Case-based MCQ

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A couple who have been trying to conceive for the past 2 years were worked-up for primary infertility. The female had a normal examination. Male partner has an atrophy of vas deferens. Which of the following investigations should be done to determine the cause? A. Ultrasound B. Semen analysis C. Sweat Chloride Test D. CT Scan E. Anti-gliadin antibodies

Correct Answer Is A This patient has a very vague presentation of teenage onset of hereditary angioedema. Angioedema has a various range of symptoms including respiratory, gastrointestinal and oral symptoms.The hallmark of this clinical condition is non-itchy non-pitting swellings which develop over a period of day or two and could include laryngeal oedema, abdominal pain, vomiting and diarrhoea. C1 and C4 levels are helpful in making a diagnosis of hereditary angioedema and are low if the condition is present. C1 q level is helpful to diagnose acquired angioedema and are low if the condition is present. Tryptase levels are raised in food poisoning. Alkaline phosphatase level is increased in a number of conditions including bile duct obstruction, Paget’s disease, multiple myeloma, secondary hyperparathyroidism and healing fractured bones. Serum immunoglobulin levels of (IgG, IgM, IgA) etc are helpful in diagnosing various immune deficiency conditions and response to vaccinations and infections.

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A 19-year-old female comes to your office after she had recurrent swelling affecting her face, arms and legs. The swelling is non-pitting and non-pruritic. She had an admission to an emergency department 3 months ago because she was unable to breath. She had an appendectomy because of severe abdominal pain. Which of the following investigations is most helpful in diagnosis of this condition? A. C1 and C4 levels B. C1q level C. Tryptase level D. Alkaline phosphatase level E. Serum immunoglobulin levels

Correct Answer Is D About 95% of patients with systemic lupus arthritis develop intermittent arthritis. The most common presentation of this arthritis is symmetrical polyarthritis affecting the hands, wrist and knees. Tenosynovitis is relatively uncommon in SLE. Joint deformities are also uncommon in SLE. Monoarthritis if present suggests an alternate diagnosis.Osteoarthritis and septic arthritis are usually monoarthritis type presentations of the joint disease.

Which of the following is the most common presentation of arthritis in systemic lupus arthritis? A. Tenosynovitis B. Joint deformity C. Monoarthritis of joints in the hand D. Symmetrical arthritis of joints in the hands E. Osteoarthritis

Correct Answer Is A The first carpometacarpal joint of the thumb is a common area affected by osteoarthritis and this pattern of joint involvement is not seen in rheumatoid arthritis. In osteoarthritis, following joints are commonly involved: 1-The first carpometacarpal joint of the thumb. 2-First metatarsophalangeal joint of the big toe. 3-Distal interphalangeal joint. 4-Proximal interphalangeal joint. 5-Cervical and lumbar spine. 6-Knee joint. 7-Hip joint. Hand osteoarthritis spares the metacarpophalangeal joints and involves the proximal interphalangeal and distal interphalangeal joints, which helps to distinguish it from rheumatoid arthritis. In rheumatoid arthritis commonly involved joints include metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Distal interphalangeal (DIP) joint involvement may occur in rheumatoid arthritis, but it usually is a manifestation of coexistent osteoarthritis. Rheumatoid arthritis does not affect the thoracic and lumbar spine. The cervical spine is involved mainly in osteoarthritis, however, atlantoaxial joint (part of the cervical spine) is involved only in rheumatoid arthritis.

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Which one of the following joints is not involved in rheumatoid arthritis and is more commonly affected in osteoarthritis? A. Carpometacarpal joint of the thumb B. Temporomandibular joint C. Cervical spine D. Atlantoaxial-axial joint E. Shoulder joint

Correct Answer Is A In a patient with rheumatoid arthritis, rheumatic factor and anti-CCP antibodies are important serological markers.Rheumatoid factor positivity is associated with more aggressive disease and more extra-articular manifestations in a patient with rheumatoid arthritis. RF sensitivity is equal to anti-CCP for diagnosis of rheumatoid arthritis. However, the specificity of anti-CCP is higher. Anti-CCP is a strong predictor of erosive disease.

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Correct Answer Is A In a patient with rheumatoid arthritis, rheumatic factor and anti-CCP antibodies are important serological markers. Rheumatoid factor positivity is associated with more aggressive disease and more extra-articular manifestations in a patient with rheumatoid arthritis. RF sensitivity is equal to anti-CCP for diagnosis of rheumatoid arthritis. However, the specificity of anti-CCP is higher. Anti-CCP is a strong predictor of erosive disease.

Which of the following is true regarding Rheumatoid factor (RF) and anti-CCP in a patient with rheumatoid arthritis? A. RF positivity is associated with more aggressive disease B. RF positivity is associated with less extra-articular manifestations C. RF sensitivity is less than anti-CCP for diagnosis of rheumatoid arthritis D. Anti-CCP is a poor predictor of erosive disease E. None of the above