2) An 87 year old female who is 2 weeks post TKR presents with a sore swollen knee. She has a history of atrial fibrillation. Her vital signs are:

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Lee Norris
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1 EMQ - Rheumatology For each clinical vignette match the correct diagnosis. Reiter s syndrome Pseudogout Septic arthritis Gout Haemarthrosis Traumatic effusion Ankylosing spondylitis Rheumatoid arthritis Osteoarthritis 1) A 65 year old man presents with a swollen and painful left knee. There is no history of trauma. HR 86 /min BP 142/88 mmhg RR 15 /min Sats 99% RA T 37.4 Appearance: Bloodstained RBC: x10 6 /L WCC: x10 6 /L % Neutrophils: 85 % +vely birefringent (yellow) crystals seen 2) An 87 year old female who is 2 weeks post TKR presents with a sore swollen knee. She has a history of atrial fibrillation. Her vital signs are: HR 66 /min BP 133/98 mmhg RR 12 /min Sats 99% RA T 37.1 Appearance: Bloodstained RBC: x10 6 /L WCC: x10 6 /L % Neutrophils: 14 % nil

2 3) A 32 year old drug user presents with a painful swollen knee. Her vital signs are: HR 116 /min BP 103/62 mmhg RR 19 /min Sats 99% RA T 38.6 Appearance: Turbid RBC: x10 6 /L WCC: x10 6 /L % Neutrophils: 83 % gram +ve cocci seen nil 4) A 62 year old man presents with a painful swollen knee. He has no history of trauma. HR 82 /min BP 163/91 mmhg RR 14 /min Sats 99% RA T 37.2 Appearance: Turbid RBC: x10 6 /L WCC: x10 6 /L % Neutrophils: 51 % -vely birefringent (blue) crystals seen 5) An 18 year old university student presents complaining of dysuria. He also has a sore swollen knee. HR 96 /min BP 111/77 mmhg RR 10 /min Sats 99% RA T 37.9 Appearance: Turbid RBC: x10 6 /L WCC: x10 6 /L % Neutrophils: 62 % nil

SAQ 1. An 86 year old female self presents to the emergency department after a fall in her garden. She has a history of rheumatoid arthritis, ischaemic heart disease and hypertension.

3 SAQ 1. An 86 year old female self presents to the emergency department after a fall in her garden. She has a history of rheumatoid arthritis, ischaemic heart disease and hypertension. She is complaining of midline upper neck pain. Question 1. What are your immediate actions? (3 marks) Question 2. Should a plain radiograph or CT be performed? Why? (2 marks) Question 3. There is a problem with the CT scanner, and a plain film of the neck is obtained in the interim. What are the major abnormalities? (2 marks) Question 4. What is the injury? (1 mark) Question 5. In light of the xray findings, what are your immediate actions? (2 marks)

4 SAQ 2. A 65 year old man presents with fever dyspnoea and haemoptysis. He also describes dark discolouration of the urine and lower limb swelling. HR 112 /min BP 145/85 mmhg RR 32 /min Sats 88% 15L NRB T 38.1 GCS 15 Question 1. His chest xray is shown below. Describe the major abnormalities and give 4 important negatives? 4 marks Question 2. List your differential diagnoses (4 marks) Question 3. What are your treatment priorities? (2 marks)

SAQ 3. A 55 year old diabetic woman presents with a painful knee. There is no history of trauma. Her vital signs are: HR 140 /min BP 85/45 mmhg RR 22 /min Sats 99% RA T 39.

5 SAQ 3. A 55 year old diabetic woman presents with a painful knee. There is no history of trauma. Her vital signs are: HR 140 /min BP 85/45 mmhg RR 22 /min Sats 99% RA T 39.4 GCS 15 A clinical image of the knee is shown below. Question 1. What are the major abnormalities present in the image? (3 marks) Question 2. What is your differential diagnosis? (2 marks) Question 3. Describe your technique for aspiration of the joint. (5 marks)

6 SAQ 4. A 26 year old man presents to the ED with painful legs and dysuria. He has swelling to both ankles, the left knee and the small joints of his right hand. HR 102 /min BP 114/78 mmhg RR 14 /min Sats 98% RA T 37.4 GCS 15 Question 1. List your 3 most likely differential diagnoses (2 marks) Question 2. What specific historical features will you ask about? (2 marks) Question 3. What investigations will you perform? (2 marks) Question 4. A presumptive diagnosis of reactive arthritis is made. Outline your discharge plan. (4 marks)

SAQ 5. A 39 year old man presents with a diffuse rash across both legs. He had diarrhoea a week previously. A photo of his legs is shown below. Question 1. Describe the photograph.

7 SAQ 5. A 39 year old man presents with a diffuse rash across both legs. He had diarrhoea a week previously. A photo of his legs is shown below. Question 1. Describe the photograph. (3 marks) Question 2. Select pathology results are shown below. Describe the results (4 marks) INR 1.0 PT 12 s APTT 29 s Plt count 25 x10 9 /L Fibrinogen 5.0 g/l D-dimer 0.1 mg/dl Urea 15.8 mmol/l Creatinine 120 umol/l Question 3. Interpret the results and give the most likely diagnosis (3 marks)

2) An 87 year old female who is 2 weeks post TKR presents with a sore swollen knee. She has a history of atrial fibrillation. Her vital signs are:

2) An 87 year old female who is 2 weeks post TKR presents with a sore swollen knee. She has a history of atrial fibrillation. Her vital signs are: EMQ - Rheumatology For each clinical vignette match the correct diagnosis. Reiter s syndrome Pseudogout Septic arthritis Gout Haemarthrosis Traumatic effusion Ankylosing spondylitis Rheumatoid arthritis