Question Easy: A 70-year-old woman presents to the GP with joint pain and stiffness, particularly in the mornings, which lasts about 30 minutes. She also notes some crepitus in her knees. There is no swelling, and she is otherwise well. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Psoriatic arthritis
E) Septic arthritis
Question Medium: A 55-year-old man presents to the A&E with acute right knee pain and swelling. He is a known case of hypertension and uses moderate amounts of alcohol. Joint aspiration reveals needle-shaped negatively birefringent crystals. What is the definitive treatment he should receive for this condition?
A) Ibuprofen
B) Colchicine
C) Methotrexate
D) Prednisolone
E) Allopurinol
Question Hard: A 35-year-old woman is referred to the rheumatology clinic with a diagnosis of seronegative spondyloarthropathy. She presents with low back pain, heel pain, and bilateral uveitis. Which of the following HLA types is most likely associated with her condition?
A) HLA-DQ2
B) HLA-DR4
C) HLA-B27
D) HLA-A3
E) HLA-B8
Explanations & Answers:
Question Easy Answer: A) Osteoarthritis
Question Easy Explanation: The symptoms described are classic for osteoarthritis (OA), characterized by joint pain and morning stiffness lasting less than an hour. The presence of crepitus further supports this diagnosis. Rheumatoid arthritis (option B) typically presents with prolonged morning stiffness and symmetrical joint involvement, while the other options present with different symptomatology.
Question Medium Answer: B) Colchicine
Question Medium Explanation: The clinical picture provided suggests gout, confirmed by the presence of urate crystals. According to NICE guidelines, the primary treatment for an acute gout attack includes NSAIDs or colchicine. Colchicine is especially considered when NSAIDs are contraindicated or for those already on an NSAID for other conditions. Allopurinol (option E) is used for long-term management and not for acute attacks.
Question Hard Answer: C) HLA-B27
Question Hard Explanation: The triad of low back pain, heel pain, and uveitis is suggestive of ankylosing spondylitis, which is a type of seronegative spondyloarthropathy highly associated with HLA-B27. This genetic marker is commonly checked in suspected cases of this condition.
Medical fact of the day: Did you know the prevalence of osteoarthritis increases with age, affecting 50% of individuals over 65? It is one of the leading causes of disability in the elderly.
Quote of the day: “In the care of others, we see the finest reflection of our own purpose. Let compassion be the physician’s guide.”