A 21-year-old man presents with episodic pain in his buttocks, low back pain and stiffness that is worst in the mornings. A lateral X-ray of his lower spine shows blurring of the upper and lower vertebral rims at the thoracolumbar junction. He is found to be HLA-B27-positive.
Given the likely diagnosis, what would be the most appropriate treatment for him?
1- Aspirin
2- Prednisolone
3- Diclofenac
4- Physiotherapy
5- Dextropropoxyphene
Answer: 4- Physiotherapy
A 10-year-old girl presents with a high fever, rash and hip and knee joint pains. A slit-lamp examination of her eyes is normal. Blood tests are negative for autoantibodies.
What is the most likely diagnosis?
1- Persistent oligoarthritis
2- Still’s disease
3- Polyarticular arthritis
4- Enthesitis-related arthritis
5- Henoch-Schönlein purpura
Answer: 2- Still’s disease
A 73-year-old woman complains of dry, gritty eyes, a constant sensation of mouth dryness and swollen parotid glands. You suspect that she has Sjögren’s syndrome.
Which of the following tests is not likely to help in establishing the diagnosis?
1- Serum antibody to Ro antigen
2- Lymph node biopsy
3- Schirmer’s test
4- Labial biopsy
5- Magnetic resonance imaging of the parotid gland
Answer: 2- Lymph node biopsy
A 59-year-old man with a history of gout presents with a swollen and painful first metatarsophalangeal joint. He currently takes allopurinol 400mg od as gout prophylaxis. What should happen to his allopurinol therapy?
- Stop and recommence 4 weeks after acute inflammation has settled
- Reduce allopurinol to 100mg od until acute attack has settled
- Stop and switch to colchicine prophylaxis
- Stop and recommence 2 weeks after acute inflammation has settled
- Continue allopurinol in current dose
Answer: 5-Continue allopurinol in current dose
A 65-year-old woman being treated for epilepsy presents with bone pain and muscle weakness. Blood tests show increased serum alkaline phosphatase, normal plasma calcium and low serum phosphate levels. An X-ray of the femur reveals linear areas of low density surrounded by sclerotic borders.
What is the most likely diagnosis?
1- Osteoporosis
2- Osteomalacia
3- Paget’s disease
4- Osteosarcoma
5- Polymyalgia rheumatica
Answer: 2- Osteomalacia
A 34-year-old woman has been admitted for investigation for fatigability & general ill health. On further questioning, she mentions that her hands have been painful and stiff over the past few months and she has a past medical history of three miscarriages and a deep venous thrombosis in the right leg. A diagnosis of systemic lupus erythematosus (SLE) is suspected and a full autoantibody screen is sent to the laboratory. Which of the following auto-antibodies is most specific to the suspected diagnosis?
- Anti-nuclear antibody
- Anti-double stranded DNA antibody
- Rheumatoid factor
- Anti-centromere antibody
- Anti-mitochondrial antibody
Answer: 2-Anti-double stranded DNA antibody
A 35-year-old man presents with abdominal pain, joint pains, fever and weight loss. He gives a history of passing bulky, malodorous stools over the past month that are difficult to flush away. A biopsy of the small bowel shows stunted villi with PAS (Periodic acid-Schiff)-positive macrophages.
What is a characteristic finding in this condition?
1- Occult blood in stools
2- The presence of bacilli within macrophages on electron microscopy
3- Mesenteric thickening with lymph node enlargement on CT scan
4- Positive HLA-B27
5- Bony erosions and subluxation of joints on X-ray of affected joints
Answer: 2- The presence of bacilli within macrophages on electron microscopy
A 35 years old white female presents with pain & stiffness of joints of her both hands & wrists. Examination shows redness, warmth, swelling & tenderness of proximal interphalangeal metacarpophalangeal joints & wrists. Which of the following would support the diagnosis of rheumatoid arthritis (RA)
- Polyarthritis
- High ESR
- Periarticular osteopenia & marginal erosion on x- ray
- Asymmetrical pattern of arthritis
- Duration of symptoms less than 6 weeks
Answer: 3-Periarticular osteopenia & marginal erosion on x- ray
A 30-year-old woman presents with severe scaly, erythematous lesions all over her body. She has also developed swelling and severe pain in her distal interphalangeal joints.
Given the diagnosis of psoriasis, what treatment is likely to be most suitable for her?
1- Topical corticosteroids
2- Diclofenac
3- Coal tar
4- Long-wave ultraviolet radiation (psoralen ultraviolet A; PUVA)
5- Methotrexate
Answer: 5- Methotrexate
A 25-year-old man presents with back pain. Which one of the following may suggest a diagnosis of ankylosingspondylitis?
- Rapid onset
- Gets worse following exercise
- Bone tenderness
- Pain at night
- Improves with rest
Answer: 5-Pain at night
A 22-year-old homosexual man gives a history of high-grade fever associated with pustules on his hands and severe joint pain 4 weeks ago. His left knee is now swollen and red. Cultures from blood and joint aspirate are negative. Urethral discharge shows the presence of gonococci. He has a history of penicillin sensitivity.
Which drug would be most suitable in this condition?
1- Oral penicillin
2- Amoxicillin
3- Prednisolone
4- Erythromycin
5- Ciprofloxacin
Answer: 5- Ciprofloxacin
A 47-year-old woman presents with an inability to raise her arms over her shoulders. Over the past few weeks she has also been having difficulty swallowing food. On examination there is muscle wasting and the muscles are tender with reduced tendon reflexes. Her serum creatine kinase is elevated.
What is the most likely diagnosis?
1- Polymyalgia rheumatica
2- Polymyositis
3- Hypocalcaemia
4- Painful arc syndrome
5- Frozen shoulder
Answer: 2- Polymyositis
A 73-year-old man presents with severe back pain. An X-ray shows the presence of osteolytic lesions in his vertebrae and pelvis. He also complains of malaise but no other symptoms of note.
Based on the clinical findings and radiology, what is the most probable diagnosis?
1- Paget’s disease of bone
2- Prostatic carcinoma
3- Multiple myeloma
4- Hypocalcaemia
5- Chronic myeloid leukaemia
Answer: 3- Multiple myeloma
A 28-year-old man presents to the clinic with painful knees and ankles. He is noted to have a rash on the glans penis. He has a history of urethritis due to Chlamydia trachomatis . He has also recently attended the ophthalmology department for an episode of uveitis.
What is the most likely diagnosis?
1- Reiter’s syndrome
2- Reactive arthritis
3- Gouty arthritis
4- Septic arthritis
5- Rheumatoid arthritis
Answer: 1- Reiter’s syndrome
A 35-year-old woman is diagnosed with systemic lupus erythematosus.
What is the most common finding on blood testing that would be of help in supporting your clinical findings?
1- Anti double-stranded DNA
2- Rheumatoid factor
3- VDRL-positive
4- Low complement levels
5- Anticardiolipin antibody
Answer: 4- Low complement levels
A 30-year-old farmer presents with a history of myalgia, fatiguability, occasional bouts of fever, depression and right knee joint pain for the past 6 months. On examination there is lymphadenopathy and hepatosplenomegaly. The brucella agglutination titre is elevated fourfold.
Given the likely diagnosis, what treatment would be most helpful in this condition?
1- Intravenous benzylpenicillin
2- Erythromycin
3- Doxycycline
4- Amoxicillin
5- Gentamicin
Answer: 3- Doxycycline
A 65-year-old woman presents with severe pain and stiffness of her shoulders and neck that is worse in the mornings and lasts for more than an hour. Physical examination is unremarkable. Blood tests show a mild normocytic normochromic anaemia. Her ESR is 77 mm/1st hour.
What is the most likely diagnosis?
1- Polymyalgia rheumatica
2- Polymyositis
3- Hypocalcaemia
4- Painful arc syndrome
5- Frozen shoulder
Answer: 1- Polymyalgia rheumatica
A 58-year-old woman complains of severe unilateral temporal headaches and jaw pain when eating. A provisional diagnosis of giant-cell arteritis is made.
Which of the following is a characteristic clinical feature of this condition?
1- All peripheral arteries are involved
2- It does not occur in the absence of polymyalgia rheumatica
3- Negative temporal artery biopsy excludes the disorder
4- Treatment is monitored by measuring CRP levels
5- NSAID treatment is an effective first line of management
Answer: 4- Treatment is monitored by measuring CRP levels
A 45-year-old man presents with fever, malaise, weight loss and myalgia over the past month. You suspect polyarteritis nodosa and arrange to perform some blood tests.
Which abnormality might you most expect to find?
1- Elevated creatinine
2- Anaemia
3- Leucopenia
4- Thrombocytosis
5- Positive ANCA
Answer: 1- Elevated creatinine
A young African-American woman is diagnosed as having systemic lupus erythematosus.
What is the characteristic epidemiological feature of this condition?
1- It is about twice as common in women than in men
2- The highest incidence is amongst Caucasian women
3- The age of onset is usually over 40 years
4- It is associated with HLA-B8 and -DR3 in Caucasians
5- First-degree relatives have a 25% chance of developing the disease
Answer: 4- It is associated with HLA-B8 and -DR3 in Caucasians
A middle-aged man with red scaly patches on his elbows and knees presents with pain in the distal interphalangeal joints. You suspect psoriatic arthritis.
Which of the following features is most strongly linked in men to this condition?
1- Age of onset 20-30 years
2- Occurrence of arthropathy at the same time as the skin lesions
3- Minimal destruction of cartilage and bone
4- Involvement mainly of the distal interphalangeal joints
5- Occurrence of Bouchard’s nodes in the proximal interphalangeal joints
Answer: 4- Involvement mainly of the distal interphalangeal joints
