21) A 32 year old, previously well, female presents with a seven month history of pain and stiffness in her joints. Examination reveals synovitis of the distal interphalangeal joints of the left index finger and the right ring finger together with the left wrist and left ankle joints. The ESR was 35mm in the first hour. Which one of the following is the most likely diagnosis? 1) Osteoarthritis 2) Psoriatic arthritis 3) Rheumatoid arthritis 4) Systemic lupus erythematosus. 5) Viral arthritis. 22) A man in his 20s begins to note persistent lower back pain and stiffness that diminishes with activity. In his 30s he also develops hip and shoulder arthritis, and in his 40s he is bothered by decreased lumbar spine mobility. He has no other major medical problems. These findings are most typical for which of the following? 1) Ankylosing spondylitis 2) Calcium pyrophosphate dihydrate deposition disease 3) Lyme disease 4) Osteoarthritis 5) Rheumatoid arthritis 23) A 25 year old lady with known SLE presents with the nephrotic syndrome. A renal biopsy is performed and this confirms diffuse proliferative glomeronephritis (WHO Class 1V). Which of the following treatment regimes would you advise? 1) Azathioprine alone 2) Prednisolone alone 3) Azathioprine and Prednisolone 4) Prednisolone and intravenous Cyclophosphamide 5) Prednisolone and Methotrexate 24) A 45-year-old man has noted pain in his right knee for several years. There is no joint swelling. As he moves about during the day, the pain decreases. The underlying disease process is probably which of the following? 1) Osteoarthritis 2) Osteochondroma 3) Osteomalacia 4) Osteopetrosis 5) Osteoporosis 25) A 28 year old man presented with acute stiffness and swelling of his knees and ankles, and a painful rash on his legs. The ESR was 86 mm in the first hour. Chest X-ray showed hilar lymphadenopathy. What is the most likely outcome? 1) chronic arthritis 2) pulmonary fibrosis 3) renal failure 4) skin ulceration 5) spontaneous improvement 26) Bone densitometry performed on a 48-year-old woman demonstrates bone mass decreased more than 2 standard deviations below the mean for her age in her left femoral head, wrist, and lumbar vertebral region. Six months later, the amount of bone loss is seen to be increased by repeat densitometry examination. These findings are most likely to be associated with with which of the following serum laboratory test abnormalities? 1) Intact parathormone of 5 pmol/L (1.2 - 5.8) 2) Cortisol of 2060 mmol/L (110 - 607) 3) Total serum globulin of 35 g/L 4) Uric acid of 930 micromol/L (149 - 446) 5) Total cholesterol of 10 mmol/L (< 5.17) 27) A 50 year old Asian lady with severe rheumatoid arthritis has failed on most traditional DMARD treatments. She is currently on Methotrexate 20 mg weekly and for the last 6 months has been receiving regular infusions of the anti-TNF-alpha monoclonal antibody, Infliximab. Her joint disease has dramatically improved. She now presents with fevers, pleuritic chest pain and a large left sided pleural effusion, but little evidence of joint synovitis. What is the most likely diagnosis? 1) Primary bronchial carcinoma 2) Pulmonary metastases 3) Pulmonary embolus 4) Rheumatoid related effusion 5) Tuberculosis 28) Which of the following statements regarding systemic lupus erythematosis (SLE) is correct? 1) when disease is active the levels of complements C3 and C4 are raised. 2) when evidence of mild nephritis is present, a renal biopsy is unnecessary. 3) there is a female preponderance of 8:1. 4) first manifestation of the disease may be idiopathic thrombocytopenia purpura. 5) there is neurological involvement in about 10% of cases. 29) A 50 year old woman presents with dry eyes, a dry mouth, an erythematous rash and polyarthralgia. Investigations: ANA strongly positive (1:1600), anti-Ro/SSA antibodies strongly positive, rheumatoid factor positive, IgG markedly elevated at 45 g/l (normal -
Posted on: Mon, 22 Sep 2014 01:35:52 +0000
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