Sem Rheumatology Masterclasses

Paper 2 40 A 28 year old man presents with a 36 hour history of pain and swelling in his right first metatarsophalangeal joint. On examination he is afebrile and the joint is red, hot and exquisitely tender. The most appropriate treatment is – Commence flucloxacillin – Commence diclofenac – Commence allopurinol – Commence paracetamol – Commence methotrexate

Paper 2 46 A 28 year old man with a two year history of ankylosing spondylitis presents with a 24 hour history of a red painful eye with blurred vision. The most likely finding on ophthalmological diagnosis is – Raised intra-ocular pressure – Inflammatory cells in the anterior chamber – A swollen optic disc – A superior dislocation of the lens – A scleral perforation

Paper 2 47 A 35 year old woman trips and falls forcefully onto her outstretched left hand. After the fall the wrist is painful. When you examine her there is exquisite tenderness in the area between the abductor policis brevis/longus and the extensor policis longus at the level of the wrist (the anatomical snuffbox). Which bone is most likely to have been fractured – Lunnate – Trapezium – Scaphoid – Pisiform – Triquetrum

Paper 2 48 A 72 year old man presents to your general practice with worsening mid-lumbar back pain for the past few weeks. The pain is much worse at night and a little better during the day. On examination he has some moderate localised mid lumbar tenderness but nothing else abnormal. The most appropriate first investigation is – CT scan of the lumbar spine – MRI of the lumbar spine – Plain X-ray of the lumbar spine – Nuclear bone scan of the lumbar spine – No investigation at this stage

Paper 3 7 a 35 year old architect has a history of Ankylosing spondylitis. He presents with a sore red left eye. The most likely diagnosis is: a) herpetic keratitis b) Closed angle glaucoma c) Iritis d) Hyphaema

Paper 3 11 A 50 year old part time shop assistant presents with a history of progressive muscle weakness, swallowing trouble and exertional dyspnoea. On examination there is profound proximal muscle weakness, a hoarse voice and diplopia on upgaze. Tendon reflexes are preserved and there are no sensory signs and no rash evident. What is the most likely diagnosis? a) Dermatomyositis b) Polymyositis c) Myasthenia gravis d) Chronic inflammatory demyelinating polyneuropathy

Paper 3 27 A 80 year old retired gardener presents with a 2 year history of pelvic pain localized to the left side. It is particularly bad at night but has become an increasing problem during the day. Over the counter analgesics have been unhelpful. He also complains of “getting old” with a sore left shoulder and reduced hearing. His past history includes diet controlled type 2 diabetes, hyperlipidaemia and gout. There is no relevant family history. His medications are –: Simvastatin 10mg panadeine, panadol non steroidal anti inflammatory drugs.(NSAIDS) His examination is unremarkable.see next slide

part 2 You arrange an x ray of his pelvis and the result is shown. The left hemipelvis is sclerotic. The cortical bone is thickened particularly in the region of the ileo-pectineal line where the trabeculae are course. What is the most likely diagnosis? a) Osteoarthritis b) Fracture c) Avascular Necrosis of the Left Femoral Head d) Pagets Disease e) Sacro ileitis

Paper 3 28 Biochemistry of the above condition would include: a) Incr. Calcium, low phosphate, high PTH, incr ALP b) Normal Calcium, normal phosphate, normal PTH, increased ALP c) Normal Calcium, normal phosphate, low PTH, normal ALP d) Low Calcium, High Phosphate, low PTH, normal ALP

Paper 3 29 A useful additional test in the above condition would be: a) CT Pelvis b) Total Body Bone Scan c) MRI pelvis d) Ultrasound pelvis