rheumatology SAB question notes

Question 1

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?

Answer 1

Rheumatoid arthritis

• chronic
• systemic
• symmetrical

Question 2

what is the most specific investigation for rheumatoid arthritis?

Answer 2

anti-CCP antibodies

Question 3

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

Answer 3

psoriatic arthritis

Question 4

Herbeden’s nodes found on

Answer 4

DIPs

Question 5

Bouchards nodes found on

Answer 5

PIPs

Question 6

main features of osteoarthritis on XR

Answer 6

1. reduced joint space
2. subchondral sclerosis
3. bone cysts
4. osteophytes

Question 7

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

Answer 7

osteoarthritis

Question 8

most common cause of septic arthritis

Answer 8

staph aureus

Question 9

septic arthritis presents as

Answer 9

• hot
• red
• swollen joints

joint aspiration and blood cultures should be taken.

Question 10

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

Answer 10

septic arthritis

Question 11

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

Answer 11

psuedogout

- rhomboidal, weakly positively bifringent crystals.

Question 12

chonedrocalcinosis

Answer 12

calcification of hyaline cartilage

Question 13

asymetric polyarthritis of the lower limbs

Answer 13

reactive arthritis

Question 14

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

Answer 14

cauda equina syndrome

Question 15

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?

Answer 15

anterior uveitis associated with ankylosing spondylosis.

Question 16

70 y/o unilateral headache LHS head. severe bilateral shoulder and neck pains. lethargic.
LHS of scalp painful to touch.

likely diagnosis

Answer 16

giant cell arteritis

• severe unilateral headaches
• scalp tenderness
• jaw claudication on eating

Question 17

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

Answer 17

polymyositis

- inflammation of striated muscle

Question 18

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 ?

Answer 18

• systemic lupus erythematosus

- anti-double stranded DNA antibodies found

Question 19

shortness of breath, dry cough and bibasal fine inspiratory crackles should point too

Answer 19

pulmonary fibrosis

Question 20

pulmonary oedema would present with

Answer 20

• shortness of breath
• fine inspiratory crackles
• frothy sputum

Question 21

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

Answer 21

Berger’s disease

Question 22

avascular necrosis of the proximal femoral epiphysis

Answer 22

Perth’s disease

Question 23

hyper mobility syndrome caused by a defect in collagen.

Answer 23

Ehler’s-Danlos syndrome

Question 24

67 y/o pain in pelvis. head appears larger, deterioration in hearing in LHS ear. LHS sensorineural deafness detected. bowing of tibia seen

Answer 24

Paget’s disease

• disorder of bone remodelling
• raised ALP

Question 25

raised ALP indicative of

Answer 25

• osteoblast activity causing bone resorption

Question 26

when are bence jones proteins found?

Answer 26

• in multiple myeloma

- may be indicative of malignant lymphoma