Ankylosing Spondylitis (849/1700)

A 28yo man is inv for recurrent lower back pain. A dx of AS is suspected. Which of the following inv is most useful?
a. ESR
b. XR sacro-iliac joints
c. HLA B27
d. XR thoracic spine
e. CT lumbar spine

Parotid swelling (518/1700)

A 70yo woman presents with recurrent episodes of parotid swelling. She complains of difficulty
in talking and speaking and her eyes feel gritty on waking in the morning. What is the single
most likely dx?

a. C1 esterase deficiency
b. Crohns disease
c. Mumps
d. Sarcoidosis
e. Sjogrens syndrome

Occular manifestations of rheumatological disease (841/1700)

A 36yo lady comes with hx of early morning stiffness of her small joints and with red and painful eye. What is the single most appropriate option?

a. Iris
b. Ciliary body
c. Cornea
d. Conjunctivitis
e. Sclera
f. Lichen planus

Giant Cell Arteritis (496/1700#0

A 45yo woman has been dx with GCA and is being treated with steroids. What is the other drug
that can be added to this?
a. ACEi
b. Beta blockers
c. Aspirin
d. Interferons
e. IVIG

Malar rash, photosensitivity, TB patient (647/1700)

A 35yo woman undergoing tx for TB presents with malar rash, photosensitivity and hematuria.
What is the single most likely positive antibody?
a. Anti Ds DNA
b. Anti Sm
c. Anti Histone
d. Anti La
e. Anti centromere

Headache and loss of vision (487/1700)

A 62yo lady presents with right sided headache and loss of vision. What is the single most inv?
a. ESR
b. BUE
c. CT head
d. XR orbit
e. IOP

Dysphagia (430/1700)

A 45yo woman complains of pain in her hands precipitated by exposure to the cold weather. She
is breathlessness on walking. When she is eating, she can feel food suddenly sticking to the
gullet. It seems to be in the middle of ther esophagus but she can’t localize exactly where it
sticks. It is usually relieved with a drink of water. Choose the single most likely cause of
dysphagia from the options?

a. Esophageal carcinoma
b. Systemic sclerosis
c. SLE
d. Pharyngeal carcinoma
e. Globus hystericus

Epistaxis, Hemoptysis and ARF (1565/1700)

A 75yo man presents with ARF. He has been troubled by recurrent epistaxis but over the last
3wks he reports to have coughed up blood too. What is the single most likely positive antibody?

a. P ANCA
b. C ANCA
c. Anti Ro
d. Anti DS DNA
e. Anti centromere

Arthralgia, Lymphadenopathy, Erythema Nodosum (1478/1700)

A 37yo man presents with some raised lesions on the shin. He came with cough and also
complains of arthralgia. Exam: bilateral hilar lymphadenopathy and erythema nodosum is
present. What is the single most likely cause?
a. CD
b. UC
c. Sarcoidosis
d. Streptococcal infection
e. TB

Severe headache and jaw pain (326/1700)

A 54 yo lady presents with sudden, severe pain in the left half of her skull. She also complains of
pain around her jaw. What is the next likely step?
a. CT
b. MRI
c. Fundoscopy
d. ESR
e. Temporal artery biopsy

Sarcoidosis and renal stones (303/1700)

 A 34yo African-caribbean man with a hx of sarcoidosis has presented with bilateral kidney
stones. What is the most likely cause for this pt’s stones?
a. Hypercalcemia
b. Hyperuricemia
c. Diet
d. Recurrent UTIs
e. Hyperparathyroidism

Osteoarthritis (287/1700)

A pregnant woman with longterm hx of osteoarthritis came to the antenatal clinic with
complaints of restricted joint movement and severe pain in her affected joints. What is the
choice of drug?

a. Paracetamol
b. Steroid
c. NSAID
d. Paracetamol+dihydrocoiene
e. Pethadine

Antiphospholipid syndrome (275/1700)

A 32yo female with 3 prv 1st trimester miscarriages is dx with antiphospholipid syndrome. Anticardiolipin antibodies +ve. She is now 18wks pregnant. What would be the most appropriate
management?

a. Aspirin
b. Aspirin & warfarin
c. Aspirin & heparin
d. Heparin only
e. Warfarin only

Nodular rash over knee & arthalgia (185/1700)

A 32yo previously healthy woman has developed pain and swelling of both knees and ankles
with nodular rash over her shins. As part of the inv a CXR has been performed. What is the single
most likely CXR appearance?
a. Apical granuloma
b. Bilateral hilar lymphadenopathy
c. Lobar consolidation
d. Pleural effusion
e. Reticular shadowing in the bases

Acute Gout (21/1700)

A pt with an acute gout attack came to the ED. What drug should be given to relieve
symptoms?
a. NSAIDs
b. Allopurinol
c. Ibuprofen

Hot swollen joint with fever (10/1700)

A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?
a. Joint aspiration for cytology and culture and sensitivity
b. Joint aspiration for positive birefrengent crystals
c. Joint aspiration for negative birefrengent crystals
d. Blood culture
e. Serum uric acid