Rheumatology_2009

Which of the following activities is most likely to cause pain in osteoarthritis of the patello‐femoral joint?

What is the most common mechanism for primary hyperuricaemia? Alternative wording: What is the most common mechanism for primary hyperuriacemia in a normal person?

Where is pain most felt in patients with hip osteoarthritis?

Which of the these joints is most likely to be involved in pseudogout (calcium pyrophosphate deposition disease)?

A circulating antibody is suspected of causing disease. Which of the following is best evidence of the antibody being pathogenic?

CRP and ESR are markers of disease activity in rheumatoid arthritis. What other marker is most useful in monitoring disease activity?

A 56yo man presents with right knee swelling after a long walk. He has a history of obesity and psoriasis of 12 years. Right knee xray shows loss of cartilage in the medial compartment with chondrocalcinosis. Serum urate 0.55 (0.24 – 0.44) Synovial analysis Viscosity: normal Clarity: normal WCC: 900mm3 (<200) Differential: 90% mononuclear Crystals : occasional extracellular urate crystals What is the cause of this man’s right knee swelling?

A 59 year old woman presents with painful fingers, which are worse in winter and when cold. Mild sclerodactyly is noted on clinical examination. The remainder of the exam is unremarkable. An ANA is performed and is positive with anti centromere antibodies at a titre of 1:1280. Her ENAs are negative. Which of the following is the most appropriate?

A patient with renal impairment (Cr 152) presents with acute gout. He is on an ACE inhibitor. What is the best treatment?

A 45 year old female presents with puffy fingers, a symmetrical arthritis of the small joints of her hands, proximal weakness and Raynaud’s phenomenon. Her initial blood tests are as follows: CK 2000 ALP 180 ALT 160 GGT 150 ANA 1:1640 speckled pattern She has positive antibodies to RNP, but antibodies to Jo‐1, Sm, Ro, La, and Scl‐70 are negative. What is the most likely diagnosis?

A 63 year old male with a 12 year history of polyarthritis now presents with increasing pain in his feet with prolonged walking and discomfort in his hands. An X ray of his hand is shown below. Which one of the following conditions is the most likely diagnosis?

A 23 year old male presents with palpable purpura over his buttocks and lower limbs. He is asymptomatic. A biopsy of the rash shows a leukocytoclastic vasculitis. Immunofluorescence shows IgA deposition at the endothelium. What is the next most appropriate investigation?

A 32 year old lady is admitted to hospital with an acute onset of chest pain due to myocardial infarction. She reports a history of recurrent severe post prandial abdominal pain, intermittent lower limb claudication and recent onset of hypertension which has been difficult to control with multiple antihypertensive agents. Initial investigation results are: Hb 120 WCC 5 Platelets 300 Chol 4.0 ESR 40 CRP 3 ANCA negative ANA 1:40, speckled pattern C3 0.32 C4 0.9 Urine <10 RBC What investigation is most likely to reveal the diagnosis?