Set 1, Reumatology, Arpana
Set 1, Reumatology, Arpana
Set 1, Reumatology, Arpana
You are doing the annual review of a 50-year-old woman who has rheumatoid
arthritis. Which one of the following complications is most likely to occours as a
result of her disease?
A. Chronic ;umphocytic leukaemia
B. Hypertension
C. Colorectal cancer
D. Type 2 diabetes mellitus
E. Ischaemic heart disease
ANSWER: E
2. A 51-year-old male presents with an acute onset of swelling ans pain in his
right knee. Aspiration shows negatively birefringent crystals with no organisms
seen. His pain fails to settle with NSAIDs. What is the most appropriate next step
in his management?
A. Repeat joint aspiration and intra-articular depomedrol
B. Allopurinol
C. IV flucloxacillin
D. Diuretics
E. Low dosemethotrexate
ANSWER: A
5. Which one of the following is the most common ocular manifestation of rheumatoid
arthritis?
A. Scleritis
B. Episcleritis
C. Leratoconjunctivitis sicca
D. Corneal ulceration
E. Keratitis
ANSWER: C
7. 39-year-old woman with a history of rheumatoid arthritis presents with a two day
history of a red right eye. There is no itch or pain. Pupils are 3mm, equal and
reactive to light. Visual acuity is 6/5 in both eyes. What is the most likely
diagnosis?
A. Keratoconjunctivits sicca
B. Scleritis
C. Glaucoma
D. Episcleritis
E. Anterior uveitis
ANSWER: D
14. You review a 48-year-old woman who is taking methotrexate for rheumatoid
arthritis. Concurrent prescription of which other medication should be avoided?
A. Erythromycin
B. Trimethoprim
C. Sumatriptan
D. Lansoprazole
E. Sodium Valproate
ANSWER: B
15. A 68-year-old presents with a painful swollen left knee which has failed to
settle after a weeks rest. There is no history of trauma. On examination he has a
moderate sized effusion. A plain radiograph is reported as follows: Some loss of
joint space. Liner calcification of arthicular cartilage. Whar is the most likely
diagnosis?
A. Pseudogout
B. Rheumatoid arthritis
C. Sarcoidosis
D. Gout
E. Osteoarthritis
ANSWER: A
16. A 69-year-old man presents with an acute episode of gout on his left first
metatarsal-phalangeal joint. What is the most likely underlying mechanism?
A. Sedentary lifestyle
B. Decreased renal excretion of uric acid
C. Increased endogenous production of uric acid
D. Starvation
E. Too much protein in diet
ANSWER: B
18. A 34-year-old kitchen worker presents with a two week history of pain in her
right wrist. She has recently emigrated from Ghana and has no past medical history
of note. On examination she is tender over the base os her right thumb and also
over the radial styloid process. Ulnar deviation of the wrist recreates the pain.
What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis of the carpometacarpal joint
C. De Quervain's tenosynovitis
D. Carpal tunnel syndrome
E. Systemic lupus erythematosus
ANSWER: C
19. A 54-year-old man is diagnosed as having gout. You are discussing ways to help
prevent future attacks. Which one of the following is most likely to precipitate an
attack of gout?
A. Chocolate
B. Brazil nuts
C. Eggs
D. Sardines
E. Smoking
ANSWER: D
20. A 45-year-old man present with a painful, swollen and red lefr middle toe.
There is no history of trauma and his symptoms have been present for around a week.
Which one of the following conditions is most associated with this presentations?
A. Diabetes mellitus
B. Systemic Sclerosis
C. Rheumatoid Arthritis
D. Bisphosphonate use
E. Psoriatic arthritis
ANSWER: E
21. A 25-year-old man presents with a painful, swollen left knee. He returned 4
week ago from a holiday in Spain. There is no history of trauma and he has no knee
problems previously. On examination he has a swollen, warm left knee with a full
range of movement. His ankle joints are also painful to move but there is no
swelling. On the soles of both feet you notice a waxy yellow rash. What is the most
likely diagnosis?
A. Rheumatoid arthritis
B. Psoriatic arthritis
C. Gout
D. Reactive arthritis
E. Gonococcal arthritis
ANSWER: D
22. A 24-year-old man is investigated for chronic back pain. Which one of the
following would most suggest a diagnosis of ankylosing spondylitis?
A. Reduced lateral flexion of the lumbar spine
B. Pain gets worse during the day
C. Accentuated lumhar lordosis
D. Pain on straight led raising
E. Loss of thoracic kyphosis
ANSWER: A
23. A 45-year-old man who is known to have haemochromatosis presents with a swollen
and painful right knee. An x-ray shows no fracture but extensive chondrocalcinosis.
Given the likely diagnosis, which one of the following is most likely to present in
the joint fluid?
A. Raised hyaluronic acid levels
B. Monosodium urare crystals
C. Bipyramidal oxalate crystals
D. Negatively birefringent calcium carbonate crystals
E. Positively birefringent rhomboid-shaped crystals
ANSWER: E
27. A 41-year-old man with a past history of asthama presents with pain and
weakness in his left hand. Examinationfindings are consistent with a left ulnar
nerve palsy. Blood tests reveal an eosinophilia. Which one of the following
antobodies is most likely to be present>
A. ANA
B. Anti-Scl70
C. pANCA
D. Antipjospholipid antibodies
E. cANCA
ANSWER: C
28. A 44-year-old woman is seen in the rheumatology clinic. She has been referred
with Raynaud's phenomenon. During the revies of system she mentions that her GP is
organising an endoscopy to investigate dyspepsia. On examination she is noted to
have tight, shiny skin over her fingers. Which one of the following complications
she most likely to develop?
A. Bronchiectasis
B. Angiodysplasia
C. Arterial hypertension
D. Chronic kidney disease
E. Pulmanary hypertension
ANSWER: E
29. A 35-year-old woman who has severe Raynaud's disease is reviewed in clinic.
Three months age she was started on nifedipine. Unfortunately this has had a
minimal effect on her symptoms and has resulted in ankle oedema. What is the most
appropriate next step in management?
A. Aspirin
B. Sympathectomy
C. Intravenous prostacyclin
D. Methotrexate
E. Intravenens infliximab
ANSWER: C
30. Which one of the following is most likely to indicate an underlying connective
tissue disorder in a patient with Raynaud's phenomenon?
A. Chilblains
B. Bilateral symptoms
C. Female patient
D. Onset at 18 years old
E. Recurrent miscarriages
ANSWER: E
31. Which one of the following would not suggest an underlying connective tissue
disorder in a patient with Raynaud's?
A. Unilateral symptoms
B. Digital ulcers
C. Presence of autoantibodies
D. Onset at 25 Years old
E. Calcinosis
ANSWER: D
33. Which one of the following is least associated with Behcet's syndrome?
A. Mouth ulcers
B. Genital ulcers
C. Conjunctivitis
D. Deep vein thrombosis
E. Aseptic meningitis
ANSWER: C
35. Which one of the following is true regarding the investigation of a patient
with dermatomyositis?
A. Creatine kinase is characteristically normal
B. Muscle biopsy is contraindicated
C. Anti-Jo-1 antibodies are usually negative
D. Antinuclear antibodies are always negative
E. EMG is normal
ANSWER: C
36. A 54-year-old male presents with weakness of his upper arms. On examination he
is found to have a mscular rash over his back and the extensor aspects of his upper
arms. He is heavy smoker and his sodium is 121 mmol/l. What is the most likely
underlying diagnosis?
A. Addison's disease
B. Polymyositis
C. Overlap syndrome
D. Dermatomyositis
E. Hypothyroidism
ANSWER: D
37. A 41-year-old female presents with lethargy and pain all over her body. This
has been present for the past six months and is often worse when she is stressed or
cold. Clinical examination is unremarkable other than a large blood tests including
an autoimmune screen, inflammatory markers and thyroid function are normal. Given
the likely diagnosis, Which one of the following is not helpful in management?
A. Amitriptyline
B. Trigger point injections
C. Cognitive behavioural therapy
D. Exercise programme
E. paracetamol
ANSWER: B
38. A 41-year-old man presents with persistent fatigue for the past 8 months. Which
one of the following features is least consistent with a diagnosis of chronic
fatigue syndrome?
A. Dizziness
B. Painful lymph nodes without enlargement
C. Having a busy day improves the symptoms
D. Palpitaions
E. Headaches
ANSWER: C
39. Which one of the following features is least typical of polymyalgia rheumatica?
40. A 61-year-old man is noted to have thickened patches of skin over his knuckles
and extensor surfaces consistent with Gottron's papules. His creatinine kinase
levels are also elevated. A diagnosis of dermatomyositis is suspected. Which one of
the following types of autoantibody is most specific for this condition?
A. Anti-scl-70 antibodies
B. Anti-Jo-l antibodies
C. Anti-nuclear antibodies
D. Anti-Mi-2 antibodies
E. Anti-centromere bodies
ANSWER: D
42. Which one of the following is not a risk factor for developing osteoporosis?
A. Smoking
B. Obesity
C. Sedentary lifestyle
D. Premature menopause
E. Female sex
ANSWER: B
43. Which one of the following is least recognised as a risk factor for developing
osteoporosis?
A. Cushing's syndrome
B. Turmer's syndrome
C. Hyperparathyroidism
D. Hypothyroidism
E. Diabetes Mellitus
ANSWER: D
44. A 66-year-old female presents with pain at the base of her left thumb. She no
past medical history of note. On examination there is diffuse tenderness and
swelling of her left first carpometacarpal joint. What is the most likely
diagnosis?
A. Osteoarthritis
B. De Quervain's tenosynovitis
C. Gout
D. Rheumatoid arthritis
E. Primary hyperparathyroidism
ANSWER: A