Correct answer for all Question is A
1.) A 30 y.o. female with rheumatoid arthritis of five years duration complains of pain in the first three fingers of her right hand over past 6 weeks. The pain seems especially severe at night often awakening her from sleep. The most likely cause is?
A. Carpal tunnel syndrome
B. Atlanto-axial sublaxation of cervical spine
C. Sensory peripheral neuropathy
D. Rheumatoid vasculitis
E. Rheumatoid arthritis without complication
EXPLANATION:- Carpal tunnel syndrome is a Compression of the median nerve as it travels through the wrist at the carpal tunnel. The main symptoms are pain, numbness, and tingling, in the thumb, index finger, middle finger, and the thumb side of the ring fingers.Symptoms typically start gradually and during the night and often awakening from sleep. It is one of the most complication of RA.
Others complication of RA are;adverse effect of medications,felty syndrome,bakers cysts, Atlanto- axial sublaxation.
Others complication of RA are;adverse effect of medications,felty syndrome,bakers cysts, Atlanto- axial sublaxation.
2.) A 17 y.o. patient complains of acute pain in the knee joint and t0– 380C. He was ill with angina 3 weeks ago. Objectively: deformation and swelling of the knee joints with skin hyperemia.
Small movement causes an acute pain in the joints.
Which diagnose is the most correct?
A. Rheumatic fever, polyarthritis
B. Systemic lupus eritematodes
C. Reactive polyarthritis
D. Infectious-allergic polyarthritis
E. Rheumarthritis
EXPLANATION: Rheumatic fever is caused by group A streptococcus Beta hemolyticus. It is an inflammatory disease that can involve the heart, joints ( polyarthritis ), skin, and brain. Rheumatic fever may occur following an infection of the throat ( angina) .The underlying mechanism is believed to involve the production of antibodies against a person's own tissues.Treating people who have strep throat with antibiotics, such as penicillin, decreases the risk of developing rheumatic fever.
3.) A patient, aged 40, has been ill during approximately 8 years, complains of pain in the lumbar
part of the spine on physical excertion, in cervical and thoracal part (especially when coughing),
pain in the hip and knee joints on the right. On examination: the body is fixed in the forward
inclination with head down, gluteal muscles atrophy. Spine roentgenography: ribs osteoporosis,
longitudinal ligament ossification. What is the most likely diagnosis?
A. Ankylosing spondyloarthritis
B. Tuberculous spondylitis
C. Psoriatic spondyloarthropatia
D. Spondyloarthropatia on the background of Reiter’s disease
E. Spread osteochondrosis of the vertebral column
EXPLANATION:-Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae of spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. It affects men more than women. Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common.It is associated with HLA- B27 gene. (MRI), and X-ray studies of the spine, which show characteristic spinal changes and inflammation of the sacroiliac joint, combined with a genetic marker blood test are the major diagnostic tools. Schober's test is a useful clinical measure of flexion of the lumbar spine performed during the physical examination. X-ray showing bamboo spine in a person with ankylosing spondylitis because of longititudinal ligament ossification.
4.) A 18 y.o. male patient complains of pain in knee and ankle joints, temperature elevation to 39,
50C.He had a respiratory disease 1,5 week ago. On examination:
temperature- 38, 50C, swollen knee and ankle joints, pulse- 106 bpm, rhythmic,
AP- 90/60 mm Hg, heart borders without changes, sounds are weakened, soft systolic apical
murmur. What indicator is connected with possible etiology of the process?
A. Antistreptolysine-0
B. 1-antitrypsine
C. Creatinkinase
D. Rheumatic factor
E. Seromucoid
EXPLANATION:-The antistreptolysin O (ASO) titer test is a blood test that checks for a strep infection. Patient has respiratory disease 1.5 week ago. Pain in knee and ankles elevated temperature thus suspect of step infection that is associated with rheumatic fever. ASO titer test measures antibodies produced by our body in response to a toxin known as streptolysin O. Streptolysin O is a toxin produced by group A Streptococcus (GAS) bacteria.
5.) A man, aged 30, complains of intense pain, reddening of skin, edema in the ankle-joint area,
fever up to 390_. Sudden onset of the illness. In the past there were similar attacks lasting 5-6
days without residual changes in the joint. The skin over the joint is hyperemic without definite
borders and without infiltrative bank on the periphery. What is the most likely diagnosis?
A. Gout
B. Infectional arthritis
C. Rheumatoid arthritis
D. Erysipelatous inflammation
E. Osteoarthritis
EXPLANATION:- Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint.It mainly affect middle age male(30-45 yr) more than women. Other joints, such as the heels, knees, wrists and fingers, may also be affected. Joint pain usually begins over 2–4 hours and during the night.Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the metatarsal-phalangeal joint at the base of the big toe (podagra) affected most often, similar attacks occurs for 5-6 days without residual changes in joints.
The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:
• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. Decreased joint mobility may occur as gout progresses.
6.) A 40 y.o. woman is ill with rheumatic disease with composite mitral disease with prevalence of
the stenosis of left venous foramen.Complains of palpitation, fatigability,
progressing dyspnea, attacks of dyspnea and hemoptysis. Now she cannot be engaged even in the
easy activities.
What tactics is the most expedient?
A. Mitral comissurotomia
B. Conduction of current bicilinoprophilaxis
C. Prescription of anticoagulants
D. Prescription of venous vasodilatators
E.
EXPLANATION:- Mitral commissurotomy is an open-heart surgery that repairs a mitral valve that is narrowed from mitral valve stenosis.Patient has rheumatic disease and mostly affected valve is mitral valve with stenosis.
7.) A patient has complained of great weakness for 6 years. He fell seriously ill, the illness is
accompanied by body temperature rise, indisposition, pain in joints and along the legs muscles.
Objectively: violet-bluish erythema around eyes and over knee joints. HR- 120/min, heart sounds
are weak. Blood count: leukocytes- 12 ∗ 109/L, ESR- 40 mm/h. What is the most probable
diagnosis?
A. Dermatomyositis
B. Systemic lupus erythematosus
C. Rheumathoid arthritis
D. Atopic dermatitis
E. Reactive polyarthritis
EXPLANATION:-Dermatomyositis(DM) is a rare connective-tissue disease which is an idiopathic , autoimmune and chronic inflammatory mostly involved skin and muscles. It’s a systemic disorders that can also affect the joints, the oesophagus, the lungs, the kidney ,the heart ,etc. It’s more common in elderly people (over 40 yrs).In children most often appears between 5 and 15 years. Female to male ratio is 2:1. Black more affected. For more dermatomyositis
8.) A 54 y.o. patient has been suffering from osteomyelitis of femoral bone for over 20 years. In the
last month there appeared and gradually progressed edemata of lower extremities. Urine
analysis: proteinuria - 6,6 g/L. Blood analysis: disproteinemia in form of hypoalbuminemia,
increase of α2- and γ-globulins, ESR- 50 mm/h. What is the most probable diagnosis?
A. Secondary renal amyloidosis
B. Acute glomerulonephritis
C. Myelomatosis
D. Chronic glomerulonephritis
E. Systemic lupus erythematosus
EXPLANATION:- Patient has history of chronic disease and in urine increase level of protien and increase of α2- and γ-globulins.One common sign of kidney amyloidosis is the presence of abnormally high levels of protein in the urine, a condition known as proteinuria. Healthy kidneys prevent protein from entering the urine, so the presence of protein may be a sign that the kidneys aren't working properly.
9.) A 31 y.o. patient has been suffering from systemic scleroderma for 14 years.
She has been treated in hospital many times. She complains of occasional dull pain in the heart
region, palpitation, dyspnea, headache, eye-lid edemata, weight loss and deformation of
extremities joints. What organ affection worsens the disease prognosis?
A. Kidneys
B. Heart
C. Lungs
D. Gastrointestinal tract
E. Skin and joints
Explanation: Most affect organ is kidney because the patient has complains of eye- lid edema .'" scleroderma renal crisis" has been used to characterized the renal involvement in scleroderma ,in which malignant hypertension occurs over a days to week and is associated with acute renal failure ( rapid rise in creatinine and protein). Best drug to treat in this case is ACE inhibitors. In this case patient develop eye lid edema which is the result of protein loss because of renal failure.
10.) A 60 y.o. patient complains of pain in interphalangeal joints of hand that gets worse during
working. Objectively: distal and proximal joints of the II-IV fingers are defigured, with
Heberden’s and Bouchard’s nodes, painful, stiff. X-ray picture of joints: joint spaces are
constricted, there are marginal osteophytes, subchondral sclerosis. What is the most probable
diagnosis?
A. Osteoarthritis
B. Reiter’s disease
C. Ankylosing spondylitis
D. Rheumatic arthritis
E. Psoriatic arthritis
EXPLANATION:-Osteoarthritis sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis (OA) is the most common chronic condition of the joints . OA can affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe.In OA, the cartilage breaks down, causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain.It is most common in people older than 60. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.
Note:-Heberden’s and Bouchard’s node are a sign of osteoarthritis and are caused by formation of osteophytes (calcific spurs) of the articular (joint) cartilage in response to repeated trauma at the joint.
Note:-Heberden’s and Bouchard’s node are a sign of osteoarthritis and are caused by formation of osteophytes (calcific spurs) of the articular (joint) cartilage in response to repeated trauma at the joint.
part 2 continued.....
