AMC MCQ Musculoskeletal and Dermatology 2 — Questions and Answers
Question 1: A 55-year-old man presents with sudden severe pain, redness and swelling of the first metatarsophalangeal joint. What is the most likely diagnosis?
- Acute gout (Correct answer)
- Septic arthritis
- Rheumatoid arthritis
- Osteoarthritis
Correct answer: Acute gout
Acute podagra of the first MTP joint with rapid onset is classic for gout.
Question 2: Which investigation is most useful to confirm a diagnosis of gout in a swollen joint?
- Joint aspiration with polarised microscopy (Correct answer)
- Serum uric acid level
- Plain X-ray
- ESR
Correct answer: Joint aspiration with polarised microscopy
Negatively birefringent needle-shaped urate crystals on aspirate confirm gout.
Question 3: A 30-year-old woman has symmetrical pain and stiffness of the small joints of both hands, worse in the morning for over an hour. What is the most likely diagnosis?
- Rheumatoid arthritis (Correct answer)
- Osteoarthritis
- Gout
- Psoriatic arthritis
Correct answer: Rheumatoid arthritis
Symmetrical small-joint involvement with prolonged morning stiffness suggests rheumatoid arthritis.
Question 4: Which antibody is most specific for rheumatoid arthritis?
- Anti-cyclic citrullinated peptide (anti-CCP) (Correct answer)
- Antinuclear antibody (ANA)
- Rheumatoid factor
- Anti-dsDNA
Correct answer: Anti-cyclic citrullinated peptide (anti-CCP)
Anti-CCP antibodies are highly specific for rheumatoid arthritis.
Question 5: A child presents with a salmon-pink, erythematous rash, high spiking fevers and arthritis. Which condition is most likely?
- Systemic juvenile idiopathic arthritis (Correct answer)
- Henoch-Schonlein purpura
- Kawasaki disease
- Rheumatic fever
Correct answer: Systemic juvenile idiopathic arthritis
Spiking fevers with an evanescent salmon-pink rash and arthritis indicate systemic JIA (Still disease).
Question 6: Which skin finding is characteristic of dermatomyositis?
- Heliotrope rash on the eyelids (Correct answer)
- Malar butterfly rash
- Erythema migrans
- Honey-coloured crusting
Correct answer: Heliotrope rash on the eyelids
A violaceous heliotrope rash over the eyelids is a hallmark of dermatomyositis.
Question 7: A 70-year-old woman presents with bilateral shoulder and hip girdle pain and stiffness, with a markedly raised ESR. What is the most likely diagnosis?
- Polymyalgia rheumatica (Correct answer)
- Fibromyalgia
- Osteoarthritis
- Polymyositis
Correct answer: Polymyalgia rheumatica
Proximal girdle stiffness with high ESR in an elderly patient suggests polymyalgia rheumatica.
AMC MCQ Musculoskeletal and Dermatology 2
A 55-year-old man presents with sudden severe pain, redness and swelling of the first metatarsophalangeal joint.
What is the most likely diagnosis?