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MCQs on Rheumatology

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MCQs on Rheumatology

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CASE SCENARIO ,,, A 48 year old man comes to your office complaining of severe right knee pain for 8 hours. He states that the pain, which started abruptly at 2 AM and woke him from sleep, was quite severe, so painful that even the weight of the bed sheets on his knee was unbearable. By the morning, the knee had become warm, swollen, and tender. He explains that he prefers to keep his knee bent, and extending his leg to straighten the knee causes the pain to worsen. He has never had pain, surgery, or injury to his knees. A year ago, he did have some pain and swelling at the base of his great toe on the left foot, which was not as severe as this episode, and resolved in 2 or 3 days after taking ibuprofen. His only medical history is hypertension, which is controlled with hydrochlorothiazide. He works as a financial analyst; he is married and does not smoke, but he does consume one or two drinks after work one to two times per week.
On examination, his temperature is 100.6F, heart rate 104 bpm, and blood pressure 136/78 mmHg. His head and neck examinations are unremarkable, his chest is clear, and his heart is tachycardic but regular, with no gallops or murmurs. His right knee is swollen, with a moderate effusion, and appears erythematous, warm, and very tender to palpation. He is unable to fully extend the knee because of pain. He has no other joint swelling, pain, or deformity, and no skin rashes.

• What is the most likely diagnosis?
• What is your next step?
• What is the best initial treatment?
   

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True & False

Correct statements about rheumatoid arthritis include:

1. The hip joint is usually affected at the onset of the disease.
2. The distal interphalangeal joints are involved in the most of the cases.
3. The dorsal and lumbar spines are involved.
4. Backer’s cyst is the collection of fluid in the cubital fossa.
5. Palindromic rheumatism describes widespread polyarticular involvement.

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CASE SCENARIO ,,, A 35 year old  man with painful right knee swelling. This has occurred rapidly over the past 36 hours. There is no history of trama or previous joint problems. He feels unwell & has noticed his eyes to be sore. No previous medical illness. He returned 3 weeks ago from a business trip to Thailand. Examination: temperature is 38C. Both eyes red, Brown macular rash on palms & soles. Examination of cardiovascular, respiratory, abdominal & neurology systems is normal. His  right knee is swollen, hot & tender. No other joints appears to be affected. Investigations: WCC 13.6 & ESR 64mm/h. What is your diagnosis?

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