Joint Differentials

Question 1

What is HLA-DR4 associated with?

Answer 1

Rheumatoid arthritis

Question 2

What is HLA-B227 assoicated with?

Answer 2

Psoriatic arthritis
Enteropathic arthritis

Question 3

What causes painless bilateral proximal muscle weakness in the elderly?

Answer 3

Polymyositis

Question 4

What examination finding is seen in patients with osteoarthritis?

Answer 4

Heberden’s nodes prominent bony outgrowths that can be palpated on the outer aspect of the distal interphalangeal joints

Question 5

What cases fever and chills over joint with history of open fracture?

Answer 5

Septic arthritis

Question 6

What cases fever and chills and tenderness over bone with history of open fracture?

Answer 6

Osteomyelitis

Question 7

What are anti-hsitory ntibodiies associated with?

Answer 7

drug induced SLE

Question 8

What are anti-topoisomerase I antiboides associated with?

Answer 8

Diffuse cutaneous systemic sclerosis

Question 9

What are anti-dsDNA antibodies associated with?

Answer 9

Idiopathic SLE

Question 10

What are anti-CCP antibodies specific for?

Answer 10

Rheumatoid arthritis

Question 11

What does joint pain with recent tuberculosis treatment idnicate?

Answer 11

Isoniazid treatment induces drug induced lupus, which will have positive NANA

Question 12

What causes reccurrent miscarriages?

Answer 12

Antiphospholipid syndrome

Question 13

Which antibodies are specific for antiphospholipid syndrome?

Answer 13

Anti-beta-2-glycoprotein I antibodies

Question 14

What causes stiffness and nail separation?

Answer 14

Psoriatic arthritis causing onycholysis

Question 15

What causes urethritis, conjuctivities and arthritis?

Answer 15

Reactive arthritis

Question 16

What does Dactylitis, and asymmetric involvement of DIP’s and nails indicate?

Answer 16

Reactive or psoriatic arthritis

Question 17

What causes arthritis with a waxy yellow skin lesion?

Answer 17

Reactive arthritis which causes kartoderma blenorrhagicum, the waxy yellow skin lesion

Question 18

Which HLA subtypes are associated with SLE?

Answer 18

HLA-DR2 and 3

Question 19

What does bone pain, tenderness and proximal myopathy idnicate?

Answer 19

Osteomalacia

Question 20

What does diffuse skin tightening indicate?

Answer 20

Systemic sclerosis

Question 21

What are anti-centromere antibodies assoicated with?

Answer 21

Limited cutaneous systemic sclerosis

Question 22

What are anti-Ro antibodies associated with?

Answer 22

Sjögren’s syndrome

Question 23

What are anti-Mi-2 antibodies associated with?

Answer 23

Dermatomyositis

Question 24

What are anti-Scl-70 antiboides associated with?

Answer 24

Diffuse cutaneous systemic sclerosis

Question 25

What does anti-cardiolipin antibody positive idnicate?

Answer 25

Anti-phospholipid syndrome

Question 26

What is given for optic. Neuritia

Question 27

What causes proximal muscle pain and vision loss?

Answer 27

Polymalgia rheumatica with giant cell arteritis that causes anterior ischaemic optic neuroapthy

Question 28

What does recurrent venous thromboses, recurrent pregnancy loss, livedo reticularis, thrombocytopenia and a paradoxically prolonged APTT indicate?

Answer 28

Antiphospholipid syndrome

Question 29

How to differentiate STI cause of arthritis?

Answer 29

Septic will have raised WBC Reactive arthritis will have sterile aspiration and have urethritis and conjunctivitis

Question 30

What causes painful finger ulcers, Raynaud’s and fibrosis?

Answer 30

Systemic sclerosis

Question 31

What causes proximal muscle weakness with lilac rash around the eye?

Answer 31

Heliotrope rash linked to dermatomyositis

Question 33

What causes asymmetrical DIP joint pain worse in morning and relieved by activity?

Answer 33

Psoratic arthritis

Question 34

What causes migratory polyarthritis?

Answer 34

Syphyillis -> manage with IM benzathine penicillin and refer to sexual health services

Question 35

What causes dermatitis, tneosynovitis and polyarthritis?

Answer 35

Disseminated gonococcoal infection -> manage with IV ceftriaxone

Question 36

What causes splenomegaly, joint pain and leukocytosis but negative rheumatoid factor and ANA?

Answer 36

Adult onset sitll’s disease

Question 37

What causes fever, polyarthralgia and rash with raised ferritin?

Answer 37

Adult onset still’s disease

Question 38

What is anterior uveitis associated with?

Answer 38

Behçet’s disease Ulcerative colitis Ankylosing spondylitis

Question 39

What is optic neuritis assoicated with?

Answer 39

Multiple sclerosis

Question 40

What does proximal muscle weakness and a photosensitive rash with elevated creatine kinase indicate as investigation?

Answer 40

Dermatomyositis which is associated with underlying malignancylike ovarian, breast, and lung cancer

Question 41

What joint causes acutely swollen, painful, erythematous joint, accompanied by a temperature

Answer 41

Knee-septic arthritis

Question 42

What causes acute joint pain with calcinosis on radiography?

Answer 42

Pseudogout due to calcium pyrophospohate deposition

Question 43

What causes abrupt onset of bilateral early morning stiffness in the over 60s?

Answer 43

Polymyalgia rheumatica: On examination, movement is limited by stiffness and pain but strength is preserved

Question 44

How to differentiate polymyalgia and polymyositis?

Answer 44

polymyositis is characterised by progressive weakness, not stiffness Polymyalgia will have abrupt onset proximal stiffness but preserved strength

Question 45

What causes new joint weakness and blurred vision in a young woman?

Answer 45

Suspect multiple sclerosis

Question 46

What is MRC grade 5?

Answer 46

Normal

Question 47

What is MRC grade 4.

Answer 47

Movement against an external resistance with reduced strength

Question 48

What is MRC grade 3?

Answer 48

Movement against only gravity

Question 49

What is MRC grade 2?

Answer 49

Movement at the joint with gravity eliminated

Question 50

What is MRC grade 1?

Answer 50

Trace of contraction

Question 51

What is MRC grade 0?

Answer 51

No muscle movement

Question 52

What MRC grade is only moving leg when turned sideways and lifting his knees up towards his chest?

Answer 52

MRC grade 2 as gravity is removed

Question 53

What causes salmon pink rash with fever?

Answer 53

Still’s disease: Pyrexia is in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and maculopapular rash. They will be rheumatoid factor and ANA negative

Question 54

What is used to diagnose Arill’s disease?

Answer 54

Ya,gaucho criteria

Question 55

What is first line for still’s disease!

Answer 55

NSAID which must be used for one week before trialling steroids

Question 56

What is ovarian teratoma associated with?

Answer 56

Autoimmune encephalitis target neuronal surface receptors, most commonly NMDA receptors

Question 57

What to suspect with recurring oral and genital ulcers!

Answer 57

Behçet’s disease, more common in Mediterranean and Japanese patients

Question 58

What causes Arthralgia, recurrent oral and genital ulcers with erythema nodosum?

Answer 58

Behçet’s disease,