31.) A 32-year-old male patient has beensuffering from pain in the sacrum and coxofemoral joints,
painfulness and stiffness in the lumbar spine for a year. ESR - 56 mm/h. Roentgenography
revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What
is the most likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’s disease
E. Spondylosis
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 (over 38 yr) 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.
32.) A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and
knee joints, lumbar area. The disease has an acute character and is accompanied by fever up to
38oC. Objectively: the left sternoclavicular and knee joints are swollen and painful. In blood:
WBCs - 9, 5 · 109/l, ESR - 40 mm/h, CRP - 1,5 millimole/l, fibrinogen - 4,8 g/l, uric acid - 0,28
millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely
diagnosis?
A. Reiter’s syndrome
B. Rheumatic arthritis
C. Gout
D. Bechterew’s disease
E. Rheumatoid arthritis
EXPLANATION: Also known as reactive arthritis, autoimmune condition that develop to an infection in another part of body usually genitourinary and gastrointestinal infection. Mostly caused by chlamydia, e coli, campylobacter etc
Traid - Conjunctivitis, Arthritis, Non gonococcal urethritis
Treatment - tetracycline (chlamydia)
33.) A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with
berotec. Over a few last months he has experienced pain in the joints and sensitivity disorder of
legs and feet skin. Ps - 80/min, AP - 210/100 mm Hg. In blood: eosinophilia at the rate of 15%.
What disease can be suspected in this case?
A. Periarteritis nodosa
B. Systemic lupus erythematosus
C. Systemic scleroderma
D. Dermatomyositis
E. Wegener’s disease
34.) A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers,
muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia,
constipations. The patient’s face is masklike, solid edema of hands is present. The heart is
enlarged; auscultation revealed dry rales in lungs. In blood: ESR - 20 mm/h, crude protein - 85/l,
γ- globulines - 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
EXPLANATION:-Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) is associated with limited scleroderma.There are two forms of scleroderma: localized and systemic. The localized (limited) form affects the skin of only the face, hands, and feet. The systemic (diffuse) form involves those and, in addition, may progress to visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract.
35.) A 35-year-old patient complains about pain and morning stiffness of hand joints and
temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years.
Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What
examination should be administered?
A. Roentgenography of hands
B. Complete blood count
C. Rose-Waaler reaction
D. Immunogram
E. Proteinogram
EXPLANATION: Patient diagnosed as rheumaroid arthritis so best diagnosis for RA is roentgenography of hands.Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
36.) A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints,
painfulness and stiffness in the lumbar spine for a year. ESR- 56 mm/h. Roentgenography
revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What
is the most likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’s disease
E. Spondylosis
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 (over 38 yr) 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.
37.) A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers,
muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia,
constipations. The patient’s face is masklike, solid edema of hands is present. The heart is
enlarged; auscultation revealed dry rales in lungs. In blood: ESR- 20 mm/h, crude protein - 85/l,
γ- globulines - 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
EXPLANATION:-Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) is associated with limited scleroderma.There are two forms of scleroderma: localized and systemic. The localized (limited) form affects the skin of only the face, hands, and feet. The systemic (diffuse) form involves those and, in addition, may progress to visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract.
38.) A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the
anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely
etiological factor in this case?
A. Streptococcus
B. Staphylococcus
C. Pneumococcus
D. Klebsiella
E. Proteus
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.
39.) 5 weeks after hypothermia a 22-year-old patient developed fever, weakness, muscle pain,
inability to move independently. Objectively: tenderness, induration of shoulder and shin
muscles, restricted active movements, erythema on the anterior surface of chest. There is a
periorbital edema with heliotropic erythema. Gottron’s sign is present. What study is required to
verify the diagnosis?
A. Muscle biopsy
B. Aminotransferase activity
C. Pneumoarthrography
D. ASO titre
E. Rheumatoid factor
EXPLANATION:-Heliotropic erythema. Gottron’s sign specific sign for dermatomyositis .Gold standard for diagnosis of it is muscle biopsy.
40.) A 60-year-old male patient, who works as a construction worker, complains of pain in the right
hip and knee joints, that is getting worse on exertion. These presentations have been observed for
the last 5 years. Objectively: the patient is overnourished. Right knee joint is moderately
deformed. Examination of other organs and systems revealed no pathology. Blood tet results:
WBCs - 8, 2 · 109/l, ESR - 15 mm/h. Uric acid - 0,35 mmol/l. What is the most likely diagnosis?
A. Deforming osteoarthritis
B. Reactive arthritis
C. Gout
D. Rheumatoid arthritis
E. Reiter’s disease
EXPLANATION:-Osteoarthritis is a type of joint disease that results from breakdown of joint cartilage and underlying bone . ON xray joint space narrow .The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become worse and constant. Heberden’s(DIP) and Bouchard’s nodes(PIP).
part 5
part 5
