Musculoskeletal

Question 1

Assymetric joint pain and stiffness

Answer 1

Osteoarthritis

• Worse with activity
• Morning stiffness <30mins
• Joint deformity - Heberden’s (DIP joint)

Question 2

Symmetrical joint pain and swelling

DIP joint sparing

Answer 2

Rheumatoid arthritis

• Red, warm, swollen joint
• Morning stiffness that eases as day progresses
• Deformities - swan neck, z shaped thumb

Question 3

Monoarticular, hot, swollen, red, painful joint with tophi

Diet high in seafood and red meat + alcohol

Answer 3

Gout

• Commonly big toe
• Sometimes wrist

Question 4

Hot, swollen, painful joint of the knee

Diet high in canned fish

Answer 4

Pseudogout

Question 5

Entire finger swollen, pain around the heel area, joint pain, rash

Affects primarily the DIP joint

Answer 5

Psoriatic arthritis

Family history of psoriasis

Question 6

Joint pain following infection, that includes morning stiffness and night time pain.
(most common bacteria?)

Answer 6

Reactive arthritis

(Urethritis, conjunctivitis)

• Campylobacter
• Chlamydia trachomatis

Question 7

Abdominal pain, blood in stools, joint pain (knee, hip)

Answer 7

Enteric arthritis

• Assymetric joint pain

Question 8

Worsening back pain and stiffness that is worst in the morning, red eye, pain around the elbow

Answer 8

Ankylosing spondylitis

• Dactylitis

Question 9

Big forehead and mandible, hearing loss

Answer 9

Paget’s disease of bone

Question 10

Bone pain that is severe, red and swollen, fever

Patient just had a recent surgery

Answer 10

Osteomyelitis

Can be due to direct contamination via fracture also

S.aureus

Question 11

African carribean/asian woman. Fatigue, joint pain, fingers turning pale then blue (in the cold), oral ulcers

Answer 11

Systemic lupus erythematosus

• Photosensitive rash

Question 12

Dry mouth, dry eyes

Answer 12

Sjogren’s syndrome

Question 13

Had a recent PE/DVT, purplish skin changes on the legs, bleeding takes longer to clot.

Answer 13

Antiphospholipid syndrome

• Recurrent miscarriage

Question 14

Gradual onset, symmetrical proximal muscle weakness, gottron papules on knuckles and elbows

Answer 14

Polymyositis - higher risk with autoimmune conditions

Dermatomyositis - heliotrope rash

Question 15

Pale fingers that turn blue, dysphagia, skin tightening over fingers

Answer 15

Scleroderma

• Calcinosis
• Telangiesctasia

Question 16

Unilateral headache around the temple, scalp tenderness

Answer 16

Giant cell arteritis

• Jaw claudication
• Amaurosis fugax

Question 17

Epistaxis, sob, haemoptysis, haematuria, nose shape has changed

Answer 17

Wegener’s granulomatosis

Question 18

Depressed older woman Widespread joint pain and stiffness for at least 3 months, sleep disturbance, fatigue

Answer 18

Fibromyalgia

• Mood changes
• Stressful life

Question 19

Monoarticular, hot, swollen, painful joint (KNEE), fever -

patient had a recent surgery

Answer 19

Septic arthritis

RF
- Immunosuppresion
- IVDU

Question 20

Symmetrical pain and stiffness of the shoulders and hips, bilateral proximal muscle weakness, fever, fatigue

Answer 20

Polymyalgia rheumatica

• Associated with GCA