Correct answer for all Question is A
21.) A 13 year old girl was admitted to the cardiological department because of pain in the muscles
and joints. Examination of her face revealed an edematic erythema in form of butterfly in the
region of nose bridge and cheeks. What is the most probable diagnosis?
A. Systemic lupus erythematosus
B. Rheumatism
C. Dermatomyositis
D. Rheumatoid arthritis
E. Periarteritis nodosa
EXPLANATION:- Systemic lupus erythematous an autoimmune systemic disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.
American College of Rheumatology (ACR) established .A person has SLE if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.
• Malar rash (rash on cheeks- BUTTERFLY RASH)
• Discoid rash (red, scaly patches on skin that cause scarring).
• Serositis: Pleurisy (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart).
• Oral ulcers (includes oral or nasopharyngeal ulcers).
• Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion.
• Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups).
• Blood—hematologic disorder—hemolytic anemia (low red blood cell count), leukopenia (white blood cell count<4000/µl), lymphopenia (<1500/µl), or low platelet count (<100000/µl) in the absence of offending drug. Hypocomplementemia is also seen, due to either consumption of C3 and C4 by immune complex-induced inflammation or to congenitally complement deficiency, which may predispose to SLE.
• Renal disorder: More than 0.5 g per day protein in urine or cellular casts seen in urine under a microscope.
• Antinuclear antibody test positive.
• Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody . Presence of anti-ss DNA in 70% of cases(most common in SLE).
• Neurologic disorder: Seizures or psychosis.
Note: Libman–Sacks endocarditis associated with SLE
22.) A 38 year old female patient complains about body stiffness in the morning, especially in the
articulations of her upper and lower limbs, that disappears 30-60 minutes later after active
movements. She has also arthritis of metacarpophalangeal and proximal phalangeal articulations,
subfebrile temperature. ESR- 45 mm/h. Roentgenography revealed osteoporosis and erosion of
articular surface of small hand and foot articulations. What is the most probable diagnosis?
A. Rheumatoid arthritis
B. Psoriatic arthropathy
C. Osteoarthrosis deformans
D. Systemic lupus erythematosus
E. Reactive polyarthritis
EXPLANATION;-Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
23.) A 30 year old man complains of intense pain, reddening of skin, edema in the ankle-joint area,
fever up to 39oC. There was an acute onset of the illness. In the past there were similar attacks
lasting 5-6 days without residual changes in the joint. The skin over the joint is hyperemic and
ill-defined, without infiltrative bank on the periphery. What is the most likely diagnosis?
A. Gout
B. Infectious arthritis
C. Rheumatoid arthritis
D. Erysipelatous inflammation
E. Osteoarthritis
EXPLANATION:- Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint.It mainly affect middle age male(30-45 yr) more than women. Other joints, such as the heels, knees, wrists and fingers, may also be affected. Joint pain usually begins over 2–4 hours and during the night.Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the metatarsal-phalangeal joint at the base of the big toe (podagra) affected most often, similar attacks occurs for 5-6 days without residual changes in joints.
The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:
• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. Decreased joint mobility may occur as gout progresses.
24.) A 52 year old patient complains about headache, weakness of his upper left extremity.
Neurological symptoms become more intense during physical stress of the left extremity.
Pulsation on the arteries of the left extremity is sharply dampened but it remains unchanged on
the carotid arteries. What is the most probable diagnosis?
A. Occlusion of the left subclavicular artery, steal syndrome
B. Thoracal outlet syndrome
C. Raynaud’s syndrome
D. Takayasu’s disease
E. Occlusion of brachiocephalic trunk
25.) A 47-year-old obese man complained of periodic attacks of acute arthritis in the st left
tarsophalangeal joint. Lab exam revealed increased serum rate of uric acid. What is the
diagnosis?
A. Gout arthritis
B. Reiter’s disease
C. Rheumatoid arthritis
D. Rheumatic arthritis
E. Osteoarthritis
EXPLANATION:- Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint.It mainly affect middle age male(30-45 yr) more than women. Other joints, such as the heels, knees, wrists and fingers, may also be affected. Joint pain usually begins over 2–4 hours and during the night.Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the metatarsal-phalangeal joint at the base of the big toe (podagra) affected most often, similar attacks occurs for 5-6 days without residual changes in joints.
The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:
• Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
• Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
• Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
• Limited range of motion. Decreased joint mobility may occur as gout progresses.
Note: increase serum uric acid indicate gout.
,
26.) A 33-year-old man with a history of rheumatic fever complains of fever up to 38 − 39oC
abdominal pain, dyspnea, tachycardia. Heart borders are displaced to the left by 2 cm, systolic
and diastolic murmurs above aorta, BP of 160/30 mm Hg. Petechial rash occurs after
measurement of blood pressure. Liver is enlarged by 3 cm, spleen is palpable. Urine is brown-
yellow. What is the most likely diagnosis?
A. Infectious endocarditis
B. Rheumatic fever
C. Acute hepatitis
D. Acute nephritis
E. Aortic regurgitation
EXPLANATION:-Subacute bacterial endocarditis (also called endocarditis lenta) is a type of endocarditis (more specifically, infective endocarditis). Subacute bacterial endocarditis can be considered a form of type III hypersensitivity.It is usually caused by a form of streptococci viridans bacteria that normally live in the mouth (Streptococcus mutans (Associated with tooth infectioins after extraction ), mitis, sanguis or milleri).Diagnosis of subacute bacterial endocarditis can be done by collecting three blood culture specimens over a 24-hour period for analysis, also it can usually be indicated by the existence of:
• Osler's nodes.
• Roth's spots
• Nail clubbing
It can be congenital heart disease, it can be characterized by long term fever,malaise,weakness ,excessive sweat too,low diastolic pressure,high pulse,distant heart murmur( most common for congenital one) . subacute bacterial endocarditis connected to IV drugs users ,hepatitis,tonsilitis tooth extraction,etc.
27.) A 35-year-old patient complains about pain and morning stiffness of hand joints and
temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years.
Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What
examination should be administered?
A. Roentgenography of hands
B. Complete blood count
C. Rose-Waaler reaction
D. Immunogram
E. Proteinogram
EXPLANATION: Patient diagnosed as rheumaroid arthritis so best diagnosis for RA is roentgenography of hands.Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
28.) A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints,
painfulness and stiffness in the lumbar spine for a year. ESR - 56 mm/h. Roentgenography
revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What
is the most likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’s disease
E. Spondylosis
EXPLANATION:-Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae of spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. It affects men (over 38 yr) more than women. Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common.It is associated with HLA- B27 gene. (MRI), and X-ray studies of the spine, which show characteristic spinal changes and inflammation of the sacroiliac joint, combined with a genetic marker blood test are the major diagnostic tools. Schober's test is a useful clinical measure of flexion of the lumbar spine performed during the physical examination. X-ray showing bamboo spine in a person with ankylosing spondylitis because of longititudinal ligament ossification.
29.) A 30-year-old patient presented with body temperature rise up to 38, 5oC, pain in the small
articulations of hands; face edemata and erythema. In blood: RBCs - 2, 6 · 1012/l; Hb- 98 г/л;
WBCs - 2 · 109/l; ESR - 58 mm/h. In the urine: protein - 3,1 g/l; RBCs - 10-15 in the vision
field. What disease can be suspected in this case?
A. Systemic lupus erythematosus
B. Sepsis
C. Systemic scleroderma
D. Periarteritis nodosa
E. Acute glomerulonephritis
EXPLANATION:-is an autoimmune systemic disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.
American College of Rheumatology (ACR) established .A person has SLE if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.
• Malar rash (rash on cheeks- BUTTERFLY RASH)
• Discoid rash (red, scaly patches on skin that cause scarring).
• Serositis: Pleurisy (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart).
• Oral ulcers (includes oral or nasopharyngeal ulcers).
• Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion.
• Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups).
• Blood—hematologic disorder—hemolytic anemia (low red blood cell count), leukopenia (white blood cell count<4000/µl), lymphopenia (<1500/µl), or low platelet count (<100000/µl) in the absence of offending drug. Hypocomplementemia is also seen, due to either consumption of C3 and C4 by immune complex-induced inflammation or to congenitally complement deficiency, which may predispose to SLE.
• Renal disorder: More than 0.5 g per day protein in urine or cellular casts seen in urine under a microscope.
• Antinuclear antibody test positive.
• Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody . Presence of anti-ss DNA in 70% of cases(most common in SLE).
• Neurologic disorder: Seizures or psychosis.
Note: Libman–Sacks endocarditis associated with SLE
30.) A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers,
muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia,
constipations. The patient’s face is masklike, solid edema of hands is present. The heart is
enlarged; auscultation revealed dry rales in lungs. In blood: ESR - 20 mm/h, crude protein - 85/l,
γ- globulines - 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
EXPLANATION:-Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) is associated with limited scleroderma.There are two forms of scleroderma: localized and systemic. The localized (limited) form affects the skin of only the face, hands, and feet. The systemic (diffuse) form involves those and, in addition, may progress to visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract.
painfulness and stiffness in the lumbar spine for a year. ESR - 56 mm/h. Roentgenography
revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What
is the most likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’s disease
E. Spondylosis
EXPLANATION:-Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae of spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. It affects men (over 38 yr) more than women. Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common.It is associated with HLA- B27 gene. (MRI), and X-ray studies of the spine, which show characteristic spinal changes and inflammation of the sacroiliac joint, combined with a genetic marker blood test are the major diagnostic tools. Schober's test is a useful clinical measure of flexion of the lumbar spine performed during the physical examination. X-ray showing bamboo spine in a person with ankylosing spondylitis because of longititudinal ligament ossification.
32.) A 35-year-old patient has been admitted to a hospital for pain in the left sternoclavicular and
knee joints, lumbar area. The disease has an acute character and is accompanied by fever up to
38oC. Objectively: the left sternoclavicular and knee joints are swollen and painful. In blood:
WBCs - 9, 5 · 109/l, ESR - 40 mm/h, CRP - 1,5 millimole/l, fibrinogen - 4,8 g/l, uric acid - 0,28
millimole/l. Examination of the urethra scrapings reveals chlamydia. What is the most likely
diagnosis?
A. Reiter’s syndrome
B. Rheumatic arthritis
C. Gout
D. Bechterew’s disease
E. Rheumatoid arthritis
EXPLANATION: Also known as reactive arthritis, autoimmune condition that develop to an infection in another part of body usually genitourinary and gastrointestinal infection. Mostly caused by chlamydia, e coli, campylobacter etc
Traid - Conjunctivitis, Arthritis, Non gonococcal urethritis
Treatment - tetracycline (chlamydia)
33.) A 32-year-old patient has a 3-year history of asthma attacks, that can be hardly stopped with
berotec. Over a few last months he has experienced pain in the joints and sensitivity disorder of
legs and feet skin. Ps - 80/min, AP - 210/100 mm Hg. In blood: eosinophilia at the rate of 15%.
What disease can be suspected in this case?
A. Periarteritis nodosa
B. Systemic lupus erythematosus
C. Systemic scleroderma
D. Dermatomyositis
E. Wegener’s disease
EXPLANATION: Periarteritis nodosa
34.) A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers,
muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia,
constipations. The patient’s face is masklike, solid edema of hands is present. The heart is
enlarged; auscultation revealed dry rales in lungs. In blood: ESR - 20 mm/h, crude protein - 85/l,
γ- globulines - 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
EXPLANATION:-Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) is associated with limited scleroderma.There are two forms of scleroderma: localized and systemic. The localized (limited) form affects the skin of only the face, hands, and feet. The systemic (diffuse) form involves those and, in addition, may progress to visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract.
35.) A 35-year-old patient complains about pain and morning stiffness of hand joints and
temporomandibular joints that lasts over 30 minutes. She has had these symptoms for 2 years.
Objectively: edema of proximal interphalangeal digital joints and limited motions of joints. What
examination should be administered?
A. Roentgenography of hands
B. Complete blood count
C. Rose-Waaler reaction
D. Immunogram
E. Proteinogram
EXPLANATION: Patient diagnosed as rheumaroid arthritis so best diagnosis for RA is roentgenography of hands.Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
36.) A 32-year-old male patient has been suffering from pain in the sacrum and coxofemoral joints,
painfulness and stiffness in the lumbar spine for a year. ESR- 56 mm/h. Roentgenography
revealed symptoms of bilateral sacroileitis. The patient is the carrier of HLA B27 antigen. What
is the most likely diagnosis?
A. Ankylosing spondylitis
B. Coxarthrosis
C. Rheumatoid arthritis
D. Reiter’s disease
E. Spondylosis
EXPLANATION:-Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae of spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. It affects men (over 38 yr) more than women. Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common.It is associated with HLA- B27 gene. (MRI), and X-ray studies of the spine, which show characteristic spinal changes and inflammation of the sacroiliac joint, combined with a genetic marker blood test are the major diagnostic tools. Schober's test is a useful clinical measure of flexion of the lumbar spine performed during the physical examination. X-ray showing bamboo spine in a person with ankylosing spondylitis because of longititudinal ligament ossification.
37.) A 58-year-old patient complains about sensation of numbness, sudden paleness of II-IV fingers,
muscle rigidness, intermittent pulse. The patient presents also with polyarthralgia, dysphagia,
constipations. The patient’s face is masklike, solid edema of hands is present. The heart is
enlarged; auscultation revealed dry rales in lungs. In blood: ESR- 20 mm/h, crude protein - 85/l,
γ- globulines - 25%. What is the most likely diagnosis?
A. Systemic scleroderma
B. Dermatomyositis
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Raynaud’s disease
EXPLANATION:-Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) is associated with limited scleroderma.There are two forms of scleroderma: localized and systemic. The localized (limited) form affects the skin of only the face, hands, and feet. The systemic (diffuse) form involves those and, in addition, may progress to visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract.
38.) A 10-year-old girl was admitted to a hospital with carditis presentations. It is known from the
anamnesis that two weeks ago she had exacerbation of chronic tonsillitis. What is the most likely
etiological factor in this case?
A. Streptococcus
B. Staphylococcus
C. Pneumococcus
D. Klebsiella
E. Proteus
EXPLANATION: Rheumatic fever is caused by group A streptococcus Beta hemolyticus. It is an inflammatory disease that can involve the heart, joints ( polyarthritis ), skin, and brain. Rheumatic fever may occur following an infection of the throat ( angina) .The underlying mechanism is believed to involve the production of antibodies against a person's own tissues.Treating people who have strep throat with antibiotics, such as penicillin, decreases the risk of developing rheumatic fever.
39.) 5 weeks after hypothermia a 22-year-old patient developed fever, weakness, muscle pain,
inability to move independently. Objectively: tenderness, induration of shoulder and shin
muscles, restricted active movements, erythema on the anterior surface of chest. There is a
periorbital edema with heliotropic erythema. Gottron’s sign is present. What study is required to
verify the diagnosis?
A. Muscle biopsy
B. Aminotransferase activity
C. Pneumoarthrography
D. ASO titre
E. Rheumatoid factor
EXPLANATION:-Heliotropic erythema. Gottron’s sign specific sign for dermatomyositis .Gold standard for diagnosis of it is muscle biopsy.
40.) A 60-year-old male patient, who works as a construction worker, complains of pain in the right
hip and knee joints, that is getting worse on exertion. These presentations have been observed for
the last 5 years. Objectively: the patient is overnourished. Right knee joint is moderately
deformed. Examination of other organs and systems revealed no pathology. Blood tet results:
WBCs - 8, 2 · 109/l, ESR - 15 mm/h. Uric acid - 0,35 mmol/l. What is the most likely diagnosis?
A. Deforming osteoarthritis
B. Reactive arthritis
C. Gout
D. Rheumatoid arthritis
E. Reiter’s disease
EXPLANATION:-Osteoarthritis is a type of joint disease that results from breakdown of joint cartilage and underlying bone . ON xray joint space narrow .The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become worse and constant. Heberden’s(DIP) and Bouchard’s nodes(PIP).
To be continued...part 3
To be continued...part 3
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