A 53 year old lady is admitted to the acute medical unit with a painful knee. It is hot and swollen. Her observations on admission include oxygen saturations of 96%, blood pressure 99/68mmHg, temperature 38.1 degrees and heart rate 101bpm. On examination there is reduced movement on flexion and extension of the joint due to pain. She looks flushed and is concerned because she has rheumatoid arthritis and is worried this is another flare. What is the most likely cause for the above presentation?
A Gout
B Osteoarthritis
C Pseudogout
D Rheumatoid Arthritis Flare
E Septic Arthritis
A 65 year old man presents to your GP clinic with a painful left foot. He was recently discharged from the acute medical unit at the local hospital where he was treated for acute alcohol intoxication. He also has a past medical history of ischaemic heart disease and type II diabetes. On examination you notice extreme tenderness and marked erythema over his left greater toe, with a firm, irregular chalky coloured mass underneath the skin. Which of the following investigations would provide a definitive diagnosis for the above presentation?
A Blood uric acid levels
B Erythrocyte sedimentation Rate
C Left foot X Ray
D Skin biopsy
E Synovial fluid aspiration
A 62 year old lady has attended clinic for a review of her osteoarthritis. She recently had an operation to manage pain in her left knee. However she is now stating that her handwriting is being affected by her long term medical condition. Which of the following clinical signs are you most likely to identify on examination of this lady’s hands?
A Bouchard’s nodes at distal interphalangeal joints
B Boutonnière's deformity
C Heberden’s nodes at distal interphalangeal joints
D Swan neck deformity
E Ulnar deviation
A 72 year old gentleman has presented to AMU with progressively worsening shortness of breath. He also has digital clubbing, a dry cough and diffuse fine inspiratory crackles are noted on auscultation. Pulmonary nodules are found on the lungs on CT scan. Which of the following rheumatological conditions are most likely to have caused this pathology?
A Osteoarthritis
B Psoriatic Arthritis
C Reactive Arthritis
D Rheumatoid Arthritis
E Systemic Lupus Erythematosus
A 45 year old man presents to clinic with worsening lower back pain. The pain is worse in the morning and improves throughout the day with exercise. The pain spreads to his buttocks and is associated with stiffness. Schober’s test shows increased distance of less than 4cm. He recalls having this pain since he was in his early twenties, and it has never resolved. A lumbar X ray is organised. which shows squaring of the vertebral bodies. Which of the following conditions is most likely to contribute to the above findings?
A Ankylosing spondylitis
B Malignancy
C Mechanical back pain
D Osteoarthritis
E Tuberculosis
A 49 year old lady has presented with pain in multiple joints, especially her hands and feet. She has increased fatigue and low mood. She has morning stiffness and complains of swollen joints. However, on examination, there are no swollen joints, instead she is diffusely tender throughout her lower back, arm and legs. Routine bloods, including ESR and CRP, are normal, whilst all X rays are normal. What is the most likely cause of this presentation?
A Rheumatoid Arthritis
B Fibromyalgia
E Raynaud’s Phenomenon
A 60 year old builder presents to his GP for the first time in many years. He is concerned because the fourth finger on his right hand is ‘not moving as well’. On examination there is a fixed flexoral deformity of this finger. It is painless and has been getting progressively worse over the past 18 months. What is the most common underlying cause of this presentation?
A Alcohol excess
B Anticonvulsant therapy
C Diabetes
D Genetic predisposition
E Trauma
A 44 year old lady attends her GP clinic with tingling in her fingers. On examination she has paraesthesia on the lateral three fingers on her left hand. It is worse at night and she occasionally encounters a burning sensation. Phalen’s sign is positive. What is the most common underlying cause of the above presentation?
A Acromegaly
B Diabetes
C Idiopathic
D Post-Colle’s fracture
E Pregnancy
A 71 year old lady presents to clinic with ulnar deviation, rheumatoid nodules and squaring of the thumb. She states this has been a progressive change over the last 10 years, but she has ‘just got on with things’. Which blood test would be most specific for this condition?
A Anti-CCP
B Anti-nucleotide Antibody
C CRP
D ESR
E Rheumatoid Factor
A 72 year old lady presents with neck pain radiating to her left and right shoulders for the last 3 weeks. The pain is accompanied by stiffness, which is particularly worse in the morning. Her ESR and CRP are both elevated. She is treated with steroids and her symptoms abate. What is the most likely cause of the above presentation?
A Ankylosing Spondylitis
B Cervical Spondylosis
C Polymyalgia Rheumatica
D Polymyositis
E Supraspinatus Tendonitis
A 71 year old man attends his GP stating that he has found a lump at the back of his knee. It is not painful and he states that it has been there for 2 weeks. On examination you note a transilluminable, non-pulsatile swelling in the posteriomedial aspect of the knee. What is the most likely cause of this presentation?
A Baker’s cyst
B Benign neoplasm
C Meniscal cyst
D Popliteal artery aneurysm
A 45 year old gentleman is admitted to the acute medical unit with joint pain. His radiology indicates symmetrical blurring and narrowing of the sacroiliac joint. Which condition would this finding be most consistent with?
C Psoriatic Arthritis
A 66 year old man is seen by his GP with longstanding relapsing and remitting wrist pain and swelling. This is always relieved after anti-inflammatories. He has a wrist X ray which shows well defined periarticular erosions. Which condition would be most consistent with this finding?
A Acute gout
B Chronic gout
C Osteoarthritis
D Psoriatic arthritis
E Rheumatoid arthritis flare
A 50 year old lady is referred to rheumatology for joint aspiration after presenting with a hot, painful knee. She is haemodynamically stable. The aspirated synovial fluid is found to contain positively bifringent rhomboid crystals. What is the most likely cause of this lady’s presentation?
B Pseudogout
D Septic Arthritis
E SLE
A 12 year old boy attends A&E after falling from a tree. He has sustained trauma to his left wrist. X Ray indicates that the wrist is not broken, however he is unable to extend his wrist. This could be indicative of damage to which nerve?
A Axillary
B Long thoracic
C Median
D Radial
E Ulnar
A 29 year old gentleman presents with wrist pain. During her examination, the GP grasps the patient’s thumb and ulnar deviates the hand sharply. This elicits sharp pain along the distal radius. What is the name of this described test?
A Finkelstein’s test
B Froment’s test
C Phalen’s test
D Sweep test
E Tinel’s test
A 51 year old lady with a past medical history of severe rheumatoid arthritis, diabetes and mild cognitive impairment presents to the acute medical unit. She has a temperature of 39.1 degrees and her blood pressure is 90/54mmHg. Admission bloods show: Hb 139 (115-160) WCC 3.0 (4.0-11.0) Platelets 339 (150-400) Neutrophils 1.1 (2.0-5.0) Which of her regular medications is most likely contributing to this presentation?
A Codeine
B Diclofenac
C Methotrexate
D Metformin
E Simvastatin
A 49 year old gentleman with severe debilitating rheumatoid arthritis presents to clinic for review. He has just completed a six month trial of methotrexate and sulfasalazine therapy, with limited success. His DAS28 score has been greater than 5.1 on two occasions. He has also had low dose glucocorticoids. He is keen to try further medical treatment. Which medication would be the most appropriate to commence in the next step of this gentleman’s management?
A Azothiaprine
B Celecoxib
C Ciclosporin
D Hydroxychloroquine
E Infliximab
A 52 year old lady has severe hand and wrist pain and is referred for X Ray. The X ray shows soft tissue swelling, ill-defined marginal erosions, loss of joint space and peri-articular osteopenia. Which condition would be consistent with the above findings?
B Chronic Gout
D Osteoporosis
E Rheumatoid arthritis
A 39 year old man presents to his GP with worsening low back pain, malaise, fatigue and fever. He also notes pain when passing urine. He reports having come back from holiday in Thailand one month previously. What is the most likely causative organism for this presentation?
A Campylobacter jejuni
B Chlamydia trachomatis
C Neisseria gonorrhoeae
D Salmonella enterica
E Shigella dysenteriae
A 87 year old man is admitted to A&E with severe hip pain and is unable to weight bear. He has an X ray which shows an undisplaced fracture of the neck of his right femur. He denies having a fall, instead stating that he bent over to pick up a towel and ‘heard a crack’. What is the most appropriate investigation to organize in order to assess the cause of the fracture?
A Bone densitometry scan
B Cardiac echo
C ECG
D Electroencephalogram
E MRI Hip
A 75 year old lady is admitted for an elective right total hip replacement. She has a past medical history of arthritis but is otherwise fit and well. Following surgery, her pain management is stepped down from morphine to oral codeine and paracetamol after three days. She has one temperature of 37.9 degrees celcius and her WCC rises to 12.0. She has a successful trial without catheter and is passing urine normally. Her AMTS score is 3/10 and MMSE is 12/30. What is the most likely factor to impact negatively on her rehabilitation potential?
A Delirium
B Dementia
C Poor social support
D Sepsis
E Urinary Tract Infection
A 81 year old gentleman is admitted for an elective left total knee replacement. Following the operation, he becomes breathless and develops pleuritic-sounding chest pain and haemoptysis. There is no green sputum. His oxygen saturations are 94% on air and he is apyrexial. On inspection he has an erythematous and swollen left leg below the surgical wound site. What would be the most important investigation to organize at this point?
A Chest X Ray
B CT Pulmonary Angiogram
C D Dimer
D Sputum sample
E Wound swab
A 66 year old woman presented with joint pain and mild deformity in her distal interphlalangeal joints. On examination you note an erythematous plaque on her hairline and signs of scale on her scalp. On examination of her hands, which finding would you be most likely to observe?
A Clubbing
B Heberden’s nodes
C Koilonychia
D Nail plate separation from nail bed
E Nail plate thinning
