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All Rheumatology

Contains all the Rheumatology questions from the question bank!

1 / 6

Category: Rheumatology

1) You are a Physician Associate in General Practice. A 68-year-old woman visits reporting bilateral shoulder pain persisting for three weeks, initially starting on one side. She mentions feeling stiff for about an hour upon waking and experiencing increased fatigue lately. During examination, she notes pain radiating to her elbows, with no apparent swelling, deformity, or redness in the shoulders. Her vital signs show a temperature of 37.0°C, pulse of 79 beats per minute, blood pressure of 135/90 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 99% on room air.

What is the most likely diagnosis?

2 / 6

Category: Musculoskeletal

2) You are a Physician Associate in a General Practice. A 51-year-old man visits his GP, reporting joint aches in his fingers along with dyspepsia and Raynaud's phenomenon. He has no prior medical history but takes omeprazole 20 mg once daily. During examination, his hands and face exhibit tight, shiny skin, and he displays a few telangiectasias around his mouth.

Which of the following antibodies is most specific for the underlying diagnosis?

3 / 6

Category: Rheumatology

3) You are a Physician Associate working in General Practice. Your next patient, a 58 year old female presents to you with dry eyes, dry mouth, arthralgia and fatigue. She also has a positive Schirmer’s test. 

Which antibody test would support the likely diagnosis? 

 

4 / 6

Category: Rheumatology

4) Which of these deformities is commonly associated with rheumatoid arthritis?

 

5 / 6

Category: Rheumatology

5) You are a Physician Associate working in GP. Harry a 64 year old gentleman comes to see you regarding a 3 day history of a worsening right sided headache. Harry first noticed it when he brushed his hair the other day. He also reports pain on the right side of his jaw when chewing. When asked about his vision he states he has new double vision and visual loss in the right eye. On examination, there is reduced visual acuity in the right eye, diplopia and  tenderness over the right temporal region. Fundoscopy is normal.

Given the most likely diagnosis, what is the single most appropriate immediate management?

 

6 / 6

Category: Rheumatology

6) You are a Physician Associate working in General Practice. Your next patient is a 4 year old girl who has been brought in by her mother. Her mother tells you that her daughter is currently complaining of pain in her knees and ankles. On further questioning, you learn that 2 months ago the patient had a period of fevers that lasted for 2 weeks before resolving. These fevers peaked in the afternoon/evening and were accompanied with a salmon pink rash on the patients back. The mother does not think these are related. 

What is the most likely diagnosis? 

 

Your score is

The average score is 50%

0%

Reference Ranges:

Full blood count (FBC)
Haemoglobin (Hb)
  • Male: 130 – 180 g/L
  • Female: 115 – 165 g/L
White cell count (WCC)
  • Total: 3.6 – 11.0 x 10⁹/L
  • Neutrophils: 1.8 – 7.5 x 10⁹/L
  • Lymphocytes: 1.0 – 4.0 x 10⁹/L
  • Monocytes: 0.2 – 0.8 x 10⁹/L
  • Eosinophils: 0.1 – 0.4 x 10⁹/L
  • Basophils: 0.02 – 0.10 x 10⁹/L
Platelet count
  • 140 – 400 x10⁹/L
Red cell count (RCC)
  • Male: 4.5 – 6.5 x 10⁹/L
  • Female: 3.8 – 5.8 x 10⁹/L
Haematocrit
  • Male: 0.40 – 0.54 /L
  • Female: 0.37 – 0.47 /L
Mean cell volume (MCV)
  • 80 – 100 fL
Mean corpuscular haemoglobin (MCH)
  • 27 – 32 pg/cell
Reticulocyte count
  • 0.2 – 2%
Coagulation
Prothrombin time (PT)
  • 10 – 14 seconds
Activated partial thromboplastin time (APTT)
  • 24 – 37 seconds
Fibrinogen
  • 1.50 – 4.50 g/L
D-Dimer
  • 500 ng/mL
Haematinics
Ferritin
  • Male: 25 – 350 ng/mL
  • Female: 10 – 300 ng/mL
Vitamin B12
  • 180 – 1000 pg/mL
Folate
  • 4.0 ng/mL
Total serum iron
  • Male: 11.6 – 35.0 μmol/L
  • Female: 4.6 – 30.4 μmol/L
Transferrin
  • 2.0 – 3.6 g/L
Transferrin saturation
  • 20 – 50%
Total iron binding capacity (TIBC)
  • 45 – 81 μmol/L
Erythrocyte sedimentation rate (ESR)
  • Male: ≤ 49 years: 1 – 7
  • Male: ≥ 50 years: 2 – 10
  • Female: ≤ 49 years: 3 – 9
  • Female: ≥ 50 years: 5 – 15
 
Urea & electrolytes
Na⁺
  • 133 – 146 mmol/L
K⁺
  • 3.5 – 5.3 mmol/L
Ca²⁺ (adjusted)
  • 2.2 – 2.6 mmol/L
Mg²⁺
  • 0.7 – 1.0 mmol/L
Phosphate
  • 0.74 – 1.4 mmol/L
Chloride
  • 98 – 106 mmol/L
Urea
  • 2.5 – 7.8 mmol/L
Creatinine
  • Male: 59 – 104 μmol/L
  • Female: 45 – 84 μmol/ L
Liver function tests (LFTs)
Alkaline phosphatase (ALP)
  • 30 – 130 U/L
Alanine aminotransferase (ALT)
  • Male: < 41 U/L
  • Female: < 33 U/L
Aspartate aminotransferase (AST)
  • 1 – 45 U/l
Bilirubin
  • <21 μmol/L
GGT
  • Male: < 60 U/L
  • Female: < 40 U/L
Albumin
  • 35 – 50 g/L
Inflammatory markers
CRP
  • 5mg/L
Arterial blood gas
pH
  • 7.35 – 7.45
PaO₂
  • 11 – 13 kPa (82.5 – 97.5 mmHg)
PaCO₂
  • 4.7 – 6.0 kPa (35.2 – 45 mmHg)
HCO₃
  • 22 – 26 mmol/L
Base excess (BE)
  • (-2 to +2 mmol/L)
Metabolic tests
Serum ketones
  • < 0.6 mmol/L
Fasting blood glucose
  • 4.0 to 6.0 mmol/L
Postprandial (2 hours after eating)
  • up to 7.8 mmol/L
HbA1c
  • < 42 mmol/mol (6.0%)
Cholesterol
  • < 5 mmol/L
Triglyceride
  • 0.55 – 1.90 mmol/L
LDL
  • < 3mmol/L
HDL
  • > 1 mmol/L
Cholesterol/HDL
  • < 4
Endocrinology
TSH
  • 0.4 – 5.0 mU/L²
Free T4
  • 9 – 24 pmol/L
Free T3
  • 3.5 – 7.8 pmol/L
Parathyroid hormone
  • 10 – 65 ng/L
Growth hormone (random)
  • < 5 ng/mL
  • < 10 ng/mL
Cortisol (random)
  • 137 – 429 nmol/L
Testosterone
  • Male <50: 10-45 nmol
  • Male >50: 6.2-26 nmol
Other biochemistry tests
Serum total protein
  • 60 – 78 g/L
Troponin T
  • < 0.01 µg/L
Creatine kinase (CK)
  • Male: 40 – 320 U/L
  • Female: 25 – 200 U/L
Lactate dehydrogenase (LDH)
  • 240 – 480 U/L
Lactate (plasma)
  • 0.5 – 2.2 mmol/L
Urate
  • Male: 200 – 430 μmol/L
  • Female: 140 – 360 μmol/L
Amylase
  • 28 – 100 U/dL
Ammonia
  • 10 – 35 μmol/L
NT-proBNP
  • <75 years: <125 pg/mL
  • >75 years: <450 pg/mL
Copper
  • 70 – 150 μg/dL
Ceruloplasmin
  • 15 – 60 μmol/L
Vitamin D
  • >50 nmol/L
Serum osmolality
  • 275 – 295 mOsmol/kg
24h urine osmolality
  • 500 – 800 mOsm/kg
Random urine osmolality
  • 300 – 900 mOsm/kg
12h fluid restricted urine osmolality
  • >850 mOsm/kg
24h urine sodium (Na⁺)
  • 100 – 260 mmol/24h
24h urine potassium (K⁺)
  • 25 – 100 mmol/24h
24h urine total protein
  • < 100 mg/24h
Urine pH (random)
  • 5 – 7
Adult vital signs
Body temperature
  • 36.5°C to 37.3°C
  • 97.8°F to 99.1°F
Pulse
  • 60 – 100 beats per minute
Blood pressure
  • 90/60 – 120/80 mmHg
Respiratory rate
  • 18 breaths per minute
Pulse oximetry
  • >94%
Paediatric vital signs
Blood pressure
  • < 1 year: 70 – 90 mmHg
  • 1 – 2 years: 80 – 95 mmHg
  • 2 – 5 years: 80 – 100 mmHg
  • 5 – 12 years: 90– 110 mmHg
Heart rate
  • < 1 year: 110 – 160
  • 1 – 2 years: 100 – 150
  • 2 – 5 years: 95 – 140
  • 5 – 12 years: 80 – 120
Respiratory rate
  • < 1 year: 30 – 40
  • 1 – 2 years: 25 – 35
  • 2 – 5 years: 25 – 30
  • 5 – 12 years: 20 – 25
Tumour markers
Beta human chorionic gonadotrophin (bHCG)
  • < 5 mU/mL
Alpha fetoprotein
  • < 44 ng/mL
Prostate specific antigen (PSA)
  • < 4.0 ng/mL
Carcinoembryonic antigen (CEA)
  • Non-smokers at 50 years: < 3.6μg/L
  • Non-smokers at 70 years: < 4.1μg/L
  • Smokers: < 5μg/L
CA-125
  • < 35 U/mL
CA19-9
  • < 40 U/mL
Immunology
Anti-SS-A (La)
  • Negative: < 3 U/mL
  • Positive: > 4 U/mL
Anti-streptolysin O titre (ASOT)
  • Pre-school age: < 100
  • School age: < 250
  • Adults: < 125
Rheumatoid factor (RF)
  • Negative: < 20 U/mL
  • Positive: > 30 U/mL
Anti-mitochondrial antibodies (AMA)
  • Negative: < 10 U/mL
  • Positive: > 10 U/mL
Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA)
  • Negative: < 5 U/mL
  • Positive: > 5 U/mL
Anti-histone antibodies
  • Negative: < 25 U/mL
  • Positive: > 25 U/mL
IgA
  • 110 – 560 mg/dL
IgD
  • 0.5 – 3.0 mg/dL
IgE
  • 0.01 – 0.04 mg/dL
IgG
  • 800 – 1800 mg/dL
IgM
  • 54 – 200 mg/d
Anti-ds-DNA
  • Negative: < 40 U/mL
  • Positive: > 60 U/mL
Anti-ss-DNA
  • Negative: < 8 U/mL
  • Positive: > 10 U/mL
Cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA)
  • Negative: < 20 U/mL
  • Positive: > 30 U/mL
Anti-SS-A (Ro)
  • Negative: < 15 U/mL
  • Positive: > 25 U/mL
Lumbar puncture results
Appearance
  • Clear and colourless
White blood cells (WBC)
  • 0 – 5 cells/µL
  • No neutrophils present, primarily lymphocytes
  • Normal cell counts do not rule out meningitis or any other pathology
Red blood cells (RBC)
  • 0 – 10/mm³
Protein
  • 0.15 – 0.45 g/L (or <1% of the serum protein concentration)
Glucose
  • 2.8 – 4.2 mmol/L (or ≥ 60% plasma glucose concentration)
Opening pressure
  • 10 – 20 cm H₂O