Pathology EMQ template.

Name: Mustafa Anjari

Candidate number: 00338656

Theme: Autoimmune disease

OPTION LIST

A	Goodpasture's syndrome	I
B	Guillain-Barre syndrome	J
C	Polymyalgia rheumatica	K
D	Rheumatoid arthritis	L
E	Scleroderma	M
F	Sjogren's syndrome	N
G	Systemic lupus erythematosus	O
H	Wegener's granulomatosis	P

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

1. A 25 year old male presents to A&E with haemoptysis and acute glomerulonephritis. He is noted to have fusion of the index and middle fingers.

2. A 35 year old Afro-Caribbean lady comes for a follow-up appointment to check the progress of her disease. You notice a non-specific maculopapular rash on her face and chest for which she is being treated with hydroxychloroquine, and you are worried about drug-induced retinopathy. She had previously had a false positive syphilis serology test.

3. A 70 year old female is referred to the dermatology clinic having developed an allergic skin reaction to sulfasalazine. She had been prescribed the drug to treat a disease that was only recently diagnosed and caused her pain, stiffness and deformity of the small joints of the feet. A serum sample is negative for rheumatoid factor, but positive for anti-cyclic citrullinated peptide antibodies.

4. Six months later, the patient above comes to clinic to have a repeat autoantibody screen. Rheumatoid factor is now present in the serum, as is antinuclear antibody, and following a clinical history, the Schirmer test is indicated.

5. A 76 year old Caucasian lady presents with aching and morning stiffness of the shoulders and proximal limb muscles. This is symmetrical and has arisen over the past two weeks, following a flu-like illness. She reveals that she has giant cell arteritis, but hadn’t taken steroids for the past month. One week later, the prescribed prednisolone has elicited major improvement of symptoms.

ANSWERS

1. A

2. G

3. D

4. F

5. C