Week 2.06 Flashcards
A 62 year old woman presents with hand deformity, which has developed over the last 4 – 5 years. She has stiffness in her joints and decreased hand grip. A photo is shown below: The deformity demonstrated in the 5th finger is?
Swan neck deformity
A 32 year old woman presents to accident and emergency with a 2 week history of fever, malaise, rash and symmetrical small joint polyarthritis. She has been taking ibuprofen for her symptoms over the last week. On examination she is febrile 37.8C, tender over most joints of her hands and wrists, has a macular rash on her trunk and proximal limbs. Investigations reveal ESR 35 mm Hg (N <25), CRP 40 (N <6), Rheumatoid factor 30 (N <25), anti CCP negative.The most likely diagnosis is?
N= Normal rangeESR = erythrocyte sedimentation rateCRP = C-reactive proteinANA = Anti nuclear antibodyRF = Rheumatoid factorAnti CCP = anti cyclic citrullinated peptide antibody
Systemic lupus erythematous
A 62 year old lady presents with a 3 month history of pain, swelling and stiffness in her wrists, knees, metacarpophalangeal joints and feet. On examination she has swelling of the distal interphalangeal joints, Metacarpophalangeal joints, squaring at the base of her thumb and bilateral knee effusions. She also has restricted neck movement with tenderness in the surrounding muscles.Which finding is most suggestive of a diagnosis of rheumatoid arthritis?
Metacarpophalangeal joint swelling
A 38 year old woman has recently been diagnosis with rheumatoid arthritis. She asks about genetic tests which may help in the diagnosis. Which of the following is a genetic risk factor for rheumatoid arthritis?
HLA-DR4
A 45 year old woman presents to her GP with recently diagnosed rheumatoid arthritis. She has a past history of diabetes, hypercholesterolaemia and hypothyroidism. She is obese with a BMI 32. She works in a factory and smokes 20 cigarettes/day. Which aspect of her history represents the strongest risk factor for rheumatoid arthritis?
Smoking
A 32 year old woman presents to her specialist for follow-up of newly diagnosed rheumatoid arthritis (RA). She has an identical twin who is worried about developing RA. What is relative risk compared to the normal population?
X 15
Mrs JB is a 62 year old woman who presents to her GP with a non-productive cough. She has a long history of a deforming arthritis affecting both small and large joints. She has had no fever or other systemic features. Examination of her hands is shown: A chest Xray is performed which shows 2 lesion; one 2 X 2 cms in the right upper lobe, and another 0.5 X 0.5 in her left lower lobe.The most likely cause of these lung lesions is/are:
Rheumatoid nodules
A 38 year old woman presents to her GP with a 4 month history of a symmetrical small joint polyarthritis. She has an hour of early morning stiffness and is fatigued with a low grade fever. Examination reveals tenderness and bogginess over her metacarpophalangeal and proximal interphalangeal joints. Investigations reveal an ESR 28 (N<25), CRP 18 (N<6), Anti-nuclear antibody 1:160 (N <40), RF 40 (N < 26), anti CCP 50 (N <6).The investigation which is most specific in making a diagnosis is?
N= Normal rangeESR = erythrocyte sedimentation rateCRP = C-reactive proteinANA = Anti nuclear antibodyRF = Rheumatoid factorAnti CCP = anti cyclic citrullinated peptide antibody
Anti-CCP
A 47 year old woman presents to her GP for follow-up. She has recently been diagnosed with rheumatoid arthritis and has been started on therapy with Prednisone 10 mgs daily and weekly methotrexate. She brings along a range of bloods tests
Result Date 02/01/15 03/03/15 Rheumatoid factor 50 35 Anti-CCP 30 26 C-reactive protein 38 15 Erythrocyte sedimentation rate 30 30 White cell count 10 X 10^6/L 12 X 10^6/L Which of the tests if most helpful in assessing activity of disease?
C-reactive protein
A 46 yr old woman presents to a rheumatologist with a 6 month history of pain and stiffness in her hands, wrists and feet. She has been taking an anti-inflammatory, diclofenac, without relief. On examination she has tenderness and swelling of the metacarpophalangeal joints, wrists and metatarsophalangeal joints. She has a nodule over her left elbow. Blood tests reveal an ESR 35 (N <25), C- reactive protein 30 (N <6), RF 40 (N <26), anti CCP 200 (N <6).The most appropriate management is?
N= Normal rangeESR = erythrocyte sedimentation rateCRP = C-reactive proteinANA = Anti nuclear antibodyRF = Rheumatoid factorAnti CCP = anti cyclic citrullinated peptide antibody
Methotrexate
A 59 year old man with a history of rheumatoid arthritis presents to accident and emergency with cough, fever and shortness of breath. He has been on methotrexate and adalumimab (monoclonal antibody TNF). Examination reveals he is febrile 380C, Chest examination: decreased percussion note right base, bronchial breath sounds at right base. CXR shows consolidation at right baseThe most likely cause of his symptoms is:
Pneumonia
What is demonstrated on this cervical spine X-ray?
Atlanto-axial subluxation
With respect to this X-ray which of the following changes are shown?
Osteophytes distal interphalangeal joints
For each mechanism of action, select the correct drug: Inhibits dihydrofolate reductase
Methotrexate
For each mechanism of action, select the correct drug: Interleukin 6 antibody
Tocilizumab
