NAME

STUDENT ID
PART 1
Mr D.S. is a 69 year old single man who has been referred to your out patient rehabilitation
clinic with a three month history of bilateral pain and swelling in his metacarpophalyngeal
and proximal interphalyngeal joints . He also reports joint stiffness in the mornings which
usually lasts for one to two hours. He has been fatigued and has recently lost five kilograms
in weight . Clinically you suspect he has rheumatoid arthritis.
(a) List the six (6) most likely differential diagnoses other than rheumatoid arthritis. (3
marks)
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
5. _____________________________________________________________________
6. _____________________________________________________________________
(b) List eight (8) manifestations of rheumatoid arthritis that may occur in the hands other than
pain and swelling of the joints. (4 marks)
1. ____________________________________________________________________
2. ____________________________________________________________________
3. ____________________________________________________________________
4. ____________________________________________________________________
5. ____________________________________________________________________
6. ____________________________________________________________________
7. ____________________________________________________________________
8. ____________________________________________________________________
(c) List four (4) investigation results which would indicate a poor prognosis in rheumatoid
arthritis. (4 marks)
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
(d) List four (4) clinical indicators of a poor prognosis in rheumatoid arthritis. (4 marks)
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
NAME
STUDENT ID
PART 2
Mr D. S.s rheumatologist has discussed treatment options with him and Mr D.S.. now asks
you about potential side effects of these medications.
(e) List six ( 6 ) significant side effects of non- steroidal anti-inflammatory medications other
than rash.
1. _____________________________________________________________________
2. _____________________________________________________________________

3. _____________________________________________________________________
4. _____________________________________________________________________
5. _____________________________________________________________________
6. _____________________________________________________________________
(f) List six (6) significant side effects of methotrexate.
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
5. _____________________________________________________________________
6. _____________________________________________________________________
(g) Other than methotrexate, list four (4) disease modifying agents that are commonly used in
rheumatoid arthritis at present.
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
(h) Three months later Mr D.S. returns to your clinic with a hot and swollen wrist which has
been present for two weeks. He has just been seen by his rheumatologist who excluded
infection and performed an intra-articular injection of steroid into his wrist joint. He also
increased his dose of methotrexate
List the five ( 5 ) main aims of the rehabilitation plan you would provide for Mr D.S. at
this point.
1.
2.
3.
4.
5.

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

NAME
STUDENT ID
PART 3
(i) List ten (10) key components to the program you and your interdisciplinary rehabilitation
team would provide for a patient with rheumatoid arthritis. (5 marks)
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________
4. _____________________________________________________________________
5. _____________________________________________________________________
6. _____________________________________________________________________
7. _____________________________________________________________________
8. _____________________________________________________________________
9. _____________________________________________________________________
10. _____________________________________________________________________
(j) What X ray findings would you suspect if this was a case of rheumatoid arthritis? Name 4
such findings. (4 marks)
1. _____________________________________________________________________
2. _____________________________________________________________________

3. _____________________________________________________________________
4. _____________________________________________________________________
(k) Routine blood investigations show an increased CRP and a reduced haemoglobin. Explain
these findings. (3 marks)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(l) You suspect her eyes problems are related to her rheumatoid disease. List 2 ocular
complications associated with RA.
1. _________________________________2. __________________________________
(m)Your initial clinical impression (hat the patient is suffering from rheumatoid arthritis) is
confirmed by a rheumatologist, who, with the general practitioner, will co-manage the
medical treatment that has been commenced. List 3 other health professionals that will
be involved in the long-term care of this patient and outline what each would contribute.
(6 marks)
________________________________________________________________________
________________________________________________________________________
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