Rheumatology Flashcards

1
Q

REU - 1
Which symptom is NOT typical to lower leg nerve root compression?
A) Positive Lasegue-sign
B) Tenderness at the Valleix points
C) Positive femoral sign
D) Loss of the Achilles tendon reflex
E) Patellar ballottement

A

ANSWER
E) Patellar ballottement
EXPLANATION
Patellar ballottement is typical to knee joint fluid, the four other symptoms could be the sign of nerve route compression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

REU - 3
What medicine is NOT used to treat rheumatoid arthritis?
A) Methotrexate
B) Leflunomide
C) Methylprednisolone
D) Diclofenac
E) Colchicine

A

ANSWER
E) Colchicine
EXPLANATION
Colchicine is used to treat gout attack; the listed base (first-line) therapeutic agents, corticosteroids and non-steroidal anti-inflammatory agents are all used for treating rheumatoid arthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

REU - 4
Which of the following is an interleukin-6 R-inhibitor biological drug?
A) Etanercept
B) Adalimumab
C) Tocilizumab
D) Infliximab
E) Rituximab

A

ANSWER
C) Tocilizumab
EXPLANATION
Tocilizumab is an IL-6R inhibitor, etanercept, adalimumab and infliximab are TNF-α inhibitors, and rituximab is a B cell inhibitor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

REU - 5
Which clinical symptom is NOT characteristic of rheumatoid arthritis?
A) Early morning stiffness in the hands
B) Symmetrical small joint inflammation of the hands
C) Small joint erosions on X-ray
D) Anti-CCP positivity
E) Early low back pain with sacroiliitis

A

ANSWER
E) Early low back pain with sacroiliitis
EXPLANATION
The first four symptoms are specific to RA, early low back pain with sacroiliitis is a typical symptom of seronegative spondyloarthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

REU - 6
Which symptom is NOT characteristic of Felty syndrome?
A) Inflammatory arthritis
B) High titer rheumatoid factor positivity
C) Splenomegaly
D) Pneumoconiosis
E) Granulocytopenia

A

ANSWER
D) Pneumoconiosis
EXPLANATION
Pneumoconiosis is part of Caplan’s syndrome, the other four symptoms are characteristic of Felty’s syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

REU - 7
It does NOT belong to the characteristics of adult-onset Still’s disease:
A) Pigmented villonodular synovitis
B) High fever
C) Maculopapular rash on the upper arms
D) Arthralgia
E) Visceral symptoms

A

ANSWER
A) Pigmented villonodular synovitis
EXPLANATION
Pigmented villonodular synovitis is a benign synovial proliferation and an independent disease, the other four symptoms are characteristic of the adult-onset Still’s disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

REU - 8
It does NOT belong to the diagnostic criteria for systemic lupus erythematosus:
A) Anti-DNA positivity
B) Nervous system manifestation
C) Erosive arthritis
D) Renal involvement
E) Butterfly (malar) rash

A

ANSWER
C) Erosive arthritis
EXPLANATION
The disease could be characterized by non-erosive arthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

REU - 9
Which is the most common autoimmune disease among the following?
A) Systemic lupus erythematosus
B) Rheumatoid arthritis
C) Systemic sclerosis
D) Sjögren syndrome
E) Dermatomyositis

A

ANSWER
B) Rheumatoid arthritis
EXPLANATION
Prevalence of RA (0.5-1%) far exceeds other autoimmune disorders’ prevalence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

REU - 10
Which advanced disease state could be characterized by subcutaneous rheumatoid nodules?
A) Polymyalgia rheumatica
B) Systemic lupus erythematosus
C) Rheumatoid arthritis
D) Ankylosing spondylitis
E) Systemic sclerosis

A

ANSWER
C) Rheumatoid arthritis
EXPLANATION
Subcutaneous rheumatoid nodules occur only in RA and not in the other listed diseases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

REU - 11
Which of the listed diseases is more common in men?A) Ankylosing spondylitis
B) Rheumatoid arthritis
C) Systemic lupus erythematosus
D) Polymyalgia rheumatica
E) Sjögren syndrome

A

ANSWER
A) Ankylosing spondylitis
EXPLANATION
Only ankylosing spondylitis dominates in men, the other diseases listed are more common in women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

REU - 12
What is the base (first-line) therapy for rheumatoid arthritis?
A) Sulfasalazine
B) Cyclophosphamide
C) Methotrexate
D) Chloroquine
E) Azathioprine

A

ANSWER
C) Methotrexate
EXPLANATION
In RA, methotrexate is the most effective among the listed drugs, and is therefore compulsorily the first to be selected, prior to biological treatments.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

REU - 13
What is the most important immunological marker of mixed connective tissue disease (MCTD)?
A) Anti-CCP
B) Antinuclear factor
C) Anti-SSA
D) Anti-U1RNP
E) Anti-SSB

A

ANSWER
D) Anti-U1RNP
EXPLANATION
For MCTD, the anti-U1RNP antibody is the most specific, for RA, the anti-CCP, for SLE, the antinuclear factor, and for Sjögren’s syndrome anti-SSA and -SSB are the most specific.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

REU - 14
What joints are NOT affected in rheumatoid arthritis?A) Metacarpophalangeal (MCP) joints
B) Proximal interphalangeal (PIP) joints
C) Distal interphalangeal (DIP) joints
D) Knee joints
E) Radiocarpal joints

A

ANSWER
C) Distal interphalangeal (DIP) joints
EXPLANATION
The involvement of DIP joints is not typical for RA at all, opposed to the other typical lesions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

REU - 15
What side effect is NOT characteristic of the antirheumatic biological treatment?
A) Bone marrow depression
B) Elevated liver enzymes
C) Growing joint complaints
D) Allergic skin reaction
E) Latent tuberculosis flare-up

A

ANSWER
C) Growing joint complaints
EXPLANATION
Joint complaints tend to decrease together with the level of inflammation and not increase. Other side effects may occur occasionally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

REU - 16
Symptoms of sarcoidosis, EXCEPT:
A) Granulomatous systemic process
B) Bilateral hilaris lymphadenopathy
C) Erythema nodosum
D) Arthritis
E) Polychondritis

A

ANSWER
E) Polychondritis
EXPLANATION
Polychondritis does not occur in sarcoidosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

REU - 17
What subgroup of juvenile idiopathic arthritis is characterized primarily by rheumatoid factor positivity?
A) Polyarthritis
B) Systemic form
C) Oligoarthritis
D) Enthesopathic arthritis
E) Psoriatic arthritis

A

ANSWER
A) Polyarthritis
EXPLANATION
The polyarthritis subgroup may show seropositivity, the rest mostly doesn’t.

17
Q

REU - 18
NOT a symptom of Scheuermann’s disease:
A) Dorsal hyperkyphosis
B) Forwardly wedge-shaped vertebrae formation
C) Uneven vertebrae closing plates
D) Moderate back pain of teenagers
E) Association of avascular necrosis of femoral head

A

ANSWER
E) Association of avascular necrosis of femoral head
EXPLANATION
Avascular necrosis of femoral head is characteristic to another juvenile osteochondritis, Perthes’ disease.

18
Q

REU - 19
It does NOT belong to seronegative spondyloarthritis:
A) Ankylosing spondylitis
B) Reactive arthritis
C) Enteropathic arthritis
D) Polymyalgia rheumatica
E) Psoriatic arthritis

A

ANSWER
D) Polymyalgia rheumatica
EXPLANATION
Polymyalgia rheumatica does not belong to this group due to having different characteristics.

19
Q

REU - 20
NOT characteristic of ankylosing spondylitis:
A) Elevated erythrocyte sedimentation rate
B) Low back pain worsens after activity, improves after rest
C) Low back pain worsens during early morning rest, improves with activity
D) Early bilateral sacroiliitis
E) Syndesmophytes on spinal X-ray

A

ANSWER
B) Low back pain worsens after activity, improves after rest
EXPLANATION
Inflammatory spinal pain typical to Bechterew’s disease increases in rest, relieves with motion, oppositely to degenerative back pain which increased after motion.

20
Q

REU - 22
Characteristics of joint processes associated with inflammatory bowel diseases (IBD), EXCEPT
A) Especially lower extremities oligoarthritis
B) Spondarthritis of the spine
C) Effectiveness of infliximab therapy
D) Effectiveness of sulfasalazine therapy
E) Effectiveness of methotrexate therapy

A

ANSWER
E) Effectiveness of methotrexate therapy
EXPLANATION
Infliximab and sulfasalazine are effective in IBD however methotrexate isn’t.

21
Q

REU - 23
Which pathogen causes Lyme disease?
A) Campylobacter jejuni
B) Klebsiella pneumoniae
C) Borrelia burgdorferi
D) Coxsackie virus
E) Epstein-Barr virus

A

ANSWER
C) Borrelia burgdorferi
EXPLANATION
Only Borrelia burgdorferi causes Lyme disease.

22
Q

REU - 24
What symptom group is NOT characteristic of Lyme disease?
A) Erythema migrans
B) Arthralgia - Arthritis
C) Neurological lesions
D) Cardiac changes
E) Severe gastrointestinal symptoms

A

ANSWER
E) Severe gastrointestinal symptoms
EXPLANATION
Severe gastrointestinal symptoms are extremely rare in Lyme disease, oppositely to the others.

23
Q

REU - 25
Which medicine is NOT effective for treating an acute gout attack?
A) Allopurinol
B) Corticosteroid
C) Colchicine
D) Non-steroidal anti-inflammatory drugs
E) TNF-α inhibiting biological agents

A

ANSWER
A) Allopurinol
EXPLANATION
In gout, allopurinol is responsible for long-term reduction of elevated uric acid levels but it isn’t effective in the treatment of seizures.

24
Q

REU - 26
What is the absolute classification criteria for gout diagnosis?
A) Detection of synovial monosodium monohydrate crystals
B) Uric acid nephrolithiasis
C) Occurrence of acute flares of gouty arthritis
D) The presence of tophuses
E) Hyperuricemia

A

ANSWER
A) Detection of synovial monosodium monohydrate crystals
EXPLANATION
During the diagnosis of gout, the detection of urinary crystals is an absolute marker, the other symptoms are characteristic, but not absolute criterions.

25
Q

REU - 27
What is the most important laboratory symptom of primary osteoporosis?
A) Elevated alkaline phosphatase
B) Elevated erythrocyte sedimentation rate
C) Elevated parathyroid hormone levels
D) Decreased serum calcium levels
E) None of the above

A

ANSWER
E) None of the above
EXPLANATION
In case of primary osteoporosis the routine laboratory parameters are negative.

26
Q

REU - 28
Which bone disease is NOT characterized by elevated serum alkaline phosphatase?
A) Osteoporosis
B) Osteomalacia
C) Primary hyperparathyroidism
D) Paget’s disease of the bones
E) Secondary hyperparathyroidism

A

ANSWER
A) Osteoporosis
EXPLANATION
Serum alkaline phosphatase enzyme levels are elevated in bone diseases except in osteoporosis.

27
Q

REU - 29
What condition does NOT lead to increased formation of osteoarthritis?
A) Hip joint dysplasia
B) Significant weight gain
C) Varus / valgus deformity
D) Excessive arthritis
E) HLA B-27 positivity

A

ANSWER
E) HLA B-27 positivity
EXPLANATION
HLA B-27 positivity does not predispose to osteoarthritis, but the other factors listed are risk factors

28
Q

REU - 31
In which joints does Heberden’s osteoarthritis develop?
A) In distal interphalangeal joints
B) In proximal interphalangeal joints
C) In knee joints
D) In the small joints of the leg
E) Anywhere

A

ANSWER
A) In distal interphalangeal joints
EXPLANATION
Heberden’s osteoarthritis is a degenerative lesion of the DIP joints.

29
Q

REU - 33
Typical symptoms of lumbar discus herniation, EXCEPT
A) Antalgic posture
B) Strong lumbar back pain
C) Motor weakness of the lower extremities
D) Loss of tendon reflexes on the lower limbs
E) Acute abdominal complaints

A

ANSWER
E) Acute abdominal complaints
EXPLANATION
Lumbar discus herniation almost never causes acute abdominal complaints, however the other four symptoms are typical.

30
Q

REU - 34
NOT a characteristic hand change of rheumatoid arthritis:
A) Erosions of the small joints
B) Subluxations of the small joints
C) “Pencil in cup” lesion
D) Bone ankylosis
E) Swan-neck and boutonniere finger deformity on the hands

A

ANSWER
C) “Pencil in cup” lesion
EXPLANATION
The “pencil in cup” lesion is a feature of psoriatic arthritis, the other X-ray findings are characteristic of RA.

31
Q

REU - 35
It does NOT play an important role in the pathogenesis of rheumatoid arthritis:
A) Activation of Th1 line
B) Activation of the Th17 line
C) Activation of the Th2 line
D) Decreased operation of Treg cells
E) Decreased formation of cathepsins

A

ANSWER
E) Decreased formation of cathepsins
EXPLANATION
In the pathogenesis of RA, the activation of the Th1, Th2, Th17 lines and the decreased function of Treg cells are both involved. Cathepsins are involved in later bone- and cartilage degradation, but rather by increased formation not decreased.

32
Q

REU - 36
Which illness is associated with increased erythrocyte sedimentation rate of the following?
1) Osteoporosis
2) Psoriatic arthritis
3) Osteoarthritis
4) Rheumatoid arthritis
5) Polymyalgia rheumatica

A) the 1st, 4th and 5th answers are correct
B) the 2nd, 4th and 5th answers are correct
C) the 1st, 3rd and 4th answers are correct
D) the 2nd, 3rd and 4th answers are correct
E) the 1st, 2nd and 5th answers are correct

A

ANSWER
B) the 2nd, 4th and 5th answers are correct
EXPLANATION
Psoriatic arthritis, rheumatoid arthritis and polymyalgia rheumatica are inflammatory diseases with elevated erythrocyte sedimentation rates, while osteoporosis and osteoarthritis are not.

33
Q

REU - 38
What are the contraindications of antirheumatic biological therapy?
1) Strong joint arthritis
2) Active tuberculosis
3) NYHA class 3-4 heart failure
4) The existence of malignant disease
5) Rheumatoid factor positivity

A) the 1st, 3rd and 4th answers are correct
B) the 2nd, 3rd and 5th answers are correct
C) the 2nd, 3rd and 4th answers are correct
D) the 3rd, 4th and 5th answers are correct
E) the 1st, 2nd and 3rd answers are correct

A

ANSWER
C) the 2nd, 3rd and 4th answers are correct
EXPLANATION
Strong rheumatoid factor positive inflammatory arthritis is rather an indication than a contraindication opposite to the other three contraindications.

34
Q

REU - 39
Genetic subtypes predominant to rheumatoid arthritis:
1) HLA DRB101
2) HLA DRB1
04
3) HLA DRB1*10
4) HLA B27
5) HLA B35

A) the 1st, 2nd and 4th answers are correct
B) the 1st, 3rd and 5th answers are correct
C) the 1st, 2nd and 3rd answers are correct
D) the 3rd, 4th and 5th answers are correct
E) the 2nd, 3rd and 5th answers are correct

A

ANSWER
C) the 1st, 2nd and 3rd answers are correct
EXPLANATION
The mentioned subtypes of HLA DRB1are predisposing factors for RA while HLA B27 and B35 are associated with seronegative spondyloarthritis.

35
Q

REU - 41
Characteristics of juvenile idiopathic arthritis
1) Begins before the age of 16
2) Growth restriction of the child
3) Reduced mental development of the child
4) Joint pain is generally mild
5) Biological therapy not applicable

A) the 1st, 2.nd and 4th answers are correct
B) the 1st, 3rd and 4th answers are correct
C) the 1st, 4th and 5th answers are correct
D) the 1st, 2nd and 3rd answers are correct
E) the 1st, 3rd and 5th answers are correct

A

ANSWER
A) the 1st, 2.nd and 4th answers are correct
EXPLANATION
JIA, featured by mild joint pain, could affect growth, but not mental development, and the use of biological therapy in its treatment could led to revolutionary breakthrough.

36
Q

REU - 42
Clinical changes in ankylosing spondylitis:
1) Ankylosing inflammation of the spine
2) Association of acute anterior uveitis
3) More frequent association of lymphomas
4) Peripheral enthesitis
5) Sicca syndrome

A) the 1st, 2nd and 5th answers are correct
B) the 1st, 2nd and 4th answers are correct
C) the 1st, 2nd and 3rd answers are correct
D) the 1st, 3rd and 4th answers are correct
E) the 1st, 4th and 5th answers are correct

A

ANSWER
B) the 1st, 2nd and 4th answers are correct
EXPLANATION
Ankylosing inflammation of the spine may be associated with peripheral enthesitis and uveitis, but more frequent association with lymphomas and Sicca’s syndrome is not typical.

37
Q

REU - 44
Which drugs are used to treat osteoporosis from the following?
1) Bisphosphonates
2) Teriparatide
3) Hyaluronic acid
4) Denosumab against RANKL
5) Chondroitin sulphate

A) the 1st, 2nd and 4th answers are correct
B) the 1st, 3rd and 5th answers are correct
C) the 1st., 2nd and 5th answers are correct
D) the 1st, 3rd and 4th answers are correct
E) the 2nd, 4th and 5th answers are correct

A

ANSWER
A) the 1st, 2nd and 4th answers are correct
EXPLANATION
Bisphosphonates, teriparatide and denosumab are innovative therapeutic agents in osteoporosis; hyaluronic acid and chondroitin sulphate are used to treat osteoarthritis.