Multiple Choice Questions MCQ

Question 116# Print Question

A 58-year-old woman with a history of left hip osteoarthritis presents for review. She is currently taking cocodamol 30/500 for pain on a regular basis but this is unfortunately not controlling her symptoms. There is no past medical history of note, in particular no asthma or gastrointestinal problems.

What is the most suitable next step in management?

A. Switch to regular oral tramadol

B. Add topical ibuprofen

C. Add oral diclofenac + proton pump inhibitor

D. Add oral etoricoxib

E. Add oral diclofenac

Question 117# Which one of the following is least associated with the development of gout?
A. Psoriasis
B. Lesch-Nyhan syndrome
C. Lymphoma
D. Lithium toxicity
E. Renal failure
Correct Answer D: Gout: predisposing factors: Gout is a form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia (uric acid > 0.45 mmol/l). Decreased excretion of uric acid: Drugs: diuretics Chronic kidney disease Lead toxicity Increased production of uric acid: Myeloproliferative/lymphoproliferative disorder Cytotoxic drugs Severe psoriasis Lesch-Nyhan syndrome: Hypoxanthine-guanine phosphoribosyl transferase deficiency Inheritance = x-linked recessive Features: gout, renal failure, learning difficulties, head-banging Aspirin in a dose of 75-150mg is not thought to have a significant effect on plasma urate levels - the British Society for Rheumatology recommend it should be continued if required for cardiovascular prophylaxis.

Question 118# A 44-year-old woman is seen in the rheumatology clinic. She has been referred with Raynaud's phenomenon. During the review of systems she mentions that her GP is organizing an endoscopy to investigate dyspepsia. On examination she is noted to have tight, shiny skin over her fingers. Which one of the following complications is she most likely to develop?
A. Bronchiectasis
B. Angiodysplasia
C. Arterial hypertension
D. Chronic kidney disease
E. Pulmonary hypertension
Correct Answer E: This patient is likely to have CREST syndrome. Unfortunately pulmonary hypertension is one of the more common late complications seen in such patients. Systemic sclerosis: Systemic sclerosis is a condition of unknown aetiology characterized by hardened, sclerotic skin and other connective tissues. It is four times more common in females. There are three patterns of disease: Limited cutaneous systemic sclerosis: Raynaud's may be first sign Scleroderma affects face and distal limbs predominately Associated with anti-centromere antibodies A sub-type of limited systemic sclerosis is CREST syndrome: Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia Diffuse cutaneous systemic sclerosis: Scleroderma affects trunk and proximal limbs predominately Associated with scl-70 antibodies Hypertension, lung fibrosis and renal involvement seen Poor prognosis Scleroderma (without internal organ involvement): Tightening and fibrosis of skin May be manifest as plaques (morphoea) or linear Antibodies: ANA positive in 90% RF positive in 30% Anti-scl-70 antibodies associated with diffuse cutaneous systemic sclerosis Anti-centromere antibodies associated with limited cutaneous systemic sclerosis

Question 116# A 58-year-old woman with a history of left hip osteoarthritis presents for review. She is currently taking cocodamol 30/500 for pain on a regular basis but this is unfortunately not controlling her symptoms. There is no past medical history of note, in particular no asthma or gastrointestinal problems. What is the most suitable next step in management?
A. Switch to regular oral tramadol
B. Add topical ibuprofen
C. Add oral diclofenac + proton pump inhibitor
D. Add oral etoricoxib
E. Add oral diclofenac
Correct Answer C: NICE recommend co-prescribing a PPI with NSAIDs in all patients with osteoarthritis. Topical NSAIDs are only indicated for osteoarthritis of the knee or hand. Osteoarthritis: management: NICE published guidelines on the management of osteoarthritis (OA) in 2008: All patients should be offered help with weight loss, given advice about local muscle strengthening exercises and general aerobic fitness Paracetamol and topical NSAIDs are first-line analgesics. Topical NSAIDs are indicated only for OA of the knee or hand Second-line treatment is oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids. A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2 inhibitors. These drugs should be avoided if the patient takes aspirin Non-pharmacological treatment options include supports and braces, TENS and shock absorbing insoles or shoes If conservative methods fail then refer for consideration of joint replacement What is the role of glucosamine? Normal constituent of glycosaminoglycans in cartilage and synovial fluid A systematic review of several double blind RCTs of glucosamine in knee osteoarthritis reported significant short-term symptomatic benefits including significantly reduced joint space narrowing and improved pain scores More recent studies have however been mixed The 2008 NICE guidelines suggest it is not recommended A 2008 Drug and Therapeutics Bulletin review advised that whilst glucosamine provides modest pain relief in knee osteoarthritis it should not be prescribed on the NHS due to limited evidence of cost effectiveness

Your-Doctor Multiple Choice Questions (MCQ)

Your-Doctor
Multiple Choice Questions (MCQ)