shortness of breath, dry cough and bibasal fine inspiratory crackles should point too
pulmonary fibrosis
pulmonary oedema would present with
- shortness of breath
- fine inspiratory crackles
- frothy sputum
30 y/o Turkish man, oral ulcers, genital ulcers and painful legs.
apthous ulcers in mouth, genital ulcerations, erythema nodosum over shins. admitted under medical team.
skin pathergy test is positive
Berger’s disease
avascular necrosis of the proximal femoral epiphysis
Perth’s disease
hyper mobility syndrome caused by a defect in collagen.
Ehler’s-Danlos syndrome
67 y/o pain in pelvis. head appears larger, deterioration in hearing in LHS ear. LHS sensorineural deafness detected. bowing of tibia seen
Paget’s disease
- disorder of bone remodelling
- raised ALP
raised ALP indicative of
- osteoblast activity causing bone resorption
when are bence jones proteins found?
- in multiple myeloma
- may be indicative of malignant lymphoma
