A 35 year old man presents with a 6 month history of arthralgia, mouth ulceration and eye irritation. On examination, he had some ulceration in the mouth, bilaterally swollen wrists and reduced range of movements of both knees. His investigations showed: white cell count 11 x 109/L, C reactive protein 100 mg/dl, Rheumatoid factor negative. What is the likely diagnosis?
A 33 year old female with systemic lupus erythematosis has arthralgia involving her upper limbs. She also has a butterfly facial rash and a rash on the trunk. Urine dipstick shows no Proteinuria or haematuria. Her renal function is normal. Which one of the following medications is most appropriate?
A 75 year old woman with longstanding Rheumatoid arthritis has great difficulty walking and comments that both her legs are stiff and 'jumpy'. What is the most likely cause of the presentation?
A 50 year old woman has severe rheumatoid arthritis. She is admitted with worsening breathlessness. She is currently on ibuprofen, methotrexate, celecoxib, and paracetamol. On examination, she has features of rheumatoid changes in her hands and looks pale. There is no palpable lymphadenopathy and no abdominal masses. Investigations showed that her Hb level is 7.8 g/dl with a MCV of 90, WCC 2.1 x 109/L and platelets 55 x 109/L. Reticulocyte count is 0.3%(0.5% to 1.5%). What is the likely cause of the anaemia?
A 65 year old woman presents with dry eyes and a dry mouth. Her investigations show: ANA strongly positive (1:1600), antiRo/SSA antibodies strongly positive, rheumatoid factor positive, IgG markedly elevated at 42 g/l (normal
A 55 year old female has been on long-term steroids for chronic obstructive pulmonary disease. She complains of pain in her right groin radiating down the anteromedial thigh. She has an antalgic gait. On examination of the hip, there is decreased range of movement especially flexion, abduction and internal rotation. What is the likely diagnosis?
A 60 year old woman on treatment for longstanding rheumatoid arthritis presents with breathlessness. She complains of a dry cough. The oxygen saturation was found be 85% on air. The chest x ray shows a diffuse bilateral interstitial infiltrate. Blood cultures and sputum cultures are negative. Which drug is likely to have caused this adverse effect?
A 65 year old man presents has recently developed an acutely painful right knee. On examination, he had a temperature of 37.2°C a hot and swollen right knee. His white cell count which was raised at 14 x 109/L. A knee X ray showed reduced joint space and chondrocalcinosis. Culture of aspirated fluid showed no growth. What is the likely diagnosis?
A 60 year old man presents with a painful swollen left knee as well as pain and stiffness of both his hands. On examination his skin is pigmented. There is tenderness and swelling of the 2nd and 3rd metacarpophalangeal joints of both hands, he has hepatomegaly of 8 cm below the costal margin. His knee is swollen and aspiration of the joint yields turbid, straw coloured fluid. Which one of the following diagnosis is likely?
A 70 year old man presents with bony swellings of the DIP joints on both hands. They were painful a year ago but are now painless. The most likely diagnosis is :
A 60 year old man presents with gouty tophi. He has been commenced on allopurinol but develops severe joint pains 3 days later. On examination, he has a temperature of 39°C and erythematous swelling of his wrists, knees and ankles. Investigations reveal: urate 0.6 (0.23-0.45), creactive protein 180 mg/L. Which of the following is likely to have caused the presentation?
A 35 year old retired athlete presents with severe burning pain affecting the right leg and foot. 4 months earlier, he had several arthroscopic washouts for septic arthritis affecting his right knee, which followed an injury. Examination reveals a reduced range of movement of the right knee and ankle. There was diffuse swelling of the right leg and foot with overlying cool, scaly skin. What is the likely diagnosis?
A 55 year old patient presents with a two week history of pain and stiffness in her shoulders and wrists. The symptoms improve over the day. On examination, there was synovitis of both wrists and proximal muscle wasting. Her ESR was 40 mm/hr. What is the likely diagnosis?
A 75 year old has had increasing back and leg pains several years. X rays reveal bony sclerosis of sacroiliac, lower vertebral and upper tibial regions. He mentions greater difficulty hearing over the recent years. Blood tests reveal an elevated serum alkaline phosphatase. What is the likely diagnosis?
A 55 year old patient presents with a two week history of pain and stiffness in her shoulders and wrists. The symptoms improve over the day. On examination, there was synovitis of both wrists and proximal muscle wasting. Her ESR was 40 mm/hr. What is the likely diagnosis?
A 45 year old woman presents with numbness and weakness of her upper and lower limbs. She developed asthma at the age of 30. On examination she looks unwell. She has palpable purpura over her face and over her elbows and knees. On neurological examination she has a right sided wrist drop and there is weakness of dorsiflexion of her right foot. Sensation is also impaired over the dorsum of her right foot.
Investigations:
CXR is normal.
Hb 10.9 g/dL
MCV 90 fl
WBC 23 x 10⁹/L
Eosinophils 12%
ANCA negative
What is the likely diagnosis?
A 40 year old man has generalised joint pains and stiffness, particularly in the knees. He also has sore, dry eyes and difficulty tolerating contact lenses. On examination there are no joint swellings or effusions. His ESR is 80 mm/hour, Rheumatoid Factor positive with a titre of 1/1024. Which of the following is likely?
A 45 year old man has recurrent sinusitis and haemoptysis. He also has haematuria and mild renal impairment. Tests are sent for suspected Wegener's granulomatosis. Which one of the following tests has greatest specificity for Wegener's granulomatosis?
A lady with w hiplash injury 5 years ago presents with pains in the neck and shoulder. They were not relieved by 12 cocodamols a day. What should be done next?
A 45 year old man presents with a week history of a painful right leg. He has had previous episodes of erythema nodosum, recurrent oral and scrotal ulceration. Examination reveals a diffusely swollen left leg. What is the likely cause of his swollen leg?
A 45 year old woman presents with pain in the wrist. The pain is centred over the radial styloid and is increased by abduction of the thumb against resistance. What is the most likely diagnosis?
A 43 year rheumatoid arthritis was investigated routinely and had the following results:
Haemoglobin 11.2 g/dL
Platelets 385 x 10⁹/L
White Cell Count 8.2 x 10⁹/L
MCV 110 fL
Which drug is she likely to have been on?
72-year-woman was admitted after a fall. She lived alone and worked in the hospital benevolent society shop. You were called to see her because she is agitated, accusing staff of stealing her jewellery and wanting to leave. Which of the following would be your first intervention?
A 23-year-old man, known to have schizophrenia and being prescribed oral trifluoperazine as his only regular medication, was brought to the Emergency Department by ambulance. He was mute, with his head turned to the right in an awkward and extreme position, and he appeared to be distressed. The ambulance crew reported that he had been like this for about 30 minutes. Other than this odd posture, physical examination was normal. Which is the immediate intervention that is most likely to be appropriate?
A 42 year old woman presented in December with a one month history of gradually worsening anhedonia, loss of energy and low mood. Interview was difficult due to her slow speech and poor concentration, but she admitted to derogatory auditory hallucinations telling her she is guilty. She was convinced that she must have committed a terrible crime. Which is the most appropriate diagnosis?
You need to decide which antidepressant to prescribe for an emaciated agitated 78-year-old man who you are seeing as an out-patient. Which one of the following statements is true?
A 30-year-old woman, with a long history of intravenous drug abuse, is admitted with an abscess in her right groin related to the use of non-sterile needles. This is drained, and she is admitted to a medical ward for intravenous antibiotic treatment. She 'goes missing' from the ward at 14.00h, but is found outside a back entrance of the hospital smoking a cigarette at 15.30h and then returns to the ward. At 21.30h you are asked to see her by the ward nurses because she says she feels very unwell. She is nauseated, has had some diarrhoea, and yawns as you talk to her. Her temperature is 37.6 C and her pupils are dilated. The most likely diagnosis is:
A 28-year-old woman with a history of manic depression has been well controlled on lithium for several years. She wishes to get pregnant and asks for advice regarding the safety of lithium in pregnancy and when breast-feeding Which one of the following statements is true?
A 34-year-old woman developed chest pain after an argument with her 17-year-old daughter. She was brought to the Accident and Emergency department where she was hyperventilating and looking very anxious. She was tender to light pressure on the front of her chest, but examination was otherwise unremarkable. Breathing room air, her oxygen saturation (finger probe) was 99%. Her ECG was normal. You should:
A 78-year-old man, without significant past medical history and taking no regular medications, had become increasingly forgetful over the last 18 months, to the point where he now found it difficult to remember the names of some members of his family. He had recently been having visual hallucinations. On examination he seemed rather expressionless and had cogwheel rigidity of both arms. The most likely diagnosis is:
A 48-year-old with recurrent carcinoma of the colon admits to poor sleeping, anhedonia and feelings of hopelessness. Which of the following would you do?
A 22 year old woman had been diagnosed with generalised anxiety disorder following her presentation with a long history of pervasive and continuous symptoms of anxiety. She had been particularly troubled by poor concentration and difficulty getting to sleep. She did not have any concurrent depressive illness or substance misuse. What is the safest and most effective treatment for her generalised anxiety disorder?
Mr Jonas is admitted from his residential home with pneumonia. He is on long-term thioridazine for chronic schizophrenia. Which one of the following statements is true?
A 48-year-old man with a long history of alcohol abuse is admitted after being found collapsed in the street. He is agitated and tremulous. You make a diagnosis of alcohol withdrawal. Which one of the following is appropriate management for this condition?
A 34-year-old woman was brought to the Emergency Department after taking an uncertain quantity of paracetamol two hours previously and trying to hang herself. She became agitated and insisted that she wanted to go home immediately. How should you proceed?
A 40-year-old woman was referred to the general medical clinic with a 9-month history of feeling exhausted. She was unable to do anything that required physical exertion and felt miserable because of this. A comprehensive battery of tests failed to establish any clear medical cause for her symptoms and a diagnosis of chronic fatigue syndrome was made. Which treatment is of definite benefit in this condition?
