LE5 Flashcards
The following conditions are associated with fibromyalgia, EXCEPT:
A. Anxiety
B. Psychosis
C. Irritable bowel syndrome
D. Cognitive dysfunction
B. Psychosis
💡 Rationale: Fibromyalgia is commonly associated with psychiatric conditions like anxiety and depression, but not psychosis. Cognitive dysfunction and irritable bowel syndrome (IBS) are also frequently linked to fibromyalgia.
Which of the following is TRUE about the clinical manifestations of fibromyalgia?
A. Symptoms must persist for at least 3 months
B. Pain is well localized
C. Pain severity is mild
D. Pain does not significantly affect daily life
A. Symptoms must persist for at least 3 months
💡 Rationale: The diagnosis of fibromyalgia requires widespread pain lasting for at least 3 months. The pain is diffuse, not well localized, often severe, and significantly impacts daily life.
Which of the following statements about pharmacologic therapy for fibromyalgia is FALSE?
A. Tramadol may be used as an analgesic
B. Duloxetine, an antidepressant/anti-anxiolytic, may be used
C. Anticonvulsants such as pregabalin must be avoided
D. Glucocorticoids are not effective for fibromyalgia-related symptoms
C. Anticonvulsants such as pregabalin must be avoided
💡 Rationale: Pregabalin and gabapentin are actually approved treatments for fibromyalgia due to their role in neuropathic pain modulation. Tramadol, duloxetine (SNRI), and non-steroidal anti-inflammatory drugs (NSAIDs) are also used, while glucocorticoids are ineffective.
What is the required pressure during a tender point examination in patients with fibromyalgia?
A. 4 kg/cm²
B. 6 kg/cm²
C. 2 kg/cm²
D. 8 kg/cm²
A. 4 kg/cm²
💡 Rationale: The standard tender point examination applies 4 kg/cm² of pressure, equivalent to enough pressure to blanch the examiner’s fingernail.
The following are basic routine laboratory tests for patients with fibromyalgia symptoms, EXCEPT:
A. Complete blood count (CBC)
B. Thyroid-stimulating hormone (TSH)
C. Erythrocyte sedimentation rate (ESR)
D. Liver function tests (LFTs)
D. Liver function tests (LFTs)
💡 Rationale: Routine screening for fibromyalgia does not include LFTs. Instead, CBC, TSH, and ESR/CRP are useful to rule out other conditions like anemia, thyroid dysfunction, or inflammatory diseases.
Which of the following antidepressants used in fibromyalgia treatment acts as a serotonin-norepinephrine reuptake inhibitor (SNRI)?
A. Amitriptyline
B. Duloxetine
C. Pregabalin
D. Cyclobenzaprine
B. Duloxetine
💡 Rationale: Duloxetine and milnacipran are SNRIs approved for fibromyalgia treatment, as they help with both pain and depression. Amitriptyline (TCA), pregabalin (anticonvulsant), and cyclobenzaprine (muscle relaxant) are also used but do not act as SNRIs.
Which of the following statements about fibromyalgia is FALSE?
A. It is a common condition that can affect a patient’s quality of life
B. Non-pharmacologic treatment is not effective for fibromyalgia
C. Symptoms may worsen during periods of perceived stress
D. Neuropsychological symptoms include fatigue, stiffness, and sleep disturbances
B. Non-pharmacologic treatment is not effective for fibromyalgia
💡 Rationale: Non-pharmacologic treatments such as exercise, cognitive-behavioral therapy
The following are sites for tender point assessment in patients with fibromyalgia, EXCEPT:
A. Trapezius
B. Upper outer gluteal area
C. Medial knee
D. Infraspinatus
D. Infraspinatus
💡 Rationale: Tender points in fibromyalgia are symmetrical and located at specific muscle and tendon junctions. Common sites include the trapezius, upper outer gluteal area, and medial knee. The infraspinatus is NOT a standard tender point.
11. Which of the following statements is TRUE regarding antiphospholipid syndrome (APS)?
A. Autoantibodies should be at intermediate or high titers on two occasions at least 12 weeks apart.
B. Premature atherosclerosis is a recognized feature of antiphospholipid syndrome.
C. Transverse myelopathy is the most common neurologic manifestation in APS.
D. A first miscarriage should warrant a work-up for APS.
A. Autoantibodies should be at intermediate or high titers on two occasions at least 12 weeks apart.
💡 Rationale: The classification criteria for APS require persistent detection of anticardiolipin (aCL), lupus anticoagulant (LA), or anti-β2 glycoprotein I (B2GPI) antibodies in moderate or high titers, confirmed at least 12 weeks apart to avoid transient false-positive results.
12. Which assay is needed for the detection of antibodies against cardiolipin (aCL) in APS?
A. ELISA
B. Activated partial thromboplastin time (aPTT)
C. Kaolin clotting time (KCT)
D. Dilute Russell Viper Venom Test (DRVVT)
A. ELISA
💡 Rationale: Cardiolipin antibodies are detected using an enzyme-linked immunosorbent assay (ELISA). Functional coagulation tests like DRVVT, KCT, and aPTT are used for lupus anticoagulant, not aCL.
13. Which assay is needed for the detection of antibodies against β2-Glycoprotein I (B2GPI) in APS?
A. ELISA
B. Kaolin clotting time (KCT)
C. Dilute Russell Viper Venom Test (DRVVT)
D. Activated partial thromboplastin time (aPTT)
A. ELISA
💡 Rationale: Anti-β2GPI antibodies are measured via ELISA, similar to anticardiolipin antibodies. Functional assays (e.g., DRVVT, KCT, aPTT) are used to detect lupus anticoagulant.
14. The major cause of pregnancy morbidity in antiphospholipid syndrome presenting with recurrent miscarriage as a complication is:
A. Placental infarction
B. Preeclampsia
C. Eclampsia
D. Preterm birth
A. Placental infarction
💡 Rationale: APS causes thrombosis of placental vessels, leading to placental infarction, recurrent miscarriages (especially in the second trimester), intrauterine growth restriction (IUGR), and preeclampsia.
15. Which of the following statements about pharmacologic therapy for fibromyalgia is FALSE?
A. Tramadol may be used as an analgesic.
B. Duloxetine, an antidepressant/anti-anxiolytic medication, may be used.
C. Anticonvulsants such as pregabalin must be avoided.
D. Glucocorticoids are not effective against fibromyalgia-related symptoms.
C. Anticonvulsants such as pregabalin must be avoided.
💡 Rationale: Pregabalin and gabapentin are approved treatments for fibromyalgia, as they modulate neuropathic pain. Other treatment options include SNRIs (Duloxetine, Milnacipran) and Tricyclic Antidepressants (Amitriptyline), while glucocorticoids are ineffective.
16. What is the required pressure during a tender point examination in patients with fibromyalgia?
A. 4 kg/cm²
B. 6 kg/cm²
C. 2 kg/cm²
D. 8 kg/cm²
A. 4 kg/cm²
💡 Rationale: The standard pressure applied in a tender point examination is 4 kg/cm², which is equivalent to the pressure needed to blanch the examiner’s fingernail.
21. The autoantibody most specific for systemic lupus erythematosus (SLE) is:
A. Antihistone
B. Antiribosomal P
C. Antinuclear antibodies (ANA)
D. Anti-Smith (Anti-Sm)
D. Anti-Smith (Anti-Sm)
💡 Rationale: Anti-Smith (Anti-Sm) antibodies are highly specific for SLE, though they are found in only 30%–40% of cases. ANA is sensitive but not specific.
22. Which autoantibody correlates with depression or psychosis due to CNS lupus?
A. Antihistone
B. Antiribosomal P
C. Antinuclear antibodies (ANA)
D. Anti-Smith (Anti-Sm)
B. Antiribosomal P
💡 Rationale: Anti-ribosomal P antibodies are associated with neuropsychiatric lupus (NPSLE), particularly lupus psychosis and cognitive dysfunction.
23. Which autoantibody is more frequently found in drug-induced lupus than in SLE?
A. Antihistone
B. Antiribosomal P
C. Antinuclear antibodies (ANA)
D. Anti-Smith (Anti-Sm)
A. Antihistone
💡 Rationale: Anti-histone antibodies are present in >90% of drug-induced lupus (DILE) cases (e.g., caused by hydralazine, procainamide, isoniazid), while anti-dsDNA and anti-Sm are rare in DILE.
24. Which of the following statements regarding pathological findings in SLE is FALSE?
A. One of the findings in biopsies of affected skin is the deposition of immunoglobulins at the dermal-epidermal junction.
B. Patterns of vasculitis are not specific for SLE.
C. Leukocytoclastic vasculitis is the most common vasculitis seen in SLE.
D. Lymph node biopsies show patchy chronic inflammation and help confirm the diagnosis of SLE.
D. Lymph node biopsies show patchy chronic inflammation and help confirm the diagnosis of SLE.
💡 Rationale: Lymph node biopsy is NOT used to diagnose SLE, as the histological findings (e.g., nonspecific chronic inflammation) do not confirm SLE. Instead, SLE is diagnosed based on clinical criteria and serology (ANA, anti-dsDNA, anti-Sm, low complement levels, etc.).
25. Which autoantibody in SLE is specific and correlates with disease activity, nephritis, and vasculitis?
A. Anti-dsDNA
B. Anti-Smith (Anti-Sm)
C. Anti-La (SS-B)
D. Antiphospholipid
A. Anti-dsDNA
💡 Rationale: Anti-dsDNA antibodies are highly specific for SLE and correlate with disease activity, lupus nephritis, and vasculitis. Anti-Sm is specific but does not correlate with disease activity.
26. Which autoantibody in SLE predisposes to clotting, fetal loss, and thrombocytopenia?
A. Anti-dsDNA
B. Anti-Smith (Anti-Sm)
C. Anti-La (SS-B)
D. Antiphospholipid
D. Antiphospholipid
💡 Rationale: Antiphospholipid antibodies (aPL) (e.g., lupus anticoagulant, anticardiolipin, anti-β2 glycoprotein I) increase the risk of thrombosis, recurrent pregnancy loss, and thrombocytopenia, leading to antiphospholipid syndrome (APS).
33. The following are basic routine laboratory tests for patients with fibromyalgia symptoms, EXCEPT:
A. Complete blood count (CBC)
B. Liver function test (LFT)
C. Thyroid-stimulating hormone (TSH)
B. Liver function test (LFT)
💡 Rationale: Routine workup for fibromyalgia includes CBC (to rule out anemia), TSH (to exclude hypothyroidism), and ESR/CRP (to rule out inflammatory conditions). LFTs are not required unless other causes are suspected.
34. What is the major cause of pregnancy morbidity in antiphospholipid syndrome, leading to recurrent miscarriage?
A. Eclampsia
B. Preterm birth
C. Gestational diabetes mellitus (GDM)
D. Placental infarction
D. Placental infarction
💡 Rationale: APS causes thrombosis of placental vessels, leading to placental infarction, recurrent miscarriages, intrauterine growth restriction (IUGR), and preeclampsia.
37. What is the recommended dose of aspirin for the treatment of arthritis, fever, and arthralgia in acute rheumatic fever?
A. 50–60 mg/kg body weight per day, divided into 4–5 doses
B. 80 mg tablet, one tablet once a day
C. Loading dose of aspirin 365 mg, followed by 80 mg daily
D. None of the above
A. 50–60 mg/kg body weight per day, divided into 4–5 doses
💡 Rationale: High-dose aspirin (50–60 mg/kg/day) is used to treat arthritis, fever, and arthralgia in acute rheumatic fever. Lower doses are ineffective, and loading doses are not required.
38. The most common chronic inflammatory arthritis is:
A. Polyarthritis of rheumatic fever
B. Gouty arthritis
C. Rheumatoid arthritis
D. Reactive arthritis
C. Rheumatoid arthritis
💡 Rationale: Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis, affecting MCP and PIP joints. Gout and reactive arthritis are less common, and rheumatic fever arthritis is transient.
41. The most frequently affected joints in rheumatoid arthritis are:
A. Wrist
B. Distal interphalangeal joints (DIP)
C. Proximal interphalangeal joints (PIP)
D. Metacarpophalangeal joints (MCP)
D. Metacarpophalangeal joints (MCP)
💡 Rationale: RA primarily affects small joints, especially MCP, PIP, and wrist joints, sparing DIP joints (which are more affected in osteoarthritis).
42. The most frequent hallmark of rheumatoid arthritis is:
A. Flexor tenosynovitis
B. Dactylitis
C. Enthesitis
D. Sacroiliitis
A. Flexor tenosynovitis
💡 Rationale: Flexor tenosynovitis is a hallmark of RA, leading to stiffness, reduced grip strength, and trigger fingers. Dactylitis, enthesitis, and sacroiliitis are seen in spondyloarthropathies, not RA.
45. In a patient with rheumatoid arthritis who presents with fever >38.3°C and no evidence of infection, which extra-articular involvement should be considered?
A. Pericarditis
B. Pleuritis
C. Vasculitis
D. Felty’s syndrome
C. Vasculitis
💡 Rationale: RA-associated vasculitis can cause systemic inflammation, fever, and skin ulcers. Pericarditis and pleuritis are common but do not typically cause high fever. Felty’s syndrome presents with neutropenia and splenomegaly, not fever.
46. The most common hematologic finding in extra-articular rheumatoid arthritis is:
A. Neutropenia
B. Normocytic normochromic anemia
C. Leukemia
D. Lymphoma
B. Normocytic normochromic anemia
💡 Rationale: Anemia of chronic disease (normocytic, normochromic) is the most common hematologic abnormality in RA. Neutropenia is seen in Felty’s syndrome, while leukemia and lymphoma are not primary findings.
51. A positive Modified Schober Test, indicative of ankylosing spondylitis (AS), is defined as:
A. Increase in length by 5 cm or more
B. Increase in length by 4 cm or less
C. Increase in length by 4 cm or more
D. None of the above
B. Increase in length by 4 cm or less
💡 Rationale: A Modified Schober Test increase of ≤4 cm suggests reduced lumbar spinal mobility, a hallmark of ankylosing spondylitis (AS). A normal response is >5 cm.
52. True regarding juvenile-onset spondyloarthritis, EXCEPT:
A. Axial symptoms predominate
B. Axial symptoms supervene in late adolescence
C. Peripheral arthritis and enthesitis predominate
D. None of the above
A. Axial symptoms predominate
💡 Rationale: In juvenile spondyloarthritis (JSpA), peripheral arthritis and enthesitis are more common than axial symptoms, which tend to appear later in adolescence.
63. Patients with Sjögren’s syndrome who develop lymphoma have a decreased survival rate if they present with the following, EXCEPT:
A. Lymph node mass greater than 10 cm
B. B symptoms
C. Low histologic grade
D. All of the above
C. Low histologic grade
💡 Rationale: High-grade lymphomas are associated with worse prognosis in Sjögren’s syndrome-associated lymphoma. Poor prognostic indicators include lymph node mass >10 cm, B symptoms (fever, weight loss, night sweats), and high histologic grade.
64. True or False: The arthritis in Sjögren’s syndrome is non-erosive and may lead to Jaccoud’s arthropathy.
A. True
B. False
C. Maybe
A. True
💡 Rationale: Sjögren’s syndrome causes non-erosive arthritis, meaning it does not destroy joint surfaces. However, it may lead to Jaccoud’s arthropathy, a deforming but non-erosive hand arthritis similar to SLE.
67. Precipitating events of acute gouty arthritis, EXCEPT:
A. Dietary excess
B. Colchicine treatment
C. Surgery or trauma
D. Excessive intake of alcoholic beverages
B. Colchicine treatment
💡 Rationale: Colchicine is used for gout treatment and prevention, not as a trigger. Common triggers include dietary excess (purine-rich foods), alcohol, surgery/trauma, and dehydration.
68. Gouty arthritis is diagnosed with:
A. X-ray of the metatarsophalangeal joint of the big toe
B. Aspiration of joint fluid
C. CT scan of the joint and surrounding tissues
D. Ultrasound of the articular surfaces
B. Aspiration of joint fluid
💡 Rationale: Synovial fluid aspiration is the gold standard for diagnosing gout by identifying negatively birefringent, needle-shaped monosodium urate crystals. Imaging studies (X-ray, CT, ultrasound) are supportive but not diagnostic.
69. Which drug used in heart failure may precipitate an acute gouty arthritis attack?
A. Beta-blockers
B. ACE inhibitors
C. Diuretics
D. Nitrates
C. Diuretics
💡 Rationale: Thiazide and loop diuretics decrease uric acid excretion, increasing serum urate levels and precipitating gout attacks. Beta-blockers, ACE inhibitors, and nitrates do not directly trigger gout.
70. Diseases associated with calcium pyrophosphate crystal deposition, EXCEPT:
A. Chronic gout
B. Hypomagnesemia
C. Rheumatic fever
D. Epiphyseal dysplasia
A. Chronic gout
💡 Rationale: Calcium pyrophosphate deposition disease (CPPD, pseudogout) is associated with hypomagnesemia, hyperparathyroidism, and epiphyseal dysplasia, not chronic gout. Gout involves monosodium urate crystals, not CPPD.
71. The joint most frequently affected in calcium pyrophosphate deposition (CPPD) arthropathy is:
A. Knee
B. Wrist
C. Hand
A. Knee
💡 Rationale: The knee is the most commonly involved joint in CPPD (pseudogout). The wrist and metacarpophalangeal (MCP) joints are less frequently involved.
72. Conditions associated with apatite deposition disease, EXCEPT:
A. Hyperparathyroidism
B. Milk-alkali syndrome
C. Connective tissue disease such as systemic sclerosis
D. Hyperthyroidism
D. Hyperthyroidism
💡 Rationale: Apatite deposition disease (e.g., hydroxyapatite arthritis) is linked to hyperparathyroidism, renal failure (milk-alkali syndrome), and connective tissue diseases like systemic sclerosis. Hyperthyroidism is not a known association.
73. This vitamin is metabolized to oxalate and should be avoided in uremic and dialysis patients:
A. Ascorbic acid
B. Pyridoxine
C. Cholecalciferol
D. Alpha-tocopherol
A. Ascorbic acid
💡 Rationale: Vitamin C (ascorbic acid) is metabolized to oxalate, which can lead to oxalate nephropathy and nephrolithiasis in patients with renal failure. Pyridoxine, cholecalciferol, and alpha-tocopherol do not pose this risk.
74. The distinguishing hallmark of systemic sclerosis is:
A. Joint contractures and tendon friction rubs
B. Thick and indurated skin (scleroderma)
C. Interstitial lung disease
D. Digital ischemic ulcers
B. Thick and indurated skin (scleroderma)
💡 Rationale: Scleroderma (thickened, indurated skin) is the hallmark of systemic sclerosis. Joint contractures, interstitial lung disease, and digital ulcers are common but not the defining feature.
75. Which of the following is TRUE regarding limited cutaneous systemic sclerosis?
A. It is associated with extensive skin induration starting in the fingers and ascending from distal to proximal limbs and trunk.
B. Raynaud’s phenomenon precedes other disease manifestations.
C. The entire body is affected, including the trunk.
D. Visceral organ involvement is often aggressive.
B. Raynaud’s phenomenon precedes other disease manifestations.
💡 Rationale: Limited cutaneous systemic sclerosis (lcSSc) typically begins with Raynaud’s phenomenon, which may precede other symptoms by years. Unlike diffuse SSc (dcSSc), skin involvement remains limited to the face, hands, and forearms.
76. CREST syndrome is an acronym that includes the following presentation:
A. Calcinosis cutis
B. Rheumatoid arthritis
C. Esophagitis
D. Tendon friction rubs
A. Calcinosis cutis
💡 Rationale: CREST syndrome (a subset of limited systemic sclerosis) includes:
Calcinosis cutis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
77. Environmental factors that contribute to the development of systemic sclerosis, EXCEPT:
A. Cigarette smoking
B. Organic solvents and aromatic hydrocarbons
C. Epoxy resin
D. Welding fumes
D. Welding fumes
💡 Rationale: Organic solvents, epoxy resin, and hydrocarbons are linked to systemic sclerosis. Welding fumes are not a recognized environmental trigger.
78. Drugs implicated in systemic sclerosis-like illnesses, EXCEPT:
A. Bleomycin
B. Pentazocine
C. Cocaine
D. Appetite stimulants
D. Appetite stimulants
💡 Rationale: Appetite suppressants (e.g., fenfluramine) are linked to systemic sclerosis-like conditions, not appetite stimulants. Bleomycin, pentazocine, and cocaine are also implicated.
79. The three cardinal pathological mechanisms responsible for the clinical manifestations of systemic sclerosis include the following, EXCEPT:
A. Diffuse microangiopathy
B. Immune dysregulation
C. Visceral and vascular fibrosis
D. Atherosclerosis
D. Atherosclerosis
💡 Rationale: Systemic sclerosis is characterized by diffuse microangiopathy, immune dysregulation, and visceral/vascular fibrosis, but not atherosclerosis. Vascular occlusion in SSc is due to fibrosis, not lipid-driven atherosclerosis.
80. The most common lung finding in systemic sclerosis is:
A. Nonspecific interstitial pneumonia
B. Pulmonary fibrosis
C. Lymphocytic bronchiolitis
D. Multiple pulmonary emboli
A. Nonspecific interstitial pneumonia (NSIP)
💡 Rationale: NSIP is the most common lung pathology in systemic sclerosis, followed by usual interstitial pneumonia (UIP/pulmonary fibrosis). Pulmonary arterial hypertension (PAH) is also common but is a vascular complication.
81. The most frequent extracutaneous complication of systemic sclerosis is:
A. Raynaud’s phenomenon
B. GERD with Barrett’s esophagus
C. Interstitial lung disease
D. Myopathy
A. Raynaud’s phenomenon
💡 Rationale: Raynaud’s phenomenon is present in almost 90% of systemic sclerosis cases, making it the most frequent extracutaneous manifestation.
82. Which of the following statements is NOT true about systemic sclerosis?
A. Dry eyes and dry mouth are common.
B. Erectile dysfunction is frequent.
C. Fertility is impaired.
D. Hypothyroidism from Graves’ or Hashimoto’s disease is common.
D. Hypothyroidism from Graves’ or Hashimoto’s disease is common.
💡 Rationale: Thyroid dysfunction is not commonly associated with systemic sclerosis. However, sicca symptoms (dry eyes, dry mouth), erectile dysfunction, and impaired fertility are frequent.
83. The leading cause of death in systemic sclerosis is:
A. Raynaud’s phenomenon
B. Interstitial lung disease
C. Pulmonary arterial hypertension
D. Thromboembolism
C. Pulmonary arterial hypertension (PAH)
💡 Rationale: PAH is the leading cause of death in systemic sclerosis, followed by interstitial lung disease (ILD). Raynaud’s phenomenon and thromboembolism are complications but not primary causes of mortality.
84. Heliotrope rash with Gottron papules and dilated nailfold capillaries is diagnostic of:
A. Dermatomyositis
B. Polymyositis
C. Inclusion body myositis
D. Immune-mediated necrotizing myopathy
E. Antisynthetase syndrome
A. Dermatomyositis
💡 Rationale: Dermatomyositis (DM) presents with a heliotrope rash, Gottron papules, and periungual telangiectasia. It is an autoimmune inflammatory myopathy associated with proximal muscle weakness and malignancies.
89. Which condition is commonly associated with nonerosive arthritis and Raynaud’s phenomenon?
A. Dermatomyositis
B. Polymyositis
C. Antisynthetase syndrome
D. Inclusion body myositis
C. Antisynthetase syndrome
💡 Rationale: Antisynthetase syndrome (ASS) is an inflammatory myopathy characterized by Raynaud’s phenomenon, nonerosive arthritis, interstitial lung disease (ILD), mechanic’s hands, and myositis. Dermatomyositis and polymyositis can have arthritis but not as commonly with Raynaud’s.
90. Which of the following is NOT commonly associated with interstitial lung disease (ILD)?
A. Dermatomyositis
B. Polymyositis
C. Antisynthetase syndrome
D. None of the above (NOTA)
D. None of the above (NOTA)
💡 Rationale: ILD is a common complication of dermatomyositis, polymyositis, and antisynthetase syndrome. Among them, antisynthetase syndrome has the strongest ILD association.
91. Which of the following conditions is more commonly associated with Sjögren’s syndrome?
A. Dermatomyositis
B. Polymyositis
C. Inclusion body myositis
D. Antisynthetase syndrome
C. Inclusion body myositis
💡 Rationale: Inclusion body myositis (IBM) has been reported in association with Sjögren’s syndrome, while dermatomyositis, polymyositis, and antisynthetase syndrome are less frequently linked to Sjögren’s.
92. Which of the following conditions is associated with granular lymphocytic leukemia?
A. Dermatomyositis
B. Polymyositis
C. Inclusion body myositis
D. Antisynthetase syndrome
C. Inclusion body myositis
💡 Rationale: Granular lymphocytic leukemia (LGLL) has been associated with inclusion body myositis (IBM) and other autoimmune diseases like Sjögren’s syndrome and RA.
78. Which autoantibody is more frequently found in drug-induced lupus than in systemic lupus erythematosus (SLE)?
A. Antihistone
B. Antiribosomal P
C. Antinuclear antibodies (ANA)
D. Anti-Smith (Anti-Sm)
A. Antihistone
💡 Rationale: Antihistone antibodies are found in >90% of drug-induced lupus cases but are less common in idiopathic SLE. Anti-dsDNA and Anti-Sm are more specific for SLE.
79. Which autoantibody in SLE is specific and correlates with disease activity, nephritis, and vasculitis?
A. Anti-dsDNA
B. Anti-Smith (Anti-Sm)
C. Anti-La (SSB)
D. Antiphospholipid
A. Anti-dsDNA
💡 Rationale: Anti-dsDNA antibodies are highly specific for SLE and correlate with disease activity, lupus nephritis, and vasculitis.
80. Which autoantibody in SLE predisposes patients to clotting, fetal loss, and thrombocytopenia?
A. Anti-dsDNA
B. Anti-Smith (Anti-Sm)
C. Anti-La (SSB)
D. Antiphospholipid
D. Antiphospholipid
💡 Rationale: Antiphospholipid antibodies (APL) are associated with thrombosis, recurrent fetal loss, and thrombocytopenia, leading to antiphospholipid syndrome (APS).
81. The most common lung finding in systemic sclerosis is:
A. Nonspecific interstitial pneumonia
B. Pulmonary fibrosis
C. Lymphocytic bronchiolitis
D. Multiple pulmonary emboli
A. Nonspecific interstitial pneumonia (NSIP)
💡 Rationale: NSIP is the most common pulmonary manifestation in systemic sclerosis, followed by UIP (pulmonary fibrosis). Pulmonary arterial hypertension (PAH) is a leading cause of mortality but is a vascular complication, not an ILD pattern.
1. Thrombotic microangiopathies that mimic vasculitis include:
A. Antiphospholipid syndrome
B. Thrombotic thrombocytopenic purpura
C. All of the above
D. None of the above
C. All of the above
💡 Rationale: Antiphospholipid syndrome (APS) and thrombotic thrombocytopenic purpura (TTP) can mimic vasculitis due to microvascular thrombosis and endothelial injury without true inflammation of vessel walls.
2. Neoplasms that can mimic vasculitis, EXCEPT:
A. Atrial myxoma
B. Lymphoma
C. Carcinomatosis
D. Nodular nontoxic goiter
D. Nodular nontoxic goiter
💡 Rationale: Atrial myxoma, lymphoma, and carcinomatosis can produce vasculitis-like syndromes, including constitutional symptoms, embolic events, and immune complex deposition. Nodular goiter does not mimic vasculitis.
3. The histopathologic hallmark of Wegener’s granulomatosis is:
A. Necrotizing vasculitis of small arteries and veins with granuloma formation
B. Necrotizing fasciitis with granuloma formation
C. Vasculitis of small and medium arteries and veins with thrombus formation
D. Vasculitis of medium and large arteries and veins with aneurysmal formation
A. Necrotizing vasculitis of small arteries and veins with granuloma formation
💡 Rationale: Granulomatosis with polyangiitis (Wegener’s) is characterized by small-vessel necrotizing vasculitis with granulomatous inflammation, primarily affecting the lungs, kidneys, and upper respiratory tract.
4. Toxic levels of which of the following drugs can mimic vasculitis, EXCEPT:
A. Amphetamines
B. Technetium
C. Arsenic
D. Ergot alkaloids
B. Technetium
💡 Rationale: Amphetamines, arsenic, and ergot alkaloids can cause vasospasm, thrombosis, and necrotizing vasculopathy, mimicking vasculitis. Technetium (Tc) is used in imaging and does not cause vasculitis-like toxicity.
5. The definitive diagnosis of Wegener’s granulomatosis is made with:
A. Antiproteinase-3 ANCA
B. Elevated ESR, mild anemia, and leukocytosis
C. Tissue biopsy in a patient with compatible clinical features
D. Mild hypergammaglobulinemia of the IgA class
C. Tissue biopsy in a patient with compatible clinical features
💡 Rationale: Definitive diagnosis requires a biopsy demonstrating necrotizing granulomatous vasculitis. c-ANCA (PR3-ANCA) is highly specific but not diagnostic alone.
6. Which artery is most commonly affected in Takayasu arteritis as seen on arteriography?
A. Aortic arch
B. Common carotid artery
C. Subclavian artery
D. Abdominal aorta
C. Subclavian artery
💡 Rationale: Takayasu arteritis primarily affects the aorta and its major branches, with the subclavian artery being most commonly involved, leading to upper limb claudication.
7. The following statements about Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) are NOT true, EXCEPT:
A. It is an autoimmune disease
B. It includes necrotizing granulomatous inflammation
C. It is also known as Wegener’s granulomatosis
D. It is a pauci-immune vasculitis affecting medium and large-sized blood vessels
D. It is a pauci-immune vasculitis affecting medium and large-sized blood vessels → ❌ Incorrect, as GPA primarily affects small and medium-sized vessels, not large vessels.
8. Which vasculitis primarily affects medium-sized blood vessels?
A. Takayasu’s arteritis
B. Polyarteritis nodosa
C. IgA Vasculitis
D. None of the above
B. Polyarteritis nodosa
💡 Rationale: Polyarteritis nodosa (PAN) is a classic medium-vessel vasculitis that spares capillaries and venules. It is not associated with ANCA and often involves renal, gastrointestinal, and peripheral nervous system vessels.
9. Which vasculitis is also known as temporal arteritis?
A. Takayasu’s arteritis
B. Polyarteritis nodosa
C. Giant cell arteritis
D. Kawasaki arteritis
C. Giant cell arteritis
💡 Rationale: Giant cell arteritis (GCA), also called temporal arteritis, affects the branches of the external carotid artery and is characterized by headaches, jaw claudication, and vision loss.
10. This vasculitis is characterized by allergic rhinitis, asthma attacks, mononeuritis multiplex or polyneuropathy, and peripheral blood eosinophilia:
A. Wegener’s Granulomatosis
B. Polyarteritis nodosa
C. IgA Vasculitis
D. Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis)
D. Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis - EGPA)
💡 Rationale: Eosinophilic Granulomatosis with Polyangiitis (EGPA, formerly Churg-Strauss Syndrome) is characterized by eosinophilia, asthma, allergic rhinitis, and vasculitis involving small to medium vessels.
1. Which of the following conditions is associated with fibromyalgia, EXCEPT:
A. It is a common condition that can affect a patient’s quality of life.
B. Non-pharmacologic treatment is not effective for fibromyalgia.
C. Symptoms of fibromyalgia may be exacerbated during periods of perceived stress.
D. Neuropsychological symptoms include fatigue, stiffness, and sleep disturbances.
B. Non-pharmacologic treatment is not effective for fibromyalgia.
💡 Rationale: Non-pharmacologic treatments such as exercise, cognitive-behavioral therapy (CBT), and sleep hygiene are effective in managing fibromyalgia. While medications like duloxetine and pregabalin help, a multimodal approach is most effective.
2. What is the required pressure during a tender point examination in patients with fibromyalgia?
A. 4 kg/cm²
B. 6 kg/cm²
C. 2 kg/cm²
D. 8 kg/cm²
A. 4 kg/cm²
💡 Rationale: The standard pressure applied in a tender point examination is 4 kg/cm², which is equivalent to the pressure needed to blanch the examiner’s fingernail.
3. The following are sites for tender point assessment in patients with fibromyalgia, EXCEPT:
A. Trapezius
B. Upper outer gluteal area
C. Medial knee
D. Infraspinatus
D. Infraspinatus
💡 Rationale: Tender points in fibromyalgia are symmetrical and located at specific muscle and tendon junctions. Common sites include the trapezius, upper outer gluteal area, and medial knee. The infraspinatus is NOT a standard tender point.
4. Which of the following statements is TRUE regarding the American College of Rheumatology (ACR) criteria for fibromyalgia?
A. Among the 18 sites of pain in the old criteria, the medial epicondyle and lesser trochanter areas were included.
B. The new criteria require the presence of pain in at least 4 out of 5 areas.
C. The old ACR criteria required 11 out of 18 tender points to make a diagnosis.
D. Headache in the past 6 months is one of the associated symptoms included in the criteria.
C. The old ACR criteria required 11 out of 18 tender points to make a diagnosis.
💡 Rationale:
The 1990 ACR criteria required ≥11 out of 18 specified tender points to be present.
The 2010 ACR criteria introduced the Widespread Pain Index (WPI) and Symptom Severity Score (SSS), requiring pain in at least 4 of 5 body regions.
5. Which of the following statements about pharmacologic therapy for fibromyalgia is FALSE?
A. Tramadol may be used as an analgesic.
B. Duloxetine, an antidepressant/anti-anxiolytic medication, may be used.
C. Anticonvulsants such as pregabalin must be avoided.
D. Glucocorticoids are not effective against fibromyalgia-related symptoms.
C. Anticonvulsants such as pregabalin must be avoided.
💡 Rationale: Pregabalin and gabapentin are FDA-approved for fibromyalgia treatment due to their role in neuropathic pain modulation. Other treatment options include SNRIs (Duloxetine, Milnacipran) and Tricyclic Antidepressants (Amitriptyline), while glucocorticoids are ineffective.
1. The most common clinical features of rheumatic fever are:
A. Polyarthritis and carditis
B. Chorea
C. Erythema marginatum
D. Fever and oligoarthritis
A. Polyarthritis and carditis
💡 Rationale: Polyarthritis and carditis are the most common major manifestations of acute rheumatic fever (ARF). Other features like chorea and erythema marginatum are less common.
2. The latent period between infection with Group A Streptococcus and the appearance of clinical features in acute rheumatic fever is:
A. 6–8 weeks
B. 1–5 weeks
C. 3 months
D. 6 months
B. 1–5 weeks
💡 Rationale: Acute rheumatic fever typically occurs 1–5 weeks after a Group A streptococcal pharyngitis infection. Longer latent periods are rare.
1. The distinguishing hallmark of systemic sclerosis is:
A. Joint contractures and tendon friction rubs
B. Thick and indurated skin
C. Interstitial lung disease
D. Digital ischemic ulcers
B. Thick and indurated skin
💡 Rationale: Skin thickening (scleroderma) is the hallmark of systemic sclerosis, distinguishing it from other connective tissue diseases.
2. Which of the following is TRUE regarding limited cutaneous systemic sclerosis?
A. It is associated with extensive skin induration starting in the fingers and ascending from distal to proximal limbs and trunk.
B. The entire body is affected, including the trunk.
C. Visceral organ involvement is often aggressive.
D. Raynaud’s phenomenon precedes other disease manifestations.
D. Raynaud’s phenomenon precedes other disease manifestations.
💡 Rationale: Raynaud’s phenomenon is often the first symptom in limited cutaneous systemic sclerosis (lcSSc) and may precede other symptoms by years.
3. Environmental factors that contribute to the development of systemic sclerosis, EXCEPT:
A. Cigarette smoking
B. Organic solvents and aromatic hydrocarbons
C. Epoxy resins
D. Welding fumes
D. Welding fumes
💡 Rationale: Exposure to organic solvents, aromatic hydrocarbons, and epoxy resins is associated with systemic sclerosis. Welding fumes are not a well-established risk factor.
4. The most common lung finding in systemic sclerosis is:
A. Nonspecific interstitial pneumonia
B. Pulmonary fibrosis
C. Lymphocytic bronchiolitis
D. Multiple pulmonary emboli
A. Nonspecific interstitial pneumonia (NSIP)
💡 Rationale: NSIP is the most common interstitial lung disease (ILD) pattern seen in systemic sclerosis, followed by usual interstitial pneumonia (UIP).
5. The leading cause of death in systemic sclerosis is:
A. Raynaud’s phenomenon
B. Thromboembolism
C. Pulmonary arterial hypertension
D. Interstitial lung disease
C. Pulmonary arterial hypertension (PAH)
💡 Rationale: PAH is the leading cause of mortality in systemic sclerosis, followed by interstitial lung disease (ILD).
6. An important major criterion for systemic sclerosis is:
A. Sclerodactyly
B. Digital pitting scars
C. Proximal thickening of the skin
D. Bibasilar pulmonary fibrosis
C. Proximal thickening of the skin
💡 Rationale: Proximal skin thickening extending beyond the fingers (proximal to the MCP joints) is a major diagnostic criterion for systemic sclerosis.
7. A disorder of the skin caused by episodic vasoconstriction of the fingers, toes, tip of the nose, and earlobes when exposed to cold temperature, stress, or vibration is known as:
A. Telangiectasia
B. Limited Cutaneous Systemic Sclerosis
C. Raynaud’s Phenomenon
D. Sclerodactyly
C. Raynaud’s Phenomenon
💡 Rationale: Raynaud’s phenomenon is characterized by triphasic color changes (white, blue, red) due to vasospasm and is a hallmark of systemic sclerosis.
8. Which disease-modifying agent can control the progression of interstitial lung disease in systemic sclerosis?
A. Cyclophosphamide
B. Glucocorticoids
C. D-penicillamine
D. Methotrexate
A. Cyclophosphamide
💡 Rationale: Cyclophosphamide is the first-line treatment for interstitial lung disease (ILD) in systemic sclerosis, improving lung function and reducing fibrosis progression.
9. The most frequent extracutaneous complication of systemic sclerosis is:
A. Myopathy
B. GERD with Barrett’s esophagus
C. Raynaud’s phenomenon
D. Interstitial lung disease
C. Raynaud’s phenomenon
10. The three cardinal pathological mechanisms responsible for the clinical manifestations of systemic sclerosis include the following, EXCEPT:
A. Diffuse microangiopathy
B. Immune dysregulation
C. Visceral and vascular fibrosis
D. Atherosclerosis
D. Atherosclerosis
💡 Rationale: Systemic sclerosis is driven by diffuse microangiopathy, immune dysregulation, and fibrosis. Atherosclerosis is not a primary mechanism.
1. What is the definition of conservative management in CKD?
A. Management of symptoms without dialysis
B. Immediate initiation of dialysis
C. Kidney transplant as the first-line treatment
D. Exclusive use of diuretics
A. Management of symptoms without dialysis
💡 Rationale: Conservative management in CKD involves symptom control, lifestyle modifications, and medication use without dialysis or transplantation, often for patients who decline dialysis or are not candidates.
2. What is the KDIGO classification for a patient with Creatinine = 1.6, UPCR = 100, and eGFR = 48?
A. Low risk (green)
B. Moderate risk (yellow)
C. High risk (orange)
D. Very high risk (red)
B. Moderate risk (yellow)
💡 Rationale:
eGFR 48 mL/min/1.73m² falls in G3a (45-59 mL/min/1.73m²)
UPCR (urine protein-to-creatinine ratio) = 100 mg/g falls in A1 (<150 mg/g, normal to mild albuminuria)
According to KDIGO heatmap, this places the patient at moderate risk (yellow).
3. What is the KDIGO classification for a patient with eGFR = 46 and Albumin = 100?
A. Low risk (green)
B. Moderate risk (yellow)
C. High risk (orange)
D. Very high risk (red)
C. High risk (orange)
💡 Rationale:
eGFR 46 mL/min/1.73m² → G3a CKD
Albuminuria 100 mg/g → A2 CKD (Moderately increased albuminuria: 30-300 mg/g)
According to the KDIGO heatmap, a combination of G3a + A2 places the patient in the “High risk” (orange) category.
4. A CKD stage V patient in the emergency department awaiting dialysis initiation has a potassium level of 7.0. What is your initial management?
A. 10 units of regular insulin IV and 50 mL of 50% dextrose
B. Kayexalate administration only
C. Emergent dialysis as the only intervention
D. Increase dietary potassium intake
A. 10 units of regular insulin IV and 50 mL of 50% dextrose
💡 Rationale: In hyperkalemia (K+ >6.5 mmol/L with ECG changes), immediate treatment includes:
Insulin + dextrose (shifts K+ into cells)
Calcium gluconate (stabilizes cardiac membranes)
Beta-agonists (albuterol/salbutamol)
Kayexalate (sodium polystyrene sulfonate) and dialysis for definitive K+ removal.
5. Which intervention can help prevent the recurrence of kidney stones?
A. High oxalate diet
B. Low sodium diet
C. Low calcium diet
D. Water intake of 1.5L/day
B. Low sodium diet
💡 Rationale: A low sodium diet reduces urinary calcium excretion, lowering the risk of calcium-based kidney stones. High fluid intake (>2.5L/day) is also recommended.
6. A 33-year-old female is rushed to the ER following a vehicular accident. Which intravenous fluid should be given while waiting for blood products?
A. 0.9% isotonic saline
B. 0.45% saline
C. 0.3% saline
D. Sterile water
A. 0.9% isotonic saline
💡 Rationale: Isotonic saline (0.9% NaCl) is the preferred resuscitation fluid for trauma patients before blood transfusion.
Hypotonic solutions (0.45%, 0.3%, sterile water) worsen hypovolemia.
7. Which condition associated with nephrotic syndrome is most likely linked to immunotactoid glomerulonephritis?
A. 50-year-old with lung cancer
B. 45-year-old with hepatitis C
C. 48-year-old with monoclonal gammopathy from B-cell lymphoma
D. 22-year-old female with systemic lupus erythematosus (SLE)
C. 48-year-old with monoclonal gammopathy from B-cell lymphoma
💡 Rationale: Immunotactoid glomerulonephritis is strongly associated with monoclonal gammopathy (B-cell lymphomas, multiple myeloma).
8. Fractional excretion of sodium (FeNa) <1% is commonly seen in all the following conditions EXCEPT:
A. Congestive heart failure (CHF)
B. Cirrhosis
C. Dehydration secondary to diuretic use
D. Hepatorenal syndrome
C. Dehydration secondary to diuretic use
💡 Rationale: FeNa <1% suggests prerenal causes (CHF, cirrhosis, hepatorenal syndrome).
Diuretics falsely elevate FeNa (>1%) by promoting natriuresis.
9. Which of the following is a cause of chronic tubulointerstitial disease with a “striped pattern” on biopsy?
A. Calcineurin-inhibitor nephrotoxicity
B. Vesicoureteral reflux
C. Lithium toxicity
D. Lead toxicity
A. Calcineurin-inhibitor nephrotoxicity
💡 Rationale: Chronic calcineurin inhibitor (CNI) nephrotoxicity (tacrolimus, cyclosporine) causes tubulointerstitial disease with “striped fibrosis” on biopsy.
🚀 Exam Must-Know Mnemonic
🔹 “AIN = Inflammation, CTD = Fibrosis!”
🔹 “Eosinophils = Drug-Induced AIN!”
🔹 “Striped fibrosis = CNI nephrotoxicity (CTD)!”
🔹 “Papillary necrosis = NSAIDs or Sickle Cell!”
11. The pentad of thrombotic thrombocytopenic purpura (TTP) includes all of the following EXCEPT:
A. Thrombocytopenia
B. Microangiopathic hemolytic anemia (MAHA)
C. Neurologic abnormalities
D. Thrombocytosis
D. Thrombocytosis
💡 Rationale: The TTP pentad includes:
Thrombocytopenia (low platelets)
Microangiopathic hemolytic anemia (MAHA)
Neurologic abnormalities (confusion, seizures)
Fever
Renal dysfunction
🔹 Thrombocytosis (high platelets) is NOT a feature of TTP.
12. What are the most common intracellular and extracellular cations?
A. Sodium (Na) and Potassium (K)
B. Potassium (K) and Sodium (Na)
C. Calcium (Ca) and Chloride (Cl)
D. Magnesium (Mg) and Bicarbonate (HCO₃)
B. Potassium (K) and Sodium (Na)
💡 Rationale:
Intracellular cation: Potassium (K⁺) is the major cation inside cells.
Extracellular cation: Sodium (Na⁺) is the main cation in extracellular fluid (ECF).
13. 80% of extracellular fluid (ECF) is composed of:
A. Plasma
B. Lymph
C. Interstitial fluid
D. Cytosol
C. Interstitial fluid
💡 Rationale: Extracellular fluid (ECF) is divided into:
Interstitial fluid (~80%)
Plasma (~20%)
14. What is the major extracellular anion?
A. Chloride
B. Potassium
C. Sodium
D. Bicarbonate
A. Chloride
💡 Rationale: Chloride (Cl⁻) is the most abundant extracellular anion, playing a key role in acid-base balance and osmolality.
19. What percentage of total body water comprises the intracellular fluid (ICF)?
A. 25%
B. 33%
C. 66%
D. 75%
C. 66%
💡 Rationale:
Total body water (TBW) is ~60% of body weight.
Intracellular fluid (ICF) makes up ~2/3 (~66%) of TBW.
Extracellular fluid (ECF) makes up ~1/3 (~33%) of TBW.
21. What is the most appropriate fluid for post-obstructive diuresis?
A. 0.15% NSS
B. 0.3% NSS
C. 0.45% NSS
D. 0.9% NSS
C. 0.45% NSS
💡 Rationale: Post-obstructive diuresis can lead to dehydration and electrolyte imbalances.
Hypotonic fluids (0.45% NSS) replace free water while preventing hypernatremia.
Isotonic fluids (0.9% NSS) may worsen osmotic diuresis.
22. All of the following are criteria for initiating maintenance dialysis EXCEPT:
A. Uremic symptoms
B. Hyperkalemia unresponsive to conservative measures
C. A GFR of 10–14 mL/min per 1.73 m²
D. Persistent extracellular volume expansion despite diuretic therapy
E. Acidosis responsive to medical therapy
E. Acidosis responsive to medical therapy
💡 Rationale: Dialysis is initiated when complications of CKD become refractory to medical treatment, including:
Uremic symptoms (encephalopathy, pericarditis)
Severe hyperkalemia unresponsive to medical therapy
GFR <10-14 mL/min/1.73m²
Volume overload unresponsive to diuretics
🔹 If metabolic acidosis is controlled medically, dialysis is not immediately needed.
23. Partial return of GFR may be unlikely if the relief of obstruction is delayed beyond:
A. 1 week
B. 3 weeks
C. 5 weeks
D. 8 weeks
B. 3 weeks
💡 Rationale: If obstruction is relieved within 2 weeks, kidney function can recover. However, after 3 weeks, irreversible kidney damage is more likely.
24. A 12-year-old boy from a family with a history of renal disease presents with auditory nerve deafness, corneal dystrophy, and ocular lens dislocation. Urinalysis reveals microscopic hematuria. Renal biopsy shows glomerular capillaries with irregular basement membrane thickening, attenuation, and splitting of the lamina densa. The most likely diagnosis is:
A. Membranoproliferative glomerulonephritis
B. IgA nephropathy
C. Alport syndrome
D. Dominant polycystic kidney disease
E. Type I diabetes mellitus
C. Alport syndrome
💡 Rationale: Alport syndrome is an X-linked or autosomal inherited disorder characterized by:
Microscopic hematuria
Sensorineural hearing loss
Ocular abnormalities (lenticonus, corneal dystrophy)
GBM thickening, attenuation, and splitting on biopsy.
25. In peritoneal dialysis, which test formally evaluates peritoneal membrane characteristics by measuring the transfer rates of creatinine and glucose across the membrane?
A. Peritoneal Equilibrium Test
B. Kt/V Clearance Test
C. Dialysate Culture Sensitivity
D. Dialysate Equilibrium Test
A. Peritoneal Equilibrium Test
💡 Rationale: The Peritoneal Equilibrium Test (PET) assesses peritoneal membrane permeability, guiding dialysis prescription adjustments.
26. A 47-year-old man is evaluated for nephrotic syndrome. Laboratory studies show serum creatinine of 1.8 mg/dL, albumin of 1.9 g/dL, and 24-hour urine protein excretion of 14 g. Kidney biopsy reveals deposits positive for Congo red stain, and immunofluorescence microscopy shows no diagnostic staining for AA amyloid protein, kappa (κ), or lambda (λ) light chains. What is the most likely diagnosis?
A. Minimal Change Disease
B. Goodpasture Syndrome
C. Amyloidosis
D. IgA Nephropathy
E. Microscopic Polyangiitis
C. Amyloidosis
💡 Rationale: Amyloidosis is characterized by:
Nephrotic-range proteinuria (>3.5 g/day)
Congo red positivity (apple-green birefringence under polarized light)
If AA amyloid, kappa, and lambda light chains are negative, it suggests hereditary amyloidosis rather than secondary (AA) or AL (light chain) amyloidosis.
29. A 50-year-old woman presents with epistaxis, hoarseness, arthralgias, and microscopic hematuria. Serum creatinine is 2 mg/dL, and PR3-ANCA is positive at 150 U/mL (reference range: <20 U/mL). Kidney biopsy reveals pauci-immune, crescentic glomerulonephritis. What is the most likely diagnosis?
A. Granulomatosis with polyangiitis (Wegener’s)
B. Microscopic polyangiitis
C. Focal segmental glomerulosclerosis
D. Hypertensive nephrosclerosis
A. Granulomatosis with polyangiitis (Wegener’s)
💡 Rationale: Granulomatosis with polyangiitis (GPA, formerly Wegener’s) is an ANCA-associated small-vessel vasculitis characterized by:
PR3-ANCA positivity
Crescentic glomerulonephritis (pauci-immune)
Upper and lower respiratory tract involvement (sinusitis, epistaxis, hoarseness, hemoptysis)
🔹 Microscopic polyangiitis also causes pauci-immune glomerulonephritis but lacks granulomas and upper respiratory involvement.
30. A 24-year-old man is diagnosed with minimal change disease. Which of the following is most likely to be found in his urine?
A. >3 g/24 hr proteinuria without hematuria
B. Macroscopic hematuria and 24-hour urinary albumin of 227 mg
C. Microscopic hematuria with leukocytes
D. Positive urine culture for Streptococcus
A. >3 g/24 hr proteinuria without hematuria
💡 Rationale: Minimal change disease (MCD) is a primary cause of nephrotic syndrome, presenting with:
Massive proteinuria (>3.5 g/day)
No hematuria
Highly steroid-responsive
33. What is the intravenous fluid of choice for treating hypernatremia?
A. Hypotonic intravenous fluids
B. Hypertonic intravenous fluids
C. Isotonic intravenous fluids
D. Colloids
A. Hypotonic intravenous fluids
💡 Rationale: Hypotonic fluids (e.g., 0.45% saline, D5W) help correct free water deficit in hypernatremia.
Hypertonic fluids would worsen hypernatremia.
Isotonic fluids are used for volume resuscitation but do not effectively lower Na+.
34. Which of the following is an absolute indication for partial nephrectomy in renal carcinoma?
A. Bilateral tumors
B. Localized tumor with progressive disorder
C. History of familial renal cell carcinoma
A. Bilateral tumors
💡 Rationale: Partial nephrectomy is preferred for small renal masses, bilateral tumors, or patients with a single kidney to preserve renal function.
35. Which of the following strategies would NOT prevent nephrolithiasis recurrence in a patient with uric acid stones?
A. Targeting a urine pH less than 5.5
B. Increasing fluid intake
C. Reducing dietary purines
D. Alkalinization of urine
A. Targeting a urine pH less than 5.5
💡 Rationale: Uric acid stones form in acidic urine (pH <5.5).
Urinary alkalinization (target pH >6.5) with potassium citrate helps dissolve uric acid stones.
Urine pH clues:
pH < 5.5 → Uric acid stones
pH > 7.5 → Struvite stones (UTI-related)
pH ≥ 6.5 → Calcium phosphate stones
36. Which of the following is NOT true about minimal change disease?
A. Treatment typically involves treating the underlying disease
B. It commonly presents with nephrotic syndrome
C. It is responsive to corticosteroid therapy
D. It is more common in children
A. Treatment typically involves treating the underlying disease
💡 Rationale: MCD is a primary glomerular disease, usually idiopathic, and does not require treatment of an “underlying disease.”
First-line treatment: Corticosteroids (highly responsive).
37. Severe nephrotic syndrome may predispose patients to renal vein thrombosis. A patient suspected of having renal vein thrombosis is likely to present with all of the following EXCEPT:
A. Eosinophiluria
B. Flank pain and tenderness
C. Hematuria
D. Rapid decline in renal function
E. Proteinuria
A. Eosinophiluria
💡 Rationale: Renal vein thrombosis (RVT) presents with:
Flank pain
Hematuria
Acute kidney injury (rapid decline in renal function)
Nephrotic-range proteinuria
🔹 Eosinophiluria is more characteristic of acute interstitial nephritis, not RVT.
38. What is the most common type of kidney stone?
A. Calcium oxalate
B. Cystine
C. Uric acid
D. Struvite
A. Calcium oxalate
💡 Rationale: Calcium oxalate stones account for ~75% of all kidney stones and are associated with:
Hypercalciuria, hyperoxaluria, and hypocitraturia
Radiopacity (visible on X-ray and CT scan)
39. A 27-year-old male, with no known comorbidities, applies for a job and undergoes a routine urinalysis. The results show 15-25 RBCs, 3-5 WBCs, a few RBC casts, and +1 proteinuria. Serum creatinine is 1 mg/dL, and BP is 130/80 mmHg. What is the most appropriate next step?
A. Consider nephrolithiasis
B. Consider UTI and treat accordingly
C. Consider glomerulonephritis
D. Consider acute prostatitis and perform a prostate exam
C. Consider glomerulonephritis
💡 Rationale: Microscopic hematuria with RBC casts and mild proteinuria suggests a glomerular etiology. Further workup should include:
Serologic tests (ANA, ANCA, anti-GBM, complement levels)
Renal biopsy if necessary
40. The following signs and symptoms are seen in acute nephritic syndrome, EXCEPT:
A. Proteinuria (1-2 g/24 hr)
B. Hematuria with red blood cell casts
C. Hyperlipidemia
D. Edema/fluid retention
E. Hypertension
C. Hyperlipidemia
💡 Rationale: Nephritic syndrome presents with:
Hematuria with RBC casts
Proteinuria (1-2 g/24 hr, not in nephrotic range)
Hypertension and edema
🔹 Hyperlipidemia is a feature of nephrotic syndrome, not nephritic syndrome.
41. Which of the following stains in light microscopy is BEST used to identify hypercellularity?
A. Masson’s trichrome
B. Jones methenamine silver
C. Hematoxylin and eosin (H&E)
D. Periodic acid-Schiff (PAS)
D. Periodic acid-Schiff (PAS)
💡 Rationale: PAS stain highlights mesangial matrix expansion and hypercellularity, useful for diagnosing glomerulonephritis.
42. Which class of lupus nephritis presents with thickened basement membranes, focal endocapillary proliferation, focal subendothelial immune deposits, and mild mesangial expansion?
A. Class I
B. Class II
C. Class III
D. Class IV
E. Class V
E. Class V (Membranous Lupus Nephritis)
💡 High-Yield Rationale:
Class V lupus nephritis (Membranous LN) is characterized by:
Thickened glomerular basement membranes
Subepithelial and subendothelial immune deposits
Focal endocapillary proliferation
Mild mesangial expansion
Nephrotic syndrome features (heavy proteinuria, hypoalbuminemia, edema, hyperlipidemia)
🔹 Key Differentiation:
Class III (Focal LN) & Class IV (Diffuse LN) → More active inflammation with significant proliferative changes
Class V (Membranous LN) → Predominantly basement membrane thickening rather than extensive cellular proliferation.
🚀 Takeaway: Class V lupus nephritis is the only one with prominent basement membrane thickening and subepithelial deposits, mimicking primary membranous nephropathy.
45. A 25-year-old primigravida woman at 31 weeks gestation presents with headache, blurred vision, and constant right upper quadrant pain for the past 10 hours. BP is 139/100 mmHg, with moderate facial and finger edema. Deep tendon reflexes are 3+. Laboratory results show: Platelet count = 42,000/mm³, AST = 1300 U/L, ALT = 370 U/L, and LDH = 2000 U/L. What is the most likely diagnosis?
A. Transaminitis of pregnancy
B. Thrombotic thrombocytopenic purpura (TTP)
C. Antiphospholipid syndrome
D. HELLP syndrome
D. HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets)
Explanation:
This patient presents with hypertension, headache, blurred vision, right upper quadrant pain, moderate edema, and hyperreflexia (3+ deep tendon reflexes) at 31 weeks of gestation. Her laboratory values are also significantly abnormal:
Severe thrombocytopenia (Platelets = 42,000/mm³)
Elevated liver enzymes (AST = 1300 U/L, ALT = 370 U/L)
Hemolysis indicator (LDH = 2000 U/L)
These findings strongly suggest HELLP syndrome, which is a severe form of preeclampsia with liver involvement.
46. Which of the following is NOT a recognized risk factor for kidney stone formation?
A. Low fluid intake
B. High calcium diet
C. High doses of Vitamin C
D. High animal protein intake
B. High calcium diet
💡 Rationale:
A high calcium diet actually helps prevent calcium oxalate stones by binding dietary oxalate in the gut and reducing oxalate absorption.
Risk factors for nephrolithiasis include:
Low fluid intake → Increases urine concentration
High animal protein intake → Increases uric acid
High doses of Vitamin C → Increases oxalate production
49. The following statements about atypical hemolytic uremic syndrome (HUS) are true EXCEPT:
A. It is complement-mediated HUS
B. It can be congenital or acquired
C. Low C3 and normal C4 levels are characteristic
D. Factor X deficiency
D. Factor X deficiency
💡 Rationale:
Atypical HUS (aHUS) is complement-mediated and can be congenital or acquired.
It is associated with low C3 and normal C4 levels, due to unregulated alternative complement pathway activation.
Factor X deficiency is not related to aHUS; Factor H deficiency is more relevant.
50. What urinary crystals are shown?
A. Struvite
B. Calcium oxalate
C. Uric acid
D. Cystine
c. uric acid
51. Which of the following stains in light microscopy is BEST used to identify hypocellularity?
A. Masson’s trichrome
B. Jones-methenamine silver
C. Hematoxylin and eosin (H&E)
D. Periodic acid-Schiff (PAS)
B. Jones-methenamine silver
💡 Rationale:
Jones methenamine silver (JMS) stain is useful in highlighting the basement membrane and is commonly used for detecting glomerular sclerosis (hypocellularity).
H&E and PAS stains are more useful for cellular changes.
52. A 60-year-old female with hypertension presents to the ER with a sudden-onset tonic-clonic seizure. Physical examination reveals BP 110/80 mmHg, pulse 110 bpm, and pupils 3 mm, slowly reactive to light. Laboratory results: Hb 9 g/dL, serum creatinine 3 mg/dL, K 6 mEq/L, Na 140 mEq/L. What is the most likely diagnosis?
A. Hemolysis
B. Rhabdomyolysis
C. Ischemic acute tubular necrosis (ATN)
D. Vasculitis
C. Ischemic acute tubular necrosis (ATN)
💡 Rationale:
ATN is the most common cause of intrinsic acute kidney injury (AKI), often due to ischemia or nephrotoxins.
Hallmark features include acute kidney injury (↑ creatinine) and hyperkalemia.
Seizures can occur due to severe uremia.
59. A 66-year-old previously well male is admitted for chest pain. Upon arrival, BP is 100/70 mmHg, and initial creatinine is 0.7 mg/dL. He is found to have leukocytosis with neutrophil predominance and a suspicious infiltrate in the right lower lung field. He is started on a cephalosporin + aminoglycoside combination and undergoes emergency coronary angiography with stenting of two coronary vessels. His creatinine trend is as follows: Day 1 – 0.7 mg/dL; Day 2 – 0.8 mg/dL; Day 4 – 3.5 mg/dL (renally adjusted medications continued); Day 10 – 1.0 mg/dL. No electrolyte abnormalities were recorded. What is the most likely cause of the increase in creatinine?
A. Aminoglycoside use
B. Atheroembolism
C. Iodinated contrast use
D. Undiagnosed primary renal disease
C. Iodinated contrast use
💡 Rationale:
Contrast-induced nephropathy (CIN) is a common cause of AKI after coronary angiography.
Features include a rise in creatinine 24-72 hours after contrast exposure.
60. What risk factor primarily affects the recovery of renal function after acute obstruction?
A. Presence of diabetes mellitus
B. Duration of the obstruction
C. Presence of hypertension
D. Presence of urinary tract infection
B. Duration of the obstruction
💡 Rationale:
The longer an obstruction persists, the higher the risk of irreversible renal damage.
Recovery is best if the obstruction is relieved within 1-2 weeks.
63. What is the most common cause of extrinsic urinary tract obstruction?
A. Benign prostatic hyperplasia
B. Urinary bladder carcinoma
C. Nephrolithiasis
D. Papillary necrosis
A. Benign prostatic hyperplasia (BPH)
💡 Rationale:
BPH is the most common cause of extrinsic obstruction, especially in older men.
64. What is the most common carcinoma causing urinary tract obstruction?
A. Bladder cancer
B. Prostate cancer
C. Cervical cancer
D. Ovarian cancer
B. Prostate cancer
💡 Rationale:
Prostate cancer can cause urinary tract obstruction by compressing the urethra.
Bladder and cervical cancer can also cause obstruction but are less common.
65. Gout is a metabolic disease that results in increased deposition of which type of crystal?
A. Monosodium urate crystals
B. Calcium pyrophosphate crystals
C. Calcium apatite crystals
D. Calcium oxalate crystals
A. Monosodium urate crystals
💡 Rationale:
Gout results from monosodium urate crystal deposition in joints.
Negatively birefringent under polarized light microscopy.
66. The first episode of acute gouty arthritis frequently begins at:
A. Morning
B. Afternoon
C. Night
D. Any time of the day
C. Night
💡 Rationale:
Gout attacks often occur at night due to lower body temperature and dehydration, leading to crystal precipitation.
67. A 25-year-old female model taking Chinese herbal slimming medications presents with body weakness. Urinalysis reveals bland urine sediment, rare leukocytes, and mild proteinuria. What is the most likely cause of her nephropathy?
A. Balkan nephropathy
B. Lead toxicity
C. Aristolochic acid nephropathy
D. Lithium toxicity
C. Aristolochic acid nephropathy
💡 Rationale:
Aristolochic acid, found in some Chinese herbal medicines, is nephrotoxic and linked to interstitial fibrosis and urothelial cancer.
68. A 40-year-old male painter with chronic hypertension (BP 160/100 mmHg) complains of a swollen big toe. His serum creatinine is 2.4 mg/dL (eGFR 33 mL/min). What is the most likely diagnosis?
A. Urate nephropathy
B. Balkan nephropathy
C. Lead toxicity
D. Lithium-associated nephropathy
C. Lead toxicity
💡 Rationale:
Chronic lead exposure can cause tubulointerstitial nephropathy and gout (saturnine gout).
Painters and those exposed to old paint are at risk.
69. In the management of interstitial nephritis, corticosteroids are relatively indicated in which of the following cases?
A. Lupus nephritis
B. Idiopathic acute interstitial nephritis (AIN) with delayed recovery
C. Sarcoidosis
D. Sjogren’s syndrome
B. Idiopathic acute interstitial nephritis (AIN) with delayed recovery
💡 Rationale:
Corticosteroids can be used in AIN if renal function does not improve after stopping the offending agent.
Lupus nephritis and sarcoidosis-related nephritis typically require other immunosuppressive agents.
70. Which of the following is NOT a clinical feature of chronic tubulointerstitial nephritis (TIN)?
A. Fanconi syndrome
B. Non-anion gap metabolic acidosis
C. Anuria
D. Hyperkalemia
C. Anuria
💡 Rationale:
TIN typically causes polyuria due to an inability to concentrate urine.
Anuria is more common in acute obstructive uropathy or severe acute kidney injury (AKI).
71. Given the following values, what is the primary acid-base disturbance?
pH: 7.13, PCO₂: 25 mmHg, HCO₃: 9 mEq/L
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
pH: 7.13, PCO₂: 25 mmHg, HCO₃: 9 mEq/L
✅ A. Metabolic acidosis
💡 Rationale:
pH <7.35 → Acidosis
HCO₃⁻ is low (9 mEq/L) → Primary metabolic acidosis
PCO₂ is also low (25 mmHg), indicating respiratory compensation.
72. A 24-year-old man is diagnosed with minimal change disease (nephrotic syndrome). Which of the following is most likely to be found in his urine?
A. >3 g/24 hr proteinuria without hematuria
B. Macroscopic hematuria and 24-hour urinary albumin of 227 mg
C. Microscopic hematuria with leukocytes and 24-hour urinary albumin of 227 mg
D. Positive urine culture for Streptococcus
A. >3 g/24 hr proteinuria without hematuria
💡 Rationale:
Nephrotic syndrome is characterized by massive proteinuria (>3.5 g/day) without hematuria.
Minimal change disease is highly steroid-responsive and common in young adults and children.
73. A 63-year-old non-diabetic male presents with a gangrenous toe on his right foot. He was started on Vancomycin, with a trough level of 40. Follow-up cultures were negative, and the patient remained stable, but his creatinine increased from 0.9 mg/dL to 2.7 mg/dL. Urinalysis showed no proteinuria or hematuria but occasional granular casts and WBCs. What is the most likely etiology of the acute tubular necrosis (ATN)?
A. Sepsis
B. Ischemia/peripheral vascular disease
C. Cholesterol embolization
D. Vancomycin toxicity
D. Vancomycin toxicity
💡 Rationale:
Vancomycin-induced nephrotoxicity leads to ATN, with granular casts and rising creatinine.
Risk factors: Prolonged use, high trough levels (>20 mg/L), and concurrent nephrotoxic drugs.
74. A 68-year-old man underwent radical nephrectomy three months ago for renal cell carcinoma. A follow-up CT scan one month post-surgery revealed metastatic lesions in the liver, confirmed by biopsy. What is the most appropriate management?
A. Subcutaneous interferon alfa
B. High-dose interleukin-2
C. Sorafenib or Sunitinib
D. Metastasectomy
C. Sorafenib or Sunitinib
💡 Rationale:
Metastatic renal cell carcinoma is treated with VEGF inhibitors (e.g., Sunitinib, Sorafenib).
Immunotherapy (e.g., IL-2) is used in select cases but is not first-line.
75. A patient presents with glomerular hematuria and renal insufficiency but without proteinuria. Which of the following is the most likely diagnosis?
A. Diabetic nephropathy
B. IgA nephropathy
C. Minimal change disease
D. Membranous glomerulopathy
B. IgA nephropathy
💡 Rationale:
IgA nephropathy presents with isolated glomerular hematuria (often microscopic) and variable renal function impairment.
Proteinuria may be absent or minimal in early stages.
76. A patient in the ER has a serum potassium of 6.2 mEq/L and peaked T waves. Which of the following is the most reliable intervention to initially lower serum potassium?
A. IV calcium gluconate
B. IV insulin and glucose
C. Albuterol (beta-agonist) inhalation
D. IV sodium bicarbonate
B. IV insulin and glucose
💡 Rationale:
Insulin shifts K+ into cells quickly and is the most reliable immediate intervention.
Calcium gluconate stabilizes the myocardium but does not lower K+.
79. What type of kidney cancer originates from the distal tubule?
A. Clear cell carcinoma
B. Papillary carcinoma
C. Chromophobe carcinoma
D. Oncocytoma
C. Chromophobe carcinoma
💡 High-Yield Rationale:
**Chromophobe Renal Cell Carcinoma (RCC) originates from the distal tubules/cortical collecting duct.
Clear cell RCC and papillary RCC originate from the proximal tubule.
Oncocytomas arise from the cortical collecting duct but are benign tumors.
🔹 Key Learning:
Chromophobe RCC has a solid/tubular growth pattern and is associated with whole arm losses of chromosomes 1, 2, 6, 10, 13, 17, and 21.
It has a better prognosis than clear cell RCC but requires differentiation from oncocytomas. 🚀
80. A 68-year-old man underwent radical nephrectomy three months ago for renal cell carcinoma. A follow-up CT scan one month post-surgery revealed metastatic lesions in the liver, confirmed by biopsy. What is the most appropriate management?
A. Subcutaneous interferon alfa
B. High-dose interleukin-2
C. Sorafenib or Sunitinib
D. Metastasectomy
C. Sorafenib or Sunitinib
💡 Rationale:
Metastatic renal cell carcinoma is treated with VEGF inhibitors (e.g., Sunitinib, Sorafenib).
Immunotherapy (e.g., IL-2) is used in select cases but is not first-line.
81. What is the most common neoplasm causing urinary tract obstruction?
A. Bladder cancer
B. Cervical cancer
C. Prostate cancer
D. Renal cell carcinoma
C. Prostate cancer
💡 Rationale:
Prostate cancer can cause obstruction by compressing the prostatic urethra.
82. A 74-year-old man with benign prostatic hyperplasia underwent cystoscopy and transurethral resection of the prostate (TURP). What is expected 24 hours after the release of a bilateral obstruction?
A. Change in glomerular capillary pressure
B. Decrease in renal artery pressure
C. Decrease in single nephron GFR
D. Increase in proximal tubule pressure
C. Decrease in single nephron GFR
💡 Rationale:
Post-obstructive diuresis initially leads to transient increases in GFR, but prolonged obstruction leads to nephron injury and decreased function.
83. What is the most important determinant of water balance disorders?
A. Plasma osmolality
B. Urine osmolality
C. Plasma sodium
D. Urine sodium
A. Plasma osmolality
💡 Rationale:
Plasma osmolality determines water movement between compartments and is tightly regulated by ADH.
84. A CKD stage V patient in the emergency department awaiting dialysis initiation has a potassium level of 7.0 mEq/L. What is the initial management?
A. 10 mL of 10% calcium gluconate over 2–3 minutes
B. 10 units of regular insulin IV and 50 mL of 50% dextrose
C. 10 mg inhaled salbutamol in 4 mL normal saline over 10 minutes
D. 15 g sodium polystyrene sulfonate (SPS) orally
A. 10 mL of 10% calcium gluconate over 2–3 minutes
💡 Rationale:
Calcium gluconate stabilizes cardiac membranes and prevents arrhythmias in hyperkalemia.
Insulin/glucose, beta-agonists, and sodium polystyrene sulfonate help lower K+, but calcium gluconate is the first-line intervention in severe hyperkalemia.
A 25-year-old male presents with progressive lower back pain for the past 2 years. He describes morning stiffness lasting >30 minutes that improves with activity but worsens with rest. He has no history of trauma. Examination reveals limited lumbar flexion and tenderness over the sacroiliac joints. A Modified Schober test shows <4 cm spinal flexion. Chest expansion is reduced (<1 inch). X-ray reveals bilateral sacroiliitis and bamboo spine.
Question:
Which of the following is the most likely diagnosis?
A. Rheumatoid Arthritis
B. Psoriatic Arthritis
C. Ankylosing Spondylitis
D. Reactive Arthritis
C. Ankylosing Spondylitis**
Key Buzzwords & High-Yield Clues:
✔ Young male (<40 years old)
✔ Morning stiffness >30 minutes, improves with activity
✔ Limited lumbar flexion (Modified Schober Test <4 cm)
✔ Reduced chest expansion (<1 inch)
✔ Bilateral sacroiliitis (early MRI finding)
✔ Bamboo spine (late-stage X-ray finding)
✔ HLA-B27 positive (90% cases, but not diagnostic)
✔ First-line treatment: NSAIDs, TNF inhibitors (if refractory)
A 30-year-old male presents with knee pain and swelling that started 2 weeks after a diarrheal illness. He also reports burning sensation during urination and red, painful eyes. Examination reveals a swollen right knee, tender Achilles tendon, and painless shallow ulcers on the glans penis. His HLA-B27 test is positive, and synovial fluid aspiration is sterile with inflammatory markers elevated.
Question:
What is the most likely causative organism?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Chlamydia trachomatis
D. Mycobacterium tuberculosis
C. Chlamydia trachomatis**
Reactive Arthritis (ReA)*
Key Buzzwords & High-Yield Clues:
✔ Post-infectious arthritis (after GI or GU infection)
✔ “Can’t see, can’t pee, can’t climb a tree” (Triad: Uveitis, Urethritis, Arthritis)
✔ Asymmetric oligoarthritis (mainly lower limbs, knee, ankle)
✔ Dactylitis (“Sausage digits”)
✔ Enthesitis (Achilles tendon pain)
✔ Keratoderma blennorrhagicum (Hyperkeratotic skin lesions on palms/soles)
✔ Circinate balanitis (Painless penile ulcers)
✔ HLA-B27 positive in 30-50%
✔ Sterile synovial fluid (rule out septic arthritis)
✔ First-line treatment: NSAIDs, Treat infection (Azithromycin/Doxycycline for Chlamydia)
A 40-year-old female presents with joint pain and stiffness in her fingers and toes for the past 6 months. She has a history of scaly, silvery plaques on her elbows and scalp for several years. On examination, there is swelling of the DIP joints, nail pitting, and dactylitis (“sausage digits”). X-ray of the hands reveals a “pencil-in-cup” deformity in the affected fingers.
Which of the following is the most likely diagnosis?
A. Rheumatoid Arthritis
B. Psoriatic Arthritis
C. Ankylosing Spondylitis
D. Reactive Arthritis
B. Psoriatic Arthritis
Key Buzzwords & High-Yield Clues:
✔ History of psoriasis (Scaly plaques on extensor surfaces, scalp, nails)
✔ DIP joint involvement (Unlike RA, which affects MCP/PIP)
✔ Dactylitis (“Sausage digits”)
✔ Nail pitting, onycholysis (>80% cases)
✔ Pencil-in-cup deformity (X-ray)
✔ Asymmetric oligoarthritis (Most common pattern)
✔ Arthritis mutilans (Severe osteolysis, “telescoping fingers”)
✔ First-line treatment: NSAIDs → Methotrexate → TNF inhibitors if severe
