Krok 2 MSQ test Basics of diagnosis, treatment and prevention of major diseases of the musculoskeletal system and connective tissue

 In the development of the inflammation processes glucocorticoids reduce the

level of certain most important active enzyme. It results also in the reducing

of the synthesis of prostaglandins and leucotrienes which have a key role in

the development of inflammation processes. What is the exact name of this

enzyme?

A 30 y.o. female with rheumatoid arthritis of five years duration complains

of pain in the frist three fingers of her right hand over past 6 weeks. The pain

seems especially severe at night often awakening her from sleep.The most

likelly cause is?

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 patient has an over a year-old history of fast progressive rheumatoid

arthritis. X-raying confirms presence of marginal erosions. What basic drug

would be the most appropriate in this case?

A 60-year-old female patient complains of recurrent pain in the proximal

interphalangeal and wrist joints, their periodic swelling and reddening that

have been observed for 4 years. X-ray picture represents changes in form of

osteoporosis, joint space narrowing and single usuras. What is the most

likely diagnosis?

Examination of a 35-year-old patient with rheumatism revealed that the right

heart border was 1 cm displaced outwards from the right parasternal line, the

upper border was on the level with inferior margin of the 1st rib, the left

border was 1 cm in from the left midclavicular line. Auscultation revealed

atrial fibrillation, loud apical first sound, diastolic shock above the

pulmonary artery. Echocardiocopy revealed abnormal pattern of the mitral

valve motion. What heart disease is characterized by these symptoms?

A 18 y.o. male patient complains of pain in knee and ankle joints,

temperature elevation to 39,5 o C. He had a respiratory disease 1,5 week ago.

On examination: temperature- 38,5 o C, swollen knee and ankle joints, pulse-

106 bpm, rhythmic, AP- 90/60 mm Hg, heart borders without changes,

sounds are weakened, soft systolic apical murmur. What indicator is

connected with possible etiology of the process?

A female rheumatic patient experiences diastolic thoracic wall tremor

(diastolic thrill), accentuated S 1 at apex, there is diastolic murmur with

presystolic intensification, opening snap, S 2 accent at pulmonary artery.

What rind of heart disorder is observed?

A 26-year-old female patient has an 11-year history of rheumatism. Four

years ago she suffered 2 rheumatic attacks. Over the last 6 months there

have been paroxysms of atrial fibrillation every 2-3 months. What option of

antiarrhythmic therapy or tactics should be proposed?

A patient, aged 40, has been ill during approximately 8 years, complains of

pain in the lumbar part of the spine on physical excertion, in cervical and

thoracal part (especially when coughing), pain in the hip and knee joints on

the right. On examination: the body is fixed in the forward inclination with

head down, gluteal muscles atrophy. Spine roentgenography: ribs

osteoporosis, longitudinal ligament ossification. What is the most likely

diagnosis?

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 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 38 o C. Objectively: the left

sternoclavicular and knee joints are swollen and painful. In blood: WBCs -

9,5x10 9 /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 26-year-old male patient complains of pain in the right knee, which is

getting worse in the morning. Two weeks before, he consulted an urologist

about prostatitis. Objectively: conjunctivitis is present. There is also

periarticular edema of the knee joint, redness of the overlying skin.

Rheumatoid factor was not detected. Until further diagnosis is specified, it

would be reasonable to start treatment with the following antibiotic:

A 25-year-old patient is not married and has sex ualrelations with several partners. During the last 3 months he noticed small amount of mucoserous secretions produced from urethra. Subjectively: periodical itchingor burning pain in urethra. Two months ago pain in knee join developed. Possibility of trauma or exposure to cold is denied by the patient. During the last week eye discomfort is noted - lacrimation and itching. What provisional diagnosis can be suggested?

A 40-year-old patient complains of constant moderate pain in the lumbar spine and significantly reduced mobility. The patient has been suffering from this condition for the last 7 years since pain appeared first in the sacrum area. X-ray: ankylosis of sacroiliac articulation, significant narrowing of intervertebral joint fissures of lumbar vertebrae and calcification of spinal ligaments. What pathology is most likely to cause such X-ray image? 

A 53-year-old male has been admitted to a hospital for an attack of renal

colic which has repeatedly occurred throughout the year. Objectively: in the

region of auricles and the right elbow some nodules can be seen that are

covered with thin shiny skin. Ps- 88/min, AP- 170/100 mm Hg. There is

bilateral costovertebral angle tenderness (positive Pasternatsky's symptom).

The patient has been scheduled for examination. What laboratory value

would be most helpful for making a diagnosis?

A 58-year-old woman complains of osteoarthrosis of knee-joint. For 2

weeks she had been receiving an in-patient medical treatment. She was

discharged from the hospital in satisfactory condition with complaints of

minor pain after prolonged static work. Local hyperemia and exudative

effects in the area of joints are absent. What further tactics is the most

expedient?

A 36-year-old female patient complains of intense pain in the knee joints

and neck. In the morning she experiences pain in the interscapular region

and leg joints; pain subsides after warm-up gymnastics. The patient is

overnourished, there is a clicking sound in the knees when squatting, the

knees are somewhat disfigured, painful on palpation. Blood test results:

ESR- 18 mm/h, WBC- 8,0 * 10 9 /l. Radiography reveals subchondral sclerosis

in the left knee. What is the basis of this pathology?

 A 39-year-old male patient complains of moderate pain and weakness in the

shoulder, back and pelvic girdle muscles, that has been progressing for the

last 3 weeks; great difficulty in getting out of bed, going up and down the

stairs, shaving. Dermatomyositis has been suspected. Blood test results: Hb-

114 g/l, WBC- 10,8*10 9 /l, eosinophils - 9%, ESR -22 mm/h, C-reactive

protein - (++). The alteration in the following laboratory value wil be of

decisive diagnostic significance:

A 38-year-old patient is under observation having polyneuritic syndrome

with considerable loss of weight, fever, rise in BP. Blood test: considerable

inflammatory changes. What examination is the most expedient to make the

diagnosis?