EOCP Block 3 Round Up Quiz

A 30-year-old lady presents to her GP with a 3-month history of pain and swelling of her hands and knees. She has also been feeling much more tired over the last 3 months. She experiences stiffness in her hands and knees when she wakes up and this lasts for around 2 hours. She is usually fit and well, with no significant past medical history. She is taking paracetamol and ibuprofen.

What is the most likely diagnosis?

• Rheumatoid Arthritis

• Osteoarthritis

• Psoriatic Arthritis

• Gout

• Polymyalgia Rheumatica

Answer explanation

Which investigation is most likely to confirm a diagnosis of Rheumatoid arthritis?

• Rheumatoid Factor

• Anti-CCP

• ESR

• CRP

• FBC

Answer explanation

Anti-CCP and Rheumatoid Factor are both used for diagnosis for RA, but anti-CCP is more sensitive.

ESR and CRP may be elevated due to chronic/acute inflammation, but they are not specific for RA.

What is the clinical sign shown in this picture

• DIP erosion

• Swan Neck Deformity

• Thenar Wasting

• Boutonnier's Deformity

• Dupytren's Contracture

Answer explanation

extensor tendon injuries characterized by PIP flexion and DIP extension

What is the clinical sign shown in this image?

• Bouchard's Node

• Heberden Node

• Swan neck deformity

• Gout

• Septic joint

Answer explanation

A 65-year-old gentleman presents to A+E with a red, hot, swollen left knee. On examination, the patient cannot bear weight and there is significant effusion.

Which investigation is most likely to confirm a diagnosis?

• Knee X-Ray

• MRI

• CT Scan

• CRP

• Joint Aspiration

If a patient's joint aspiration appeared similar to the picture below, what would the diagnosis be?

• Septic Arthritis

• Gout

• Osteoarthritis

• Rheumatoid Arthritis

Answer explanation

Typically, monosodoium urate crystals

Needle-like

Under polarised light - strong negative bifringence

Which of the following is NOT a risk factor for developing septic arthritis?

• Age

• Being male at birth

• Previous joint surgery

• Rheumatoid arthritis

• Prosthetic Joint

A 78-year-old gentleman is brought to A+E by his daughter. She says that she found him on his bathroom floor this morning. She states that he is very confused but is usually independent. You cannot take a history from the patient as he is too confused. There is some bruising to his forehead. He takes Apixaban for AF.

What is the most urgent investigation?

• ECG

• FBC

• Creatine Kinase

• CT Head

• Troponin

What diagnosis is associated with the clinical signs shown in the picture?

• Frontal Bone Fracture

• Basal Skull Fracture

• Fracture of orbital socket

• Zygomatic fracture

Answer explanation

Panda eyes (bruising around the eyes) and battle sign (bruising behind the ears) are a sign of basal skull fracture

Which of the following is NOT an indication for a CT in a confused patient?

• Recent Fall

• Head Injury

• Anticoagulation

• New Onset Confusion

• New Focal Neurology