Meet two patients with chronic joint pain and test your rheumatology knowledge with this quiz! Enjoy!
Reviewed by: awaiting review
Approach to the patient with Chronic Joint Pain
STEM 1, QUESTION 1 OF 5
Janet, a 55-year old female, presents to her GP with symmetrical pain in the small joints of her hands and feet. She has been experiencing this pain for the past 4 months and it is getting worse. The doctor suspects rheumatoid arthritis.
Rheumatoid factor is an autoantibody present in the blood of 60-70% of those with rheumatoid arthritis. Following blood tests, Janet tests negative for rheumatoid factor. Which of the following antibodies is most appropriate to measure following a negative rheumatoid factor test?
Anti-centromere (ACA) antibody
Anti-cyclic citrullinated peptide (anti-CCP) antibody
Anti-double stranded DNA (anti-dsDNA) antibody
Anti-neutrophil cytoplasmic (ANCA) antibody
Antinuclear (ANA) antibody
STEM 1, QUESTION 2 OF 5The patient has some key signs of rheumatoid arthritis in her hands. One of these is Boutonnière deformity. Which of the following correctly describes this deformity?
Bending of the fingers towards the ulna bone of the forearm
Hyperextended distal interphalangeal (DIP) joint with a flexed proximal interphalangeal (PIP) joint
Hyperextended proximal interphalangeal (PIP) joint with a flexed distal interphalangeal (DIP) joint
Swelling of the distal interphalangeal joints
Swelling of the proximal interphalangeal joints
STEM 1, QUESTION 3 OF 5Janet is sent for X-rays of her hands. On X-ray images, which of the following is NOT a hallmark feature of joints affected by rheumatoid arthritis?
Joint space narrowing
Soft tissue swelling
STEM 1, QUESTION 4 OF 5The patient is prescribed methotrexate. Which of the following should also be prescribed to prevent methotrexate-induced side effects?
Cholecalciferol (vitamin D)
STEM 1, QUESTION 5 OF 5Rheumatoid arthritis is an autoimmune disease. Which of the following genes is associated with the condition?
STEM 2, QUESTION 1 OF 5
Charlie, a 19-year old male, presents to his GP with lower back pain. He also describes his back as feeling "stiff at times". This has been going on for 3 months
The GP suspects ankylosing spondylitis. Which of the following is NOT characteristic of the pain experienced by patients with this condition?
Back pain and stiffness which is worse in the morning
Back pain and stiffness which improves with rest
Back pain and stiffness which wakes the patient in the night
Pain which responds well to NSAIDs
STEM 2, QUESTION 2 OF 5The doctor decides to carry out Schober's test to determine if Charlie's lumbar spine has a decreased range of motion. The skin is marked 10cm above and 5cm below an imaginary horizontal line between Charlie's posterior superior iliac spines (PSIS). Charlie is asked to bend forwards to touch his toes. What is the MINIMUM that the distance between these two points should increase to in patients with normal lumbar flexion?
STEM 2, QUESTION 3 OF 5Which of the following is NOT a complication associated with ankylosing spondylitis?
Restrictive pulmonary disease
STEM 2, QUESTION 4 OF 5Tumour necrosis factor-alpha (TNF-alpha) inhibitors can be used in the treatment of ankylosing spondylitis (under expert supervision). Which of the following drugs is a TNF-alpha inhibitor?
STEM 2, QUESTION 5 OF 5Ankylosing spondylitis is a member of the seronegative spondyloarthropathy family of joint conditions. Which of the following genes is associated with this group of joint conditions and can be tested for as part of the diagnosis of ankylosing spondylitis?