A 56 year old lady had presented to clinic with flagellate erythema, peri-orbital oedema and papules on her knuckles, identified as 'Gottron's papules'. She is also experiencing progressive muscles weakness and fatigue. Her CK is 562 U/L (normal range 38-176 U/L). She is treated with high dose steroids and her symptoms gradually resolve following an inpatient hospital stay. Of the following options, which is the single most appropriate initial follow up investigation required?
A MRI Spine
B Skin biopsy
C Liver function tests
D ECG
E Chest X Ray
A 45 year old gentleman has presented to A&E with a dry cough, fever and progressive shortness of breath. He has an anaemia and a raised ESR on bloods. He has a chest X Ray which shows bilateral hillier lymphadenopathy. Which of the following is the most likely cause of his symptoms?
A Lymphoma
B Extrinsic allergic alveolitis
C Tuberculosis
D Sarcoidosis
E Churg-Strauss syndrome
A 34 year old lady comes back from holiday in Italy, presenting to AMU with a photosensitive rash across her face, sparing the naso-labial folds. This is accompanied by joint pain, fatigue and low mood. He has hypertension and proteinuria. Clinically you suspect Systemic Lupus Erythematous. Which of the following blood tests would be the most appropriate diagnostic tests?
A cANCA
B pANCA
C anti-Jo
D Anti-ds DNA
E ESR
A 35 year old man has presented to your clinic after being referred by his GP. He has been suffering from fatigue and weight loss. On examination you notice his fingers and toes are swollen, with the skin hardened and movements restricted. He also states that the tips of his fingers have been cold and blue frequently in the past, so he often has to wear gloves. Which is the most appropriate and specific blood test to investigate this presentation?
A Anti-Scl 70
B ANA
C ESR
D cANCA
E Rh Factor
A 29 year old man has presented to his GP with an unbearable itch, describing this as 'the most itchy experience of his life'. The itch is concentrated on a maculopapular rash across his trunk, which is not painful and there is no discharge. He has been feeling generally unwell for a few months now, and his friends have commented that he has lost weight. He reports feeling bloated after eating and having a mixture of loose stools and constipation. What would be the most appropriate, initial diagnostic test for the cause of his symptoms?
A Skin biopsy
B Anti-TTG test
C Abdominal ultrasound
D LFTs
E Colonoscopy (including biopsy)
A 31 year old man has presented to his GP with fatigue and urinary frequency. He has today also asked you to review a rash which has developed on his leg, which is scaly, erythematous and itchy. This is the first time he has experienced such a rash, and he has no past medical history. Which of the following basic tests would help diagnose the cause of this rash?
A Skin swab
B ECG
C Urinary protein
D Full blood count
E Blood glucose
A 20 year old man has presented to clinic with low back pain, which was worse in the morning, getting progressively better in the evening or with exercise. On examination, he has lack of lumbar lordosis and increased thoracic kyphosis. This could be described as a 'question mark posture'. Schober's test was positive. Which would be the most useful test for this condition?
A Rheumatoid factor
B DEXA scan
C ANA
D MRI sacro-iliac joint
E Lumbar X Ray
A 29 year old athlete has presented with a 4 month history of fatigue, weight loss and nausea, associated with generalised abdominal pain. His bowel habit is disturbed: he has loose stools and occasionally notices blood and mucus in his stools. On examination he has tender bruising on his upper arms and shins, though he reports no trauma. What is the most likely cause of the above symptoms?
A Inflammatory bowel disease
B Bowel ischaemia
C Coeliac disease
D Irritable bowel syndrome
E Bowel cancer
A 31 year old man has presented with a 1 month history of abdominal pain, sinusitis and weight loss. He develops a vasculitic rash and the rheumatology registrar who comes to review the patient suspects polyangitis with granulomatosis. Which blood test would be the most useful initial investigation?
A ANA
B cANCA
C pANCA
D CEA
