QUIZ

1. QUIZ Week 31 MSK 3

2. True or false • Rheumatoid arthritis • Is associated with HLA-DR4 genotype • Rarely affects the hands • Affects women more commonly than it affects men • Is a disease that only affects the joints • Only occurs in people that have a positive serum rheumatoid factor

3. True or false • Gout • Is more common in people with a low body mass index • Is a recognized cause of renal failure • Often causes X-ray changes after the first attack • Can be caused by high-dose salicylate therapy • Commonly affects the first metatarsophalangeal (MTP) joint

4. True or false • The following features are recognized complications of ankylosingspondylitis • Atlantoaxialsubluxation • Mitral stenosis • Plantar fasciitis • Anterior uveitis • Pulmonary fibrosis

5. True or false • Fibromyalgia • Affects men more commonly that women • Causes joint inflammation • Is commonly associated with anxiety and depression • Causes soft tissue tenderness • Is usually cured by cognitive behavioural therapy

6. True or false • The following suggest that joint pain is due to an inflammatory cause: • The pain is at its worst first thing in the morning • The joints feel stiff for at least 30 minutes after rising from bed • The pain is associated with fatigue • The is associated ‘boggy’ swelling of the joints • The joints feel warm on palpation

7. True or false • Bouchard’s nodes are a feature of rheumatic arthritis • Ulnar deviation of the wrist occurs in rheumatoid arthritis • ‘Jaccoud’s arthritis’ is the name used to describe the hand deformities of rheumatoid arthritis • The ‘question-mark’ posture in ankylosingspondylitis describes the exxaggerated lumbar lordosis and extension of the thoracic and cervical spines • Arthritis multilans is a severe deformity seen in the hands of some patients with psoriatic arthritis

8. True or false • The following are associated with HLA-B27 • Reiter’s syndrome • Psoriatic arthropathy • Wegener’s granulomatosis • Ankylosingspondylitis • Pyrophosphate arthropathy

9. True or false • Clinical features of osteoarthritis • Include crepitus of the joint • Usually get worse with activity • Of the hip include a loss of external rotation before other movements are diminished • Include general ill-health • Tend to deteriorate over time

10. True or false • Joints commonly affected by osteoarthritis include • Atlantoaxial • Distal interphalangeal (DIP) joint of the finger • Hip • Patellofemoral • Carpometacarpal joint of the thumb

11. True or false • The differential diagnosis of an acutely hot swollen joint includes: • Gout • Inflammatory arthritis • Septic arthritis • Discitis • Developmental dysplasia of the hip (DDH)

12. What is rheumatoid factor? • Antibody directed against the Fc fragment of IgGantibod. Rheumatoid factors may be of any immunoglobulin class, although IgM is the rheumatoid factor that is most commonly measured

13. What triad of clinical features is described by Reiter’s syndrome? • Arthritis • Conjunctivitis • Urethritis

14. Match the diagnosis with the description Gout Pseudogout Septic arthritis Reactive arthritis Psoriatic arthritis Ankylosingspondylitis Osteoarthritis Rheumatoid arthritis • A 68 year old lady presents with a sore throat that she has had for a few days. She has been feeling generally unwell for the last 2 weeks. She has a swollen left wrist and swollen tender right knee and right ankle. She has a normal WCC, high ESR and high CRP • An 84 year old lady with osteoarthritis develops a swollen warm right wrist. She has no other joint swelling and is otherwise well. • A 30 year old man presents with back pain and stiffness. It is worse in the morning and better by the end of the day. • An 80 year old woman presents with swelling and pain of her PIPs and DIPs of her hands. She has noticed that her joints are changing shape and that she is finding it more difficult to open bottles. Her mother also had similar shaped hands • A 64 year old woman has abnormally shaped fingers and some fingers are shorter than others. She also has pitting of her nails

15. Match the diagnosis with the description Rheumatoid arthritis Osteoarthritis Fibromyalgia Psoriatic arthritis Gout Pseudogout Enterpathic arthritis • A 60 year old lady has painful joints, no swelling, normal ESR and normal CRP • A 70 year old lady who is overweight has painful knees. She is finding it difficult to climb stairs and finds that her knees lock and creak. Her ESR and CRP are normal • A 60 year old man has a swollen painful right knee. He has chondrocalcinosis on an X-ray • A 68 year old lady has swollen MCPs bilaterally. She has stiffness in the morning for about an hour. She has raised ESR and CRP • A 50 year old man has a swollen left elbow and swollen right knee. He has stiffness for 2 hours in the morning. He has a raised ESR and CRP with a normal rheumatoid factor.

16. Which joint from the list is most likely to be affected in the following conditions? • Wrist • Knee • MCPs • MTPs • DIPs • Shoulder • Elbow Rheumatoid arthritis Gout Pseudogout Osteoarthritis Septic arthritis

17. Fill in the headings on the table