Rheumatology

Question 1

What is the most specific measure for rheumatoid arthritis?

Answer 1

Anti-CCP

Question 2

What are the 2 most specific measure for SLE?

Answer 2

Anti-dsDNA antibodies
Anti-Smith

Question 3

What are the 2 most specific measures for Sjogrens?

Answer 3

Anti-SSAs:
Anti-Ro
Anti-La

Question 4

Anti-SSAs suggest what?
a) rheumatoid arthritis
b) Sjogrens
c) Mxied CT
d) scleroderma
e) SLE

Answer 4

b) Sjogrens

Question 5

Anti-Ro and anti-la suggest what?
a) Sjogrens
b) SLE
c)rheumatoid arthritis
d) scleroderma

Answer 5

a) Sjogrens

Question 6

What is most specific for scleroderma?
a) ANAs
b) anti-CCP
c) Anti-Scl-70
d) Anti-Ro
e) Anti-SSAs

Answer 6

c) anti-scl-70

Question 7

What markers are used to monitor SLE disease activity?
a) ESR, CRP, high complement
b) ESR, CRP, low complement
c) ESR, high complement
d) complement

Answer 7

ESR and CRP
low complement

Question 8

In a patient presenting with a symmetrical polyarthritis of less than 8 weeks duration, with no other extra-articular features, most likely DDx is:
RA
Polyarticular gout
Viral infection
Reactive arthritis
Primary OA

Answer 8

Viral infection

Question 9

Which of these rheumatoid disorders predominantly involves the enthesis?
OA
Gonococcal arthritis
RA
Ank Spon
Pseudogout

Answer 9

Ank spon

Question 10

ANA pattern is homogenous. What is the least likely condition?
a) SLE
b) mixed CT disease
c) juvenile idiopathic arthritis
d) scleroderma

Answer 10

Scleroderma

Question 11

What ANA pattern is most likely in Sjogrens?
a) speckled
b) nucleolar
c) anti-centromere
d) peripheral
e) homogenous

Answer 11

Speckled

Question 12

A 58 year-old woman has had painful bluish discolouration of her fingers, precipitated by cold, for the last 20 years. She has difficulty swallowing for the last 5 years. The skin over her fingers and face is thick and shiny. The antinuclear antibody pattern is likely to be which of the following:
a) Speckled
b) Homogeneous
c) Nucleolar
d) Negative
e) anti-centromere

Answer 12

e) anti-centromere

Question 13

A 58 year-old woman has had painful bluish discolouration of her fingers, precipitated by cold, for the last 20 years. A test for antinulear antibody is positive in a titre of 1/2560, with an anticentromere pattern. She is likely to have which of the following:
a) shiny tight skin proximal to the PIP joints extending onto the trunk and legs
b) soft tissue calcifications
c) bibasal crackles
d) dilated small blood vessels on the lower limbs
e) Diarrhoea

Answer 13

b) soft tissue calcifications

Question 14

Regarding limited scleroderma, which of the following is most correct?
a) Raynaud’s phenomenon is commonly present in patients with limited scleroderma
b) renal involvement is frequently seen in patients with limited scleroderma
c) the term limited scleroderma refers to a limited number of autoantibodies being present
d) patients with limited scleroderma are at greater risk for internal organ involvement than those with diffuse scleroderma
e) the skin of the trunk is generally thickened and indurated in limited scleroderma

Answer 14

a) Raynaud’s phenomenon is commonly present in patients with limited scleroderma

Question 15

A 40 year-old woman presents with a 6-month history of painful, purplish discolouration of the fingers in cold weather. She has also noticed persistent swelling of the hands. She has had one painful ulcer on the tip of her right index finger which has been very slow to heal. The skin on her hands and forearms has become quite tight. Which of the following is the most likely life-threatening complication in the next few months?
a) interstitial lung disease
b) pulmonary embolus
c) Pericarditis
d) myocardial infarction
e) pulmonary hypertension

Answer 15

a) interstitial lung disease

Question 16

Which of the following are not features of polymyalgia rheumatica?
a) Elevated inflammatory markers
b) Shoulder girdle pain
c) Morning stiffness
d) Thickening of the skin of digits and pulp atrophy
e) Hip girdle pain

Answer 16

d) Thickening of the skin of digits and pulp atrophy

Question 17

In the management of recent onset joint inflammation:
a) therapy with disease-modifying anti-rheumatic agents is not indicated until joint inflammation has been present for at least 12 months
b) oral corticosteroids are the usual first line of therapy
c) simple analgesics are often useful in control of symptoms
d) insidious onset of joint symptoms is associated with a better long term outcome
e) presence of certain HLA-DR4 haplotypes with the “shared epitope” are associated with a better long-term outcome

Answer 17

c) simple analgesics are often useful in control of symptoms

Question 18

Which of the following treatments is most likely to reduce the rate of joint damage in psoriatic arthritis?
a) NSAIDs
b) TNF inhibitors
c) Photochemotherapy (PUVA)
d) Paracetamol
e) Physiotherapy

Answer 18

b) TNF inhibitors

Question 19

Which of the following is the most appropriate initial treatment of a patient diagnosed with ankylosing spondylitis?
a) Lumbar TENS unit
b) Bed rest
c) Methotrexate
d) TNF inhibitors
e) NSAIDs

Answer 19

e) NSAIDs

Question 20

A 24 year-old man presents with a gradual onset of low back and bilateral buttock pain and stiffness over 6 months, especially first thing in the morning. On examination, back movements are restricted and the insertion of his right Achilles’ tendon is tender and a little swollen. Which of the following would be the most helpful investigation diagnostically?
a) Alkaline phosphate
b) HLA-B27
c) X-rays of lumbrosacral spine with sacroiliac views
d) Rheumatoid factor
e) CT of the lumbar sacral spine

Answer 20

c) X-rays of lumbrosacral spine with sacroiliac views

Question 21

Which of the following is true regarding Neisseria gonorrhoea?
a) infection with N gonorrhoea causes a self-limited illness for which antibiotic therapy is not necessary
b) Infection with N gonorrhoea typically causes florid skin lesions which are difficult to miss on examination
c) The arthritis associated with N gonorrhoea infection is typically additive in nature
d) the skin lesions associated with N gonorrhoea are frequently vesicular or pustular in nature
e) Treatment for N gonorrhoea should be commenced empirically without any need for culture of the organism

Answer 21

d) the skin lesions associated with N gonorrhoea are frequently vesicular or pustular in nature

Question 22

Which of the following is true about HLA B27?
a) HLA B27 is not associated with spondylitis in patients with reactive arthritis
b) The strongest associations of HLA B27 are with inflammatory bowel disease
c) HLA B27 shows no racial variation in frequency
d) HLA B27 Is a Class I HLA antigen
e) HLA B27 occurs in approximately 25% of the normal Caucasian population

Answer 22

d) HLA B27 Is a Class I HLA antigen

Question 23

Which of the following is correct?
a) the urethritis of reactive arthritis is associated with infection with Neisseria gonorrhoea and marked urogenital symptoms
b) Achilles tendonitis is more frequently a feature of rheumatoid arthritis than reactive arthritis
c) the urethritis of reactive arthritis may be related to chlamydia infection
d) the organism most frequently implicated in the diarrhoeal illness preceding reactive arthritis is E Coli
e) conjunctivitis in reactive arthritis tends to be chronic

Answer 23

c) the urethritis of reactive arthritis may be related to chlamydia infection

Question 24

Which joint is most likely to be involved in pseudogout?
Ankle
Wrist
1st carpometacarpal
1st metacarpophalangeal
Knee

Answer 24

Knee

Question 25

Regarding osteoarthritis of the hands, which of the following statements is most correct?
a) the DIP joints are rarely involved in osteoarthritis
b) the PIP joints of the hands are rarely involved in osteoarthritis
c) the carpometacarpal joint of the thumb is a common site for osteoarthritis of the hands
d) bony enlargement at the PIP joints may produce a clinical sign known as Heberden’s nodes
e) the MCP joints of the hands are frequently involved in osteoarthritis

Answer 25

c) the carpometacarpal joint of the thumb is a common site for osteoarthritis of the hands