Rheumatology

Question 1

Joint pain as a result of rheumatic diseases is called:
A. morning stiffness
B. myalgia
C. arthralgia
D. arthritis
E. arthrosis

Answer 1

C. arthralgia

Question 2

Typical symptoms and signs of rheumatic diseases are ALL EXCEPT:
A. swollen and painful joints
B. tachycardia
C. muscle pain
D. morning stiffness of the joints
E. elevated body temperature

Answer 2

B. tachycardia

Question 3

Which of the following diseases does not manifest with elevated body temperature?
A. systemic lupus erythematosus
B. granulomatosis with polyangiitis (Wegener`s granulomatosis)
C. giant-cell arteritis
D. reactive arthritis
E. arthrosis

Answer 3

E. arthrosis

Question 4

Life-threatening diseases in rheumatology that directly affect life are:
A. rheumatoid arthritis, spondylitis ankylosis
B. granulomatosis with polyangiitis (Wegener`s granulomatosis), polyarteritis
nodosa
C. giant-cell arteritis
D. systemic lupus

Answer 4

B. granulomatosis with polyangiitis (Wegener`s granulomatosis), polyarteritis
nodosa
D. systemic lupus

Question 5

Raynaud`s phenomena:
A. the skin of the fingers turns pale/white at first, then blue and at the end red
B. the skin of the fingers turns pale/white at first, then red and at the end blue
C. the skin of the fingers turns red at first, then blue and pale/white at the end
D. the skin of the fingers turns red at first, then pale/white and blue at the end
E. the skin of the fingers turns blue at first, then red and pale/white at the end

Answer 5

A. the skin of the fingers turns pale/white at first, then blue and at the end red

Question 6

Too frequent hair fall is typical for
a. systemic lupus erythematosus
b. arthrosis
c. giant cell arteritis
d. IgA vasculitis (purpura Henoch-Shoenlein)

Answer 6

a. systemic lupus erythematosus

Question 7

Dryness of the eye conjuctiva, mouth mucosa and vagina is typical for
a. systemic lups erythematosus
b.Sjorgen’s syndrome
c. Giant cell arteritis
d. poliarteritis nodosa
e. gout

Answer 7

b.Sjorgen’s syndrome

Question 8

Ulci on nose mucosa and persistent nasal discharge are typical for
a. systemic lupus erythematosus
b. granulomatosis with polyangiitis (Wegener’s granulomatosis)
c. Giant cell arteritis
d. Ankilizirajoči spondylitis
e. Polymyositis and dermatomyositis

Answer 8

b. granulomatosis with polyangiitis (Wegener’s granulomatosis)

Question 9

If the patient mentions spontaneous abortion or stillbirth, we should think of
A. Lyme disease
B. antiphospholipid syndrome
C. eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome)
D. IgA vasculitis (purpura Henoch-Shoenlein)
E. Systemic Sclerosis

Answer 9

B. antiphospholipid syndrome

Question 10

During joint examination we use of the rules 5P. This means:
A. to look, feel, move, measure, compare with the opposite side
B. to look, feel, knock, move, compare with the opposite side
C. to look, feel, knock, listen, move
D. to look, feel, knock, listen, compare with the opposite side
E. to look, feel, move, listen, measure

Answer 10

A. to look, feel, move, measure, compare with the opposite side

Question 11

Swollen and hot joint is the result of
a. active synovitis as a part of rheumatic disease
b. infection
c. crystal-induced arthritis
d. polymyalgia rheumatica
e. arthrosis

Answer 11

a. active synovitis as a part of rheumatic disease
b. infection
c. crystal-induced arthritis

Question 12

Muscle atrophy: connect the cause and effect
A. interosseal muscle atrophy on hands is characteristic for carpal tunnel syndrome. Atrophy
of the quadriceps is characteristic for arthritis of small joints in rheumatoid arthritis. Atrophy
of thumb bundle is characteristic for chronic arthritis of the knee.
B. interosseal muscle atrophy on hands is characteristic for carpal tunnel syndrome. Atrophy
of the quadriceps is characteristic for chronic arthritis of the knee. Atrophy of thumb bundle is
characteristic for arthritis of small joints in rheumatoid arthritis.
C. interosseal muscle atrophy on hands is characterized by arthritis of the small joints in
rheumatoid arthritis. Atrophy of the quadriceps is typical for carpal tunnel syndrome. Atrophy
of thumb bundle is characteristic for chronic arthritis of the knee.
D. interosseal muscle atrophy of hands is characteristic for arthritis of the small joints in
rheumatoid arthritis. Atrophy of the quadriceps is characteristic for chronic arthritis of
the knee. Atrophy of thumb bundle is characteristic for carpal tunnel syndrome.
E. interosal muscle atrophy of hands is characteristic for chronic arthritis of the knee. Atrophy
of the quadriceps is typical for carpal tunnel syndrome. Atrophy of thumb bundle is
characteristic for arthritis of small joints in rheumatoid arthritis.

Answer 12

D. interosseal muscle atrophy of hands is characteristic for arthritis of the small joints in
rheumatoid arthritis. Atrophy of the quadriceps is characteristic for chronic arthritis of
the knee. Atrophy of thumb bundle is characteristic for carpal tunnel syndrome.

Question 13

Morning stiffness:
A. feature of arthrosis is morning stiffness that lasts 1-4 hours
B. Patient can shorten morning stiffness with massaging the joint with ice
C. morning stiffness of knee and shoulder is characteristic for early rheumatoid arthritis
D. strong morning stiffness is characteristic for polymyalgia rheumatica and rheumatoid
arthritis
E. morning stiffness is most effectively treated with antibiotics

Answer 13

D. strong morning stiffness is characteristic for polymyalgia rheumatica and rheumatoid
arthritis

Question 14

We often see Livedo reticularis in the context of:
A. Antiphospholipid syndrome and polyarteritis nodosa,
B. Sjogren’s syndrome
C. fibromyalgia and giant arteritis
D. rheumatoid and psoriatic arthritis
E. Lyme disease

Answer 14

A. Antiphospholipid syndrome and polyarteritis nodosa,

Question 15

The most common reason for the monoarthritis
A. rheumatoid arthritis and spondyloarthritis
B. joint infection and crystal-induced arthritis
C. systemic connective tissue diseases and vasculitis
D. joint infection and systemic connective tissue diseases
E. rheumatoid arthritis, and crystal-induced arthritis

Answer 15

B. joint infection and crystal-induced arthritis

Question 16

Which statements are correct for HEP-2 test?
a) in the case of a positive result we can confirm autoimmune disease with absolute certainty
b) we observe the positive reaction of potentially present autoantibodies in the nucleus at
the time of division, in nucleoli and cytoplasm
c) is usually the first screening test for autoantibodies in the diagnosis of autoimmune
diseases
d) in overlapping syndromes the test is usually negative

Answer 16

b) we observe the positive reaction of potentially present autoantibodies in the nucleus at
the time of division, in nucleoli and cytoplasm
c) is usually the first screening test for autoantibodies in the diagnosis of autoimmune
diseases

Question 17

Which statements are correct for antinuclear antibodies -ana:
a) it is a part of the HEP-2 test
b) ANA is often positive in patients with systemic lupus erythematosus, Sjögren’s
syndrome and systemic sclerosis
c) titer of ANA modifies with the activity of autoimmune diseases
d) ANA titer 1:80 or less is irrelevant in the absence of symptoms

Answer 17

a,b,d

Question 18

As a screening test for the detection of autoantibodies we use
A. ESR
B. the concentration of C-reactive protein
C. investigation on the cellular substrate HEp-2 and anti-ENA
D. investigation of anti-ds-DNA
E. investigation antineutrophil antibodies (ANCA) and anti endomysium antibodies (EMA)

Answer 18

C. investigation on the cellular substrate HEp-2 and anti-ENA

Question 19

As a first screening test for the presence of autoantibodies in rheumatology we use:
A. ACPA
B. anti-dsDNA
C. anticardiolipin antibodies (aCL)
D. HEP-2 test
E. Antineutrophil antibodies (ANCA)

Answer 19

D. HEP-2 test

Question 20

In the case of suspected systemic connective tissue disease, the result of ANA 1:40 is:
A diagnostic, the patient certainly has one of the systemic connective tissue diseases
B. diagnostic, but only for systemic lupus erythematosus. In other systemic diseases
connective tissue diseases ANA are not always present
C. extremely susceptible, the likelihood of systemic disease is at least 80 percent content
D. diagnostic for one of the systemic connective tissue diseases, but only if the patient has
also elevated ESR.
E. such a result is obtained in 30% of healthy individuals, therefore the diagnostic value
of this result is negligibly small

Answer 20

E. such a result is obtained in 30% of healthy individuals, therefore the diagnostic value
of this result is negligibly small

Question 21

Antinuclear antibodies may be found in
a. patients with inflammatory rheumatic disease
b. patients with autoimmune thyroiditis
c. patients with chronic infections
d. cancer patients
e. healthy pregnant women and the elderly

Answer 21

All

Question 22

Which statements are correct for HEP-2 test?
A. we use neutrophilic granulocytes for he substrate
B. With this test we can detect autoantibodies against antigens of the nucleus during
division, cells in division and cytoplasm
C. with this test we can detected autoantibodies against the Fc part of immunoglobulin G
D. In the case of a negative result we can certainly exclude autoimmune disease
E. the test is always negative in healthy subjects

Answer 22

B. With this test we can detect autoantibodies against antigens of the nucleus during
division, cells in division and cytoplasm

Question 23

Which statements are correct for ANA test?
a) it is the part of HEp-2 test
b) we evaluate antibodies quantitavely and express them with titer
c) A negative result means that neither in the core nor in the cytoplasm do not see
florescence
d) in patients with inflammatory rheumatic disease, ANA titers of 1:80 or lower
e) ANA titer compared to the activity of the disease varies

Answer 23

a) it is the part of HEp-2 test
b) we evaluate antibodies quantitavely and express them with titer
c) A negative result means that neither in the core nor in the cytoplasm do not see
florescence

Question 24

Antibodies against pyruvate dehydrogenase complex (anti-PDH) are the most specific for
A. Primary biliary cirrhosis
B. Rheumatoid Arthritis
C. Hashimoto thyroiditis
D. gout
E. Giant cell arteritis

Answer 24

A. Primary biliary cirrhosis

Question 25

Antibodies against pyruvate dehydrogenase complex (anti-PDH)
a. are typical for primary biliary cirrhosis
b. are typical for the antiphospholipid syndrome
c. are directed against the mitochondria
d. are directed against DNA
e. give genuine type of fluorescence in the assay on HEp-2 cells

Answer 25

a. are typical for primary biliary cirrhosis
c. are directed against the mitochondria
e. give genuine type of fluorescence in the assay on HEp-2 cells

Question 26

The presence of antibodies against double-stranded DNA - dsDNA:
a) are one of the criteria for a diagnosis of systemic lupus erythematosus (SLE)
b) they can be found in more than half of patients with SLE
c) are one of the criteria for the diagnosis of rheumatoid arthritis
d) equally good is the test against a single-stranded DNA
e) the quantity of antibodies with disease activity does not vary

Answer 26

a) are one of the criteria for a diagnosis of systemic lupus erythematosus (SLE)
b) they can be found in more than half of patients with SLE

Question 27

For systemic lupus erythematosus the most diagnostically specific antibodies are
A. against a single-stranded DNA
B. against double-stranded DNA
C. against RNA
D. against histones
E. against the mitochondria

Answer 27

B. against double-stranded DNA

Question 28

antiphospholipid antibodies include
a. Ro antibodies, LA and Jo-1
b. Anticardiolipin antibodies
c. Antibodies against double-stranded DNA
d. Lupus anticoagulants
e. Antibodies against beta 2-glycoprotein

Answer 28

b. Anticardiolipin antibodies
d. Lupus anticoagulants
e. Antibodies against beta 2-glycoprotein

Question 29

Antiphospholipid antibodies -aPL:
a) are independent prognostic factor for arterial and venous thrombosis
b) we evaluate them 2x, two weeks apart
c) we evaluate them 2x in an interval of 12 weeks
d) at the occurrence of acute thrombosis due to antiphospholipid syndrome the values of aPL
can be negative

Answer 29

a, c, d

Question 30

In which case is it unnecessary to evaluate antiphospholipid antibodies?
A 70 year old patient with prostate cancer who has got pulmonary embolism
B. In the case of 40-year-old patient with thrombosis of cerebral arteries
C. In 30 year old female who has had 5 miscarriages
D. In the case of a patient with recurrent deep vein thrombosis who mentions that more of his relatives
had had pulmonary embolism
E. In the case of 50 year-old patient who had thrombosis of the vein in his armpit two years ago, and
now has an ischemic cerebrovascular accident

Answer 30

A 70 year old patient with prostate cancer who has got pulmonary embolism

Question 31

Rheumatoid factor is antibody against
1. a double-stranded DNA
2. histon
3. Fc fragment of human immunoglobulin IgG
4. mitochondria
5. neutrophilic granulocyte

Answer 31

3. Fc fragment of human immunoglobulin IgG

Question 32

The rheumatoid factor:
a) it can be observed in patients with Sjögren’s syndrome
b) it can be observed in patients with mixed cryoglobulinemia
c) high activity early in the course of rheumatoid arthritis predicts a more aggressive course of
the disease
d) by regular repetition (for 6 months) to monitor disease activity

Answer 32

a) it can be observed in patients with Sjögren’s syndrome
b) it can be observed in patients with mixed cryoglobulinemia
c) high activity early in the course of rheumatoid arthritis predicts a more aggressive course of
the disease

Question 33

What applies to the ANCA antibodies?
1. These are the antibodies against neutrophil granulocytes
2. These are antibodies against nuclear antigen
3. Cytoplasmic florescence give most antibodies against myeloperoxidase
4. Perinuclear fluorescence give most antibodies proteinase-3
5. Perinuclear fluorescence give most antibodies against myeloperoxidase

Answer 33

1. These are the antibodies against neutrophil granulocytes
2. Perinuclear fluorescence give most antibodies against myeloperoxidase

Question 34

ANCA applies that:
1. are likely to be directly involved in the pathogenesis of vasculitis
2. participate in the activation of neutrophil granulocytes
3. are always present in the serum of patients with vasculitis
4. changes in ANCA levels reflect disease activity

Answer 34

1. are likely to be directly involved in the pathogenesis of vasculitis
2. participate in the activation of neutrophil granulocytes
3. changes in ANCA levels reflect disease activity

Question 35

The ANCA applies:
1. present in the majority of patients with granulomatosis with polyangiitis (Wegener’s
granulomatosis)
2. present in patients with microscopic polyangiitis
3. two typical immunofluorescence-type (p-ANCA and c-ANCA)
4. To determine the ANCA using HEp-2 test

Answer 35

1. present in the majority of patients with granulomatosis with polyangiitis (Wegener’s
   granulomatosis)
2. present in patients with microscopic polyangiitis
3. two typical immunofluorescence-type (p-ANCA and c-ANCA)

Question 36

For ANCA applies :
a) a c - ANCA binding to a proteinase 3 ( PR3 ) in the cytoplasm of neutrophil
granulocytes
b ) a p- ANCA binding to myeloperoxidase ( MPO ) in the cytoplasm of neutrophil
granulocytes
c ) changes in ANCA levels are usually associated with changing disease activity
d) the determination of successive levels of ANCA can monitor response to treatment

Answer 36

All of them

Question 37

The ANCA applies :
a) p- ANCA were found for systemic necrotizing vasculitis ( p- ancien give
fluorescence anti- MPO )
b) atypical ANCA is a marker for inflammatory bowel disease
c) a c - ANCA figure in most patients with granulomatosis with poliangiitisom (
Wegener’s granulomatosis ) , (c- Anci give fluorescence of anti- PR3 )
d) atypical ANCA may be present in autoimmune hepatitis or sclerosing holangitis

Answer 37

All of them

Question 38

The ANCA applies :
a) a p- ANCA were found for systemic necrotizing vasculitis,
b ) is positive in most patients with arthritis
c) a c - ANCA figure in most patients with Wegener’s granulomatosis ( granulomatosis of
poliangiitisom )
d) atypical ANCA may be present in autoimmune hepatitis or sclerosing holangitis

Answer 38

A,C,D

Question 39

ANCA applies :
a) a c - ANCA binding to myeloperoxidase ( MPO ) in the cytoplasm of neutrophil
granulocytes
b ) a p- ANCA binding to a proteinase 3 ( PR3 ) in the cytoplasm of neutrophil
granulocytes
c) the level of antibodies ANCA patients a more or less constant and is the activity of the
disease does not alter the
d) the determination of the level of ANCA in successive samples can monitor
response to treatment

Answer 39

d) the determination of the level of ANCA in successive samples can monitor
response to treatment

Question 40

Rheumatoid arthritis at the beginning most commonly affects
A. Metacarpophalangeal and metatarzofalangeal joint
B. Elbows
C. distal interphalangeal joints
D.Proximal toe joint
E. temporomandibular joint

Answer 40

A. Metacarpophalangeal and metatarzofalangeal joint

Question 41

Rheumatoid factor -RF:
a) If it is negative, the diagnosis of rheumatoid arthritis is excluded
b) high titers suggest a more aggressive course of rheumatoid arthritis
c) may also be present in patients who do not have rheumatic diseases
d) is present in more than half of patients with Sjögren’s syndrome and mixed
cryoglobulinemia

Answer 41

b) high titers suggest a more aggressive course of rheumatoid arthritis
c) may also be present in patients who do not have rheumatic diseases
d) is present in more than half of patients with Sjögren’s syndrome and mixed
cryoglobulinemia

Question 42

Antibodies to cyclic citrulinated peptide - ACPA:
a) are found in 15-30% patients with rheumatoid arthritis (RA), which have a
negative RF
b) are characteristic for the RA and occur independently of the rheumatoid factor
(RF)
c) occur late in the course of RA
d) predict a more favorable the course of the disease

Answer 42

b) are characteristic for the RA and occur independently of the rheumatoid factor
(RF)

Question 43

Antibodies against the cytoplasmic antigen of neutrophil granulocytes (ANCA):
a) occur in psoriatic arthritis and are characteristic for it
b) with the activity of the disease, the concentration of ANCA is changeing
c) present in some vasculitis, ande certain glomerulonephritis
d) are typical for systemic sclerosis

Answer 43

b) with the activity of the disease, the concentration of ANCA is changeing
c) present in some vasculitis, ande certain glomerulonephritis

Question 44

Antibodies to cytoplasmic antigens of neutrophil granulocytes (ANCA)
a) cytoplasmic fluorescence (c-ANCA) shows antibodies against proteinase 3 (PR-3)
and occur with high diagnostic value in granulomatosis with poliangiitisom
(Wegener’s granulomatosis)
b) perinuclear fluorescence (p-ANCA) shows antibodies against myeloperoxidase
(MPO) and dominate in microscopic poliangiitisu and glomerulonephritis
c) with the activity of the disease varies their concentration
d) they are often present in patients with chronic inflammatory bowel disease (CIBD)

Answer 44

All of them

Question 45

In rheumatoid arthritis:
a. the development of destructive changes occurs early (within 1 month) in the course of
the disease
b. radiographic investigation has pathognomonic characteristics
c. articular involvement is usually symmetrical
d. hand is the test area for diagnostic imaging

Answer 45

b. radiographic investigation has pathognomonic characteristics
c. articular involvement is usually symmetrical
d. hand is the test area for diagnostic imaging

Question 46

In rheumatoid arthritis, on the x-ray we see:
a) thickening of periarticular the soft tissues
b) symmetrical involvement small joints of the hands and feet with involvement of the
distal interphalangeal joints
c) symmetric involvement small joints of the hands and feet without affecting the
distal interphalangeal joints
d) the inflammation extends proximally to the other joints (wrists, elbows, hocks and
knees)

Answer 46

A,C,D

Question 47

Connect the correct combination of answers:
1) early radiological signs of rheumatoid arthritis (RA)
b. thickening of periarticular soft tissues
c. expansion of joint space
f. periarticular osteophorosis
2) Late radiological signs of rheumatoid arthritis (RA
a. joint space narrowing
d. subluxation of ulna and radius
e. deformation in the form of a swan-neck

Question 48

Late in the course of rheumatoid arthritis we find:
a) luxation of individual bones of the carpus on the interphalangeal joints are visible
deformation in the form of a swan neck
b) wrist joints are not affected
c) frontal atlanotoaxial subluxation and subluxation of the axis, which may lead to
tetraplegia and death
d) in functional imaging we find excessive extension of antedental space

Answer 48

c) frontal atlanotoaxial subluxation and subluxation of the axis, which may lead to
tetraplegia and death

Question 49

In spondyloarthritis we find:
a) the presence of inflammatory processes in the insertions of joint capsules, tendons,
fascia
b) insertion of the Achilles tendon and the insertions of tendons on the os ilium are rarely
affected
c) the most commonly affected are insertions of the frontal longitudinal ligament of
the vertebrae
d) changes in sacroiliac joints

Answer 49

A,c,d

Question 50

In the case of suspected ankylosing spondylitis we perform the following imaging
tests:
A RTG both wrists, knees, feet, functional imaging of atlanto-occipital joint, if necessary
ultrasound of small joints of hands
B ultrasound of the shoulder joint, if necessary also CT and MRI of the shoulder joint
C RTG of sacroiliac joints, if necessary, magnetic resonance imaging of sacroiliac
joints
D RTG wrists, feet, if necessary, ultraosund of joint space
E MRI knee

Answer 50

C RTG of sacroiliac joints, if necessary, magnetic resonance imaging of sacroiliac
joints

Question 51

We find typical X-ray changes in ankylosing spondylitis on:
a) on the upper part of the sacroiliac joints in sacral side
b) in the active phase of the disease we see undergoing processes of destruction and
reparation, so the radiological picture is diverse
c) the MRI show early synovial proliferation and periarticular hyperemia
d) at an early stage occurs ankylosis and joint space narrowing

Answer 51

b) in the active phase of the disease we see undergoing processes of destruction and
reparation, so the radiological picture is diverse
c) the MRI show early synovial proliferation and periarticular hyperemia

Question 52

In the case of ankylosing spondylitis:
a) Sacroiliitis normally appears before spondylitis
b) spondylitis is the first and often the only finding in the context of ankylosing
spondylitis
c) the inflammatory process spreads through the spine from the neck down to the sacrum
d) with normal X-ray picture we reliably exclude spondylitis

Answer 52

a) Sacroiliitis normally appears before spondylitis

Question 53

In the case of ankylosing spondylitis we find:
a. the X-ray image of the spine looks like a bamboo
b. inflammatory synovial activity is similarly active as in rheumatoid arthritis
c. can take place without impairment of peripheral joint
d. compared with RA the atlantooccipital joints are rarely affected

Answer 53

a. the X-ray image of the spine looks like a bamboo
c. can take place without impairment of peripheral joint
d. compared with RA the atlantooccipital joints are rarely affected

Question 54

For ankylosing spondylitis the following applies:
a) Common affected large joints (hips, shoulders)
b) we do not find pronounced joints erosions, periarticular ostheoporosis and
pseudocysts
c) coxitis is often the first sign of the disease
d) small joints of arms and legs are often affected

Answer 54

a) Common affected large joints (hips, shoulders)
b) we do not find pronounced joints erosions, periarticular ostheoporosis and
pseudocysts

Question 55

In psoriatic arthritis rule, we find:
a. symmetrical involvement of the proximal joints in the arms
b. asymmetrically (isolated) involvement of the distal interphalangeal joints of hands
c. isolated involvement of all joints of the same finger (sausage finger)
d. mild destructive process

Answer 55

b. asymmetrically (isolated) involvement of the distal interphalangeal joints of hands
c. isolated involvement of all joints of the same finger (sausage finger)

Question 56

In psoriatic arthritis:
a. early on we find a marked periostosis
b. There is asymmetric impairment of the small joints of the hands and feet
c. can occur pronounced destruction of the entire joinz
d. simultaneous affection of the spine and sacroiliac joints with high probability excludes
psoriatic arthritis

Answer 56

a. early on we find a marked periostosis
b. There is asymmetric impairment of the small joints of the hands and feet
c. can occur pronounced destruction of the entire joinz

Question 57

For psoriatic arthritis applies:
a) impairment of sacroiliac joints (Sacroiliitis) is generally one-sided
b) sindesmophytes and parasindesmophytes are rough, asymmetrical
c) frequently we find bone fusions of individual interphalangeal joints
d) atlanto-occipital joints in psoriatic arthritis are never affected

Answer 57

a) impairment of sacroiliac joints (Sacroiliitis) is generally one-sided
b) sindesmophytes and parasindesmophytes are rough, asymmetrical
c) frequently we find bone fusions of individual interphalangeal joints

Question 58

In the diagnostic imaging of reactive arthritis we find:
a. asymmetric mono-, oligo- or polyarthritis
b. more commonly affected joints of the lower limbs, joints hands rarely
c. destructive changes in joints are less extensive than in psoriatic arthritis
d. changes in the spine and sacroiliac joints are similar to those of psoriatic arthritis

Answer 58

A,b,c,d

Question 59

In the case of gout arthritis are often affected:
A. metatarsophalangeal joints of the thumb, tarsometatarsal joinzs
B. ankle and knee joints
C. distal finger joints of hands and feet
D. wrist, atlantooccipital joints
E. sacroiliac joints

Answer 59

A. metatarsophalangeal joints of the thumb, tarsometatarsal joinzs

Question 60

In the case of gout arthritis:
a. the X-ray changes at the beginning are mild, the image is nondescriptive, but in
later stages are characterized by visible tophi
b. after the first attack we see bluring of cortical bone and joint space narrowing
c. luxations and subluxations are one of the typical signs of disease
d. late in the course of the disease we see secondary arthrosis

Answer 60

a. the X-ray changes at the beginning are mild, the image is nondescriptive, but in
later stages are characterized by visible tophi
d. late in the course of the disease we see secondary arthrosis

Question 61

In the case of suspected pseudogout we perform X-ray imaging of:
A. lumbar spine, neck, sacroiliac joints
B. knees, pelvis and wrists
C. the small joints of hands
D. the small joints of the legs
E. atlantooccipital joint

Answer 61

B. knees, pelvis and wrists

Question 62

The disease of deposition of calcium hydroxyapatite:
a) separated from gout solely on the basis of the puncture and analysis of the synovial
fluid (review of crystals under a polarizing microscope, laboratory tests)
b) is more common in primary hyperparathyroidism and sarcoidosis
c) the calcination are generally symmetrically arranged and small (<1mm)
d) calcinations are most often deposited outside the joints

Answer 62

b) is more common in primary hyperparathyroidism and sarcoidosis
d) calcinations are most often deposited outside the joints

Question 63

In the case of osteoarthritis on the imaging studies (x-ray, MRT) we see following
changes:
a) subchondral sclerosis and pseudocysts
b) the imposition of new bone on the naked parts
c) joint space narrowing, osteosclerosis of the joint surface

Answer 63

a) subchondral sclerosis and pseudocysts
b) the imposition of new bone on the naked parts
c) joint space narrowing, osteosclerosis of the joint surface

Question 64

Rheumatoid arthritis:
a) it is find more often in women than in men
b) during pregnancy the course of the disease gets worse, after childbirth spontaneous
remission occurs
c) peak incidence is between 30 and 55 years
d) the disease affects only joints

Answer 64

a) it is find more often in women than in men
c) peak incidence is between 30 and 55 years

Question 65

What is true for the immunopathology of rheumatoid arthritis?
a) interleukin 1 and 6 and tumor necrosis factor alpha act proinflammatory
b) the central pathological events take place in the synovium
c) one of the key cells involved in the pathogenesis are activated eosinophils
d) one of the key cells involved in the pathogenesis are activated T lymphocytes

Answer 65

a) interleukin 1 and 6 and tumor necrosis factor alpha act proinflammatory
b) the central pathological events take place in the synovium
d) one of the key cells involved in the pathogenesis are activated T lymphocytes

Question 66

What is true for rheumatoid arthritis?
a. initial course is often rapid
b. it includes symptoms outside the joints
c. typically affected metatarsophalangeal joint of the thumb
d. joint disability is symmetric (symmetric polyarthritis)

Answer 66

b. it includes symptoms outside the joints
d. joint disability is symmetric (symmetric polyarthritis)

Question 67

In rheumatoid arthritis are the most commonly affected joints:
A. metacarpophalangeal joints, proximal interphalangeal joints of the wrists,
metatarsophalangeal joints
B. jaw joints, atlanto-occipital joints
C. sacroiliac joints
D. hip and knee joints
E. distal interphalangeal joints of the wrists

Answer 67

A. metacarpophalangeal joints, proximal interphalangeal joints of the wrists,
metatarsophalangeal joints

Question 68

At the beginning rheumatoid arthritis most commonly affects:
A. metacarpophalangeal and metatarsophalangeal joints
B. knees
C. distal interphalangeal joints
D. the basic joint of the toe
E. temporomandibular joint

Answer 68

A. metacarpophalangeal and metatarsophalangeal joints

Question 69

What is true for rheumatoid arthritis?
a) the stiffness often correlates with disease activity
b) typical ulnar deviation of the fingers
c) typical radial deviation of the fingers
d) prolonged illness causes interosal muscle atrophy

Answer 69

a) the stiffness often correlates with disease activity
b) typical ulnar deviation of the fingers
d) prolonged illness causes interosal muscle atrophy

Question 70

What is true for rheumatoid arthritis?
A prolonged illness causes interosal muscle atrophy
B. synovitis occurs rarely
C. frequent concomitant ongoing vasculitis, that primarily affects the aorta and large
arteries in the neck
d) rheumatoid nodules occur in mechanically exposed areas

Answer 70

A prolonged illness causes interosal muscle atrophy
d) rheumatoid nodules occur in mechanically exposed areas

Question 71

Rheumatoid-arthritis-associated vasculitis
a. affects middle sized arteries, arterioles and venules
b. affects skin, lungs, heart, kidneys and bones
c. appears as thrombotic occlusion of the coronary arteries
d. C3 complement fraction is highly elevated
e. C4 complement fraction is highly elevated

Answer 71

a. affects middle sized arteries, arterioles and venules
b. affects skin, lungs, heart, kidneys and bones

Question 72

Rheumatoid arthritis associated lung disease:
a. is worse in serologically negative rheumatoid arthritis
b. is present only in patients with deformative joint disease
c. is confirmed, when we find rheuma factor in pleural punctat
d. lung parenchyma, vessels and/or pleura can be affected
e. cough is always present

Answer 72

d. lung parenchyma, vessels and/or pleura can be affected

Question 73

Extra-articular manifestations of rheumatoid arthritis:
a. when we find high levels of glucose in pleural punctat we must always
think about lung disease associated with rheumatoid arthritis
b. infarctions of nail beds, peripheral neuropathy and acroosteolysis
are consequences of vasculitis
c. cataract is the most common eye disease, especially in patients who were
treated with gold compound
d. the most common neurological complication is compartment
syndrome

Answer 73

b. infarctions of nail beds, peripheral neuropathy and acroosteolysis
are consequences of vasculitis
d. the most common neurological complication is compartment
syndrome

Question 74

In the pleural effusion in rheumatoid arthritis we can find:
1. Criteria for transudates , low blood glucose , reduced activity of the
complement and rheumatoid factor
2. Criteria for transudates , glucose concentration as in serum , increased
activity of the complement and rheumatoid factor
3. Criteria for exudate , glucose level as in the serum , reduced activity of
the complement and rheumatoid factor
4. Criteria for exudate , low blood glucose , reduced activity of the
complement and rheumatoid factor
5. Criteria for exudate , low blood glucose , increased activity of the
complement and rheumatoid factor

Answer 74

4. Criteria for exudate , low blood glucose , reduced activity of the
   complement and rheumatoid factor

Question 75

Disability outside the joints in the context of rheumatoid arthritis applies:
a) cervical myelopathy is caused by narrowing of the spinal canal
b ) in the context of rheumatoid arthritis peripheral neuropathy
is not developed
c ) compartment syndrome caused by pressure on a nerve near the
affected joint
d ) peripheral gangrene is common, which requires amputations

Answer 75

a) cervical myelopathy is caused by narrowing of the spinal canal
c ) compartment syndrome caused by pressure on a nerve near the
affected joint

Question 76

For rheumatoid arthritis applies:
a) the erythrocyte sedimentation rate is proportional to the activity of
the disease
b) the concentration of C-reactive protein correlates poorly with ESR
c) less than half of the patients has rheumatoid factor (RF) in the blood
d) antibodies against citrullinated peptide (ACPA) are highly specific
for rheumatoid arthritis

Answer 76

a) the erythrocyte sedimentation rate is proportional to the activity of
the disease
d) antibodies against citrullinated peptide (ACPA) are highly specific
for rheumatoid arthritis

Question 77

For rheumatoid arthritis applies:
a) the simultaneous presence of antibodies against citrullinated peptide
(ACPA) and rheumatoid factor (RF) show less favorable course of the
disease
b) the erythrocyte sedimentation usually correlates with the levels of
C-reactive protein, and is proportional to the activity of the disease
c) a negative rheumatoid factor means that the patient doesn’t have
rheumatoid arthritis
d) a positive rheumatoid factor is present only in about 80% of patients
with rheumatoid arthritis

Answer 77

a) the simultaneous presence of antibodies against citrullinated peptide
(ACPA) and rheumatoid factor (RF) show less favorable course of the
disease
b) the erythrocyte sedimentation usually correlates with the levels of
C-reactive protein, and is proportional to the activity of the disease
d) a positive rheumatoid factor is present only in about 80% of patients
with rheumatoid arthritis

Question 78

When a patient is suspected to have rheumatoid arthritis (RA), we must be
careful not to overlook other differential diagnostic possibilities:
a) the initial signs of RA may be non-specific and similar to other
arthritis
b) if there is photodermatosis present, we have to think of systemic
lupus erythematosus
c) an increased level of urea in serum indicates the possibility of gout
also in patients who have multiple joints affected
d) viral infections are often conducted with joint pain and also joint
swelling

Answer 78

All of them

Question 79

What applies to the treatment of rheumatoid arthritis:
a. Efficiency of therapy with COX-2 is higher than COX-1
b. NSAID prevent the destruction of the joints
c. It is recommended to combine more NSAID concurrently
d. We have to prescribe the PPIs(proton pump inhibitors) to the
patients with higher risk of haemorrhage from the upper
gastrointestinal tract

Answer 79

d. We have to prescribe the PPIs(proton pump inhibitors) to the
patients with higher risk of haemorrhage from the upper
gastrointestinal tract

Question 80

Essential drugs in the treatment of rheumatoid arthritis are:
a. NSAID, infliximabe
b. Leflunomide, systemic glucocorticoids, methotrexate
c. Sulfasalazine, methotrexate, leflunomide, antimalarial agents
d. Cyclosporine, systemic glucocorticoid
e. Paracetamol

Answer 80

c. Sulfasalazine, methotrexate, leflunomide, antimalarial agents

Question 81

For basic drugs we use for the treatment of rheumathoid arthritis applies:
a. effect occurs after several weeks of treatment
b. with basic drugs can be achieved complete remission
c. patients with moderate activity of rheumathoid arthritis treated with a
combination of two basic drugs
d. combination of methotrexate and leflunomide is an effective
treatment for patients with a severe form of rheumatoid arthritis

Answer 81

a. effect occurs after several weeks of treatment
b. with basic drugs can be achieved complete remission
d. combination of methotrexate and leflunomide is an effective
treatment for patients with a severe form of rheumatoid arthritis

Question 82

For ankylosing spondylitis applies:
a. sacroiliitis occurs more often before spondylitis
b. inflammatory process spreads up the spine
c. complete bone ankylosis of sacroiliac joint is rare
d. radiological changes occure first on the lower parts of the sacroiliac joint

Question 83

Which of the following is true for the treatment of rheumatoid arthritis?
a) NSAID can improve symptoms and prognosis of RA.
b) Selective inhibitors of cyclooxygenase (COX-2) are more effective than
conventional NSAIDs (COX-1 inhibitors).
c) Patients with an increased risk for cardiovascular complications are
treated with COX-2 selective NSAIDs with the addition of a proton pump
inhibitor.
d) Patients with heart failure and progressed renal failure are treated with
COX-2 selective non-steroidal anti-inflammatory drugs.

Answer 83

None of them

Question 84

Which of the following is true for the treatment of rheumatoid arthritis?
a) Negative side effects with the use of standard drugs are rare (less
than 5% of patients).
b) Basic drugs are always combined together.
c) Treatment effects are usually seen after 2-3 days, in metorexate treatment
it takes up to two weeks.
d) With the basic drug treatment we can stop the progression of erosive
and deforming changes.

Answer 84

a) Negative side effects with the use of standard drugs are rare (less
than 5% of patients).
d) With the basic drug treatment we can stop the progression of erosive
and deforming changes.

Question 85

We decide for concomitant use of corticosteroids in the treatment of
rheumatoid arthritis:
a. always
b. simultaneously with the basic medicines in bridging period when
the basic medicines are not efficient yet
c. when there is also a vasculitis or damage to internal organs present
d. in patients where the use of NSAIDs did not achieve satisfactory
anti-inflammatory and analgesic effect

Answer 85

b. simultaneously with the basic medicines in bridging period when
the basic medicines are not efficient yet
d. in patients where the use of NSAIDs did not achieve satisfactory
anti-inflammatory and analgesic effect

Question 86

Biological drugs for the treatment of rheumatoid arthritis:
a. block TNF-alpha , IL-1 , IL-6 or B-lymphocytes
b. antibodies against TNF-alpha and IL-6 show effect after 3-6 weeks
c. antibodies against TNF-alpha and IL-6 show effect after a few
days
d. reduce the symptoms and progression of erosive changes

Answer 86

a. block TNF-alpha , IL-1 , IL-6 or B-lymphocytes
c. antibodies against TNF-alpha and IL-6 show effect after a few
days
d. reduce the symptoms and progression of erosive changes

Question 87

For treatment of rheumatoid arthritis is true:
a) Treatment with methotrexate can lead to toxic effect on the liver,
bone marrow and lungs.
b) Treatment with NSAIDs increases the risk of cardiovascular
complications and upper gastrointestinal bleeding.
c) Long-term treatment with disease-modifying antirheumatic drugs,
among other things, can cause osteoporosis.
d) Disease-modifying antirheumatic drugs of choice for treating
rheumatoid arthritis in alcoholic is methotrexate.

Answer 87

a) Treatment with methotrexate can lead to toxic effect on the liver,
bone marrow and lungs.
b) Treatment with NSAIDs increases the risk of cardiovascular
complications and upper gastrointestinal bleeding.

Question 88

Infliksimab:
a) Is an antibody against TNF.
b) Is an antibody against lymphocytes B.
c) In combination with methotrexate is long-term more effective.
d) The first improvement can be seen after first application of the
drug

Answer 88

a) Is an antibody against TNF.
c) In combination with methotrexate is long-term more effective.
d) The first improvement can be seen after first application of the
drug

Question 89

TNF-alpha inhibitors are:
a. etanercept, adalimumab, golimumab
b. adalimumab, golimumab, odalizumab
c. adalimumab, leflunomide
d. rituximab, golimumab
e. omalizumab

Answer 89

a. etanercept, adalimumab, golimumab

Question 90

Which infection needs to be considered in patients who are being
treated for rheumatoid arthritis with TNF-alpha inhibitors?
a. Pneumococcal pneumonia
b. Gram-negative sepsis
c. Reactivation of tuberculosis
d. CMV pneumonia
e. Bacterial inflammation of the joints

Answer 90

c. Reactivation of tuberculosis

Question 91

While treating with TNF-alpha inhibitors:
a) pulmonary tuberculosis develops more frequently, usually between the
second and fifth month of treatment
b) sometimes neutralizing and other autoantibodies appear in the serum
c) systemic sclerosis symptoms can get worse
d) we need to pay particular attention to the emergence or worsening of
cardiac failure

Answer 91

b) sometimes neutralizing and other autoantibodies appear in the serum
d) we need to pay particular attention to the emergence or worsening of
cardiac failure

Question 92

We evaluate the activity of rheumatoid arthritis:
a) with validated indicators of disease activity, such as DAS 28
b) based on the concentration of rheumatoid factor (RF) in the serum
c) on the basis of its responsiveness to treatment with glucocorticoids
d) based on the presence of ACPA in the serum

Answer 92

a) with validated indicators of disease activity, such as DAS 28

Question 93

Which of the following signs are predicting a more difficult course of
rheumatoid arthritis?
a) upper extremity joints involvement, large joints involvement, female
gender
b) high concentration of CRP, the presence of rheumatoid factor and
citrullinated peptide antibodies
c) male gender
d) axial skeleton joints involvement

Answer 93

a) upper extremity joints involvement, large joints involvement, female
gender
b) high concentration of CRP, the presence of rheumatoid factor and
citrullinated peptide antibodies

Question 94

In those patients where we expect a more difficult course of rheumatoid
arthritis :
a) we start with basic medicines treatment early
b) we start with biological drugs treatment early
c) we combine glucocorticoids, methotrexate and biological drugs
d) we start treatment with high doses of glucocorticoids
e) we should not start the treatment with NSAIDs

Answer 94

a) we start with basic medicines treatment early

Question 95

The term spondyloarthritis includes following diseases:
a. Ankylosing Spondylitis, Reactive Arthritis, Psoriatic Arthritis
b. Sero-negative rheumatoid arthritis
c. Enteropathic Arthritis
d. Undifferentiated Spondyloarthritis

Answer 95

a. Ankylosing Spondylitis, Reactive Arthritis, Psoriatic Arthritis
c. Enteropathic Arthritis
d. Undifferentiated Spondyloarthritis

Question 96

What holds true for spondyloarthritis ?
a. It is more common in men.
b. It is more common in patients with antigen HLA-B27.
c. Test for rheumatoid factor is negative.
d. Family history is often positive.

Answer 96

All of them

Question 97

What holds true for spondyloarthritis ?
a. Peripheral joints are affected mostly on the upper limbs.
b. The inflammation of peripheral joints is mostly asymmetric and
oligoarticular.
c. We must actively look for simultaneous pathological changes on the
eyes, skin, mucosa and heart.
d. Enthesitis is rare, however when it is present, it most commonly affects
the knee and shoulder joints.

Answer 97

b. The inflammation of peripheral joints is mostly asymmetric and
oligoarticular.
c. We must actively look for simultaneous pathological changes on the
eyes, skin, mucosa and heart.

Question 98

The basic pathological mechanism of spondyloarthritis is:
a. the destruction of joint surfaces at points of maximum pressure
b. enthesitis
c. synovial proliferation
d. osteoporosis and uncontrolled deposition of new bone
e. vasculitis

Answer 98

b. enthesitis

Question 99

What is true for ankylosing spondylitis:
a) It often starts with pain in lower back, but sometimes it begins with
peripheral arthritis
b) Enthesitis is possible anywhere, but usually affects Achilles tendon
c) small joints are often affected
d) women are more impaired than men

Answer 99

a) It often starts with pain in lower back, but sometimes it begins with
peripheral arthritis
b) Enthesitis is possible anywhere, but usually affects Achilles tendon

Question 100

To diagnose ankylosing spondylitis:
a) we have to do RTG of sacroiliac joints and other painful regions in back
B)laboratory
c) We usually find sacroiliitis on both sacroiliac joints,
d) on clinical examination we find pri straightened lumbar
lordosis,emphatic kyphosis of thorax and reduced flexibility of the spine.

Answer 100

a) we have to do RTG of sacroiliac joints and other painful regions in back
c) We usually find sacroiliitis on both sacroiliac joints,
d) on clinical examination we find pri straightened lumbar
lordosis,emphatic kyphosis of thorax and reduced flexibility of the spine.

Question 101

Ankylosing spondylitis:
a) It usually starts with pain radiating from lower spine regions and
sacroiliac region to the thighs and thorax.
b) Presence of morning stiffness.
c) Pain subsides with activity/movement.
d) Movement of the spine is restricted.
e) Presence of nocturnal pain, that causes frequent disturbances of sleep
cycle.

Answer 101

All of them

Question 102

Ankylosing spondylitis:
a) Eye involvement (iridocyclitis) in at least ¼ of the patients
b) Iridocyclitis is usually unilateral.
c) More than ½ patients have asymptomatic inflammatory bowel changes
in terminal ileum and colon, in some patients chronic inflammatory bowel
disease may develop.
d) Rare extra articular manifestations are aortic insufficiency, pulmonary
fibrosis and amyloidosis

Answer 102

All of them

Question 103

Schober’s test we use in the diagnostic of:
A. rheumatiod arthritis
B. ankylozing spondiloarthritis
C. syndrome of chronic fatigue
D. Sjögren’s syndrome
E. poliarteritis nodosa

Answer 103

B. ankylozing spondiloarthritis

Question 104

For the diagnosis of ankylosing spondiloarthritis we need (according to NY
1984):
a) we should do the x-ray of the sacroiliacal joint + the x-ray of the painful
part of the spine
b) we use the laboratory
c) for the diagnosis we need to confirm the presence of the HLA-27 Ab
d) we find a reduced/decreased mobilitiy of the spine

Answer 104

a) we should do the x-ray of the sacroiliacal joint + the x-ray of the painful
part of the spine
d) we find a reduced/decreased mobilitiy of the spine

Question 105

Felty syndrome:
a) is a version of psoriatic arthritis with concurrent generalized psoriasis,
leucopenia and infections.
b) is the result of a complication of treatment of rheumatoid arthritis with
biological drugs.
c) is a version of rheumatoid arthritis, characterized by an enlarged spleen,
neutropenia, infections and ulcers on the bottom extremities.
d) is the result of a complication of treatment of psoriatic arthritis with systemic
glucocorticoids.
e) is the combination of seronegative arthritis, urethritis and conjunctivitis.

Answer 105

c) is a version of rheumatoid arthritis, characterized by an enlarged spleen,
neutropenia, infections and ulcers on the bottom extremities.

Question 106

Ankylosing spondylitis treatment:
a) a combination of pharmacological and non-pharacological
pharmacological approaches is used.
b) 1st order treatments are methotrexate and leflunomide.
c) 1st order treatment is paracetamol.
d) NSAIDs cause more complications than benefits and are therefore not to be
used for ankylosing spondylitis.
e) TNF-alpha inhibitors are not used in the treatment of ankylosing spondylitis.

Answer 106

a) a combination of pharmacological and non-pharacological
pharmacological approaches is used.

Question 107

Ankylosing spondylitis treatment with NSAR:
a. NSAR present 1st order treatment of Ankylosing spondylitis.
b. first pharmaceutic effects occur after 48-72 hours, while full
therapeutic effect take 2 weeks to develop.
c. NSAR relieve pain and morning joint stiffness
d. NSAR are more useful for treating non-inflammatory (mechanic) pain
e. NSAR are not used in treating Ankylosing spondylitis

Answer 107

a. NSAR present 1st order treatment of Ankylosing spondylitis.
b. first pharmaceutic effects occur after 48-72 hours, while full
therapeutic effect take 2 weeks to develop.
c. NSAR relieve pain and morning joint stiffness

Question 108

Ankylosing spondylitis treatment:
a. glucocorticoids are 1st order treatment, which improve signs and
symptoms as well as prevent the advancement of the disease.
b. methotrexate, sulfasalazine and leflunomide do not have therapeutic
effects on the axial skeleton.
c. sulfasalazine has better therapeutic effects on joint symptoms as
leflunomide and methotrexate.
d. pulse therapy with intravenous methylprednisolone (375mg, >3 days)
can improve the clinical picture in the short term.

Answer 108

b. methotrexate, sulfasalazine and leflunomide do not have therapeutic
effects on the axial skeleton.
c. sulfasalazine has better therapeutic effects on joint symptoms as
leflunomide and methotrexate.
d. pulse therapy with intravenous methylprednisolone (375mg, >3 days)
can improve the clinical picture in the short term.

Question 109

Treating Ankylosing spondylitis with TNF- alpha inhibitors:
a) weakens inflammation in the sacroiliac joints and improves mobility of
the spine in a couple of days
b) improves enthesitis in peripheral arthritis
c) has a good impact on mineral bone density
d) cessation of treatment is followed by worsening of the disease

Answer 109

All of them

Question 110

For treatment of Ankylosing spondylitis applies:
a. Patients with a highly active disease at the time of diagnosis have a worse
progress of the disease.
b. Patients with a highly active disease at the time of diagnosis have a milder
progress of the disease.
c. Osteotomy of the spine is rarely required, as opposed to hip joint
prosthesis.
d. In patients unresponsive to NSAIDs, sulfasalazine, mehtotrexat and at least
two applications of local glucocorticoid (in case of enthesitis), a treatment with
rituximab is started.

Answer 110

a. Patients with a highly active disease at the time of diagnosis have a worse
progress of the disease.
c. Osteotomy of the spine is rarely required, as opposed to hip joint
prosthesis.

Question 111

Which medications, besides NSAIDs, do we use in the treatment of
ankylosing spondylitis?
a. infliximab
b. methotrexat
c. anakinra
d. etanercept

Answer 111

a. infliximab
d. etanercept

Question 112

For ankylosing arthritis applies:
a. the disease can start as peripheral monoarthritis
b. big joints (hip, knee, shoulder) are affected in ⅓ of patients,
usually asymmetrically
c. enthesitis commonly affects insertion of Achilles tendon,
intercostal muscles and plantar fascia
d. it can take more aggressive course in women

Answer 112

a. the disease can start as peripheral monoarthritis
b. big joints (hip, knee, shoulder) are affected in ⅓ of patients,
usually asymmetrically
c. enthesitis commonly affects insertion of Achilles tendon,
intercostal muscles and plantar fascia

Question 113

Psoriatic arthritis:
a. is 3-times more common in women than men
b. can erupt before occurrence of psoriasis
c. is sero-negative arthritis
d. heredity plays an important role in etiopathogenesis

Answer 113

b. can erupt before occurrence of psoriasis
c. is sero-negative arthritis
d. heredity plays an important role in etiopathogenesis

Question 114

For psoriatic arthritis applies:
a. the disease presents–, after the patient already has a diagnosis
of psoriasis
b. the disease mostly presents acutely, skin changes normally appear
after the presentation of arthritis
c. arthritis can occur in all types of psoriasis
d. the degree of psoriatic nail involvement is well correlated with
degree of joint involvement

Answer 114

a. the disease presents–, after the patient already has a diagnosis
of psoriasis
d. the degree of psoriatic nail involvement is well correlated with
degree of joint involvement

Question 115

For psoriatic arthritis applies:
a. the most common is symmetric oligoarticular arthritis affecting
mainly distal interphalangeal joints of hand and foot
b. in some patients with symmetric psoriatic polyarthritis,
rheumatoid factor in serum could be present
c. osteonecrosis results in arthritis mutilans
d. arthritis in patients with psoriasis is always psoriatic, it is so also in
the case where rheumatoid factor is present in serum
e. it is present only in patients with psoriasis where not only skin is
affected but also nails

Answer 115

b. in some patients with symmetric psoriatic polyarthritis,
rheumatoid factor in serum could be present

Question 116

For psoriatic arthritis is true that:
a)sacroiliitis in psoriatic arthritis can be a part of all subtypes of
psoriatic arthritis, only exceptionally it appears on its own
b)sacroiliitis in psoriatic arthritis is more common in men
c)the most common manifestation outside the joints is pneumonitis
d)the most common manifestation outside the joints is ocular
involvement (iritis and iridocyclitis)

Answer 116

a)sacroiliitis in psoriatic arthritis can be a part of all subtypes of
psoriatic arthritis, only exceptionally it appears on its own
b)sacroiliitis in psoriatic arthritis is more common in men
d)the most common manifestation outside the joints is ocular
involvement (iritis and iridocyclitis)

Question 117

Sausage digit (dactylitis) we can find in: here it was marked abc but i
think it is wrong
a)psoriatic arthritis
b)rheumatoid arthritis
c)reactive arthritis
d)crystal deposition arthritis
e)osteoarthrosis

Answer 117

a)psoriatic arthritis
c)reactive arthritis
d)crystal deposition arthritis

Question 118

For treatment of psoriatic arthritis applies?
a. we treat patients with moderate activity of psoriatic arthritis with
medrol which also improves skin symptoms
b. enthesitis , tenosynovitis , mono- and oligoarthritis are initially
treated with NSAIDs. If the remission is not achieved we calm the
inflammation with local application of glucocorticoids
c. we treat patients with moderate activity of psoriatic arthritis
with NSAIDs
d. we treat skin and joint symptoms simultaneously

Answer 118

b. enthesitis , tenosynovitis , mono- and oligoarthritis are initially
treated with NSAIDs. If the remission is not achieved we calm the
inflammation with local application of glucocorticoids
c. we treat patients with moderate activity of psoriatic arthritis
with NSAIDs
d. we treat skin and joint symptoms simultaneously

Question 119

For treatment of psoriatic arthritis applies?
a. enthesitis , tenosynovitis , mono- and oligoarthritis are initially
treated with NSAIDs. If the remission is not achieved we calm the
inflammation with local application of glucocorticoids
b. basic drugs are methotrexate, sulfasalazine, and cyclosporine
c. we treat patients with moderate activity of psoriatic arthritis
with NSAIDs
d. in case of unsuccessful monotherapy we can combine basic
drugs

Answer 119

All of them

Question 120

For the treatment of psoriatic arthritis it is typical:
a. rapid withdrawal of systemic glucocorticoids generally gives rise to a
deterioration of skin symptomalogy
b. infliximab, adalimumab, golimumab, etanercept can be used, if
disease is not responsive to basic medicines
c. in the case of chronic synovitis of individual joint, patient
undergoes surgical sinoviectomy
d. basic medicines are methrotrexate, sulfasalazine and cyclosporine

Answer 120

b. infliximab, adalimumab, golimumab, etanercept can be used, if
disease is not responsive to basic medicines
c. in the case of chronic synovitis of individual joint, patient
undergoes surgical sinoviectomy
d. basic medicines are methrotrexate, sulfasalazine and cyclosporine

Question 121

For ankylosing spondyilitis it is typical:
a. it is more common in men and the course of their disease is less
favorable
b. it is more common in women and the course of their disease is less
favorable
c. .it is more common in women and the course of their disease is
favorable
d. it is more common in men and the course of their disease is favorable
e. sex does not affect the frequency of course of the disease

Answer 121

a. it is more common in men and the course of their disease is less
favorable

Question 122

Which of the following statements are true?
a. rheumatoid arthritis is more common in women
b. ankylosing spondylitis is more common in women
c. psoriatic arthritis is equally common in both genders
d. systemic lupus is more common in women

Answer 122

a. rheumatoid arthritis is more common in women
c. psoriatic arthritis is equally common in both genders
d. systemic lupus is more common in women

Question 123

TNF alpha inhibitors are used to treat:
a. rheumatoid arthritis
b. ankylosing spondylitis
c. arthritis associated with systemic lupus erythematosus
d. uric arthritis

Answer 123

a. rheumatoid arthritis
b. ankylosing spondylitis

Question 124

Which statements apply to psoriatic arthritis?
a) In most patients the course is aggressive, as mutilate arthritis
b) Female gender, elevated sedimentation rate, acute onset and
polyarthritis predict unfavorable outcome
c) Unfavorable outcome is expected if the disease progresses by
rheumatic arthritis type
d) More than half of patients have erosive arthritis

Answer 124

b) Female gender, elevated sedimentation rate, acute onset and
polyarthritis predict unfavorable outcome
c) Unfavorable outcome is expected if the disease progresses by
rheumatic arthritis type

Question 125

Lung involvement in rheumatoid arthritis:
a) Is more common in patients with seropositive arthritis
b) Chronic fibrosing interstitial pneumonia diffusely affects the lungs
c) Diffuse fibrosing alveolitis affects the whole lungs and can produce
an image of honeycomb lungs
d) Can be the first sign of disease

Answer 125

a) Is more common in patients with seropositive arthritis
c) Diffuse fibrosing alveolitis affects the whole lungs and can produce
an image of honeycomb lungs
d) Can be the first sign of disease

Question 126

Choose correct statement for reactive arthritis :
a) occurs after infection of the urogenital, gastrointestinal or respiratory tract
b) for the diagnosis we must isolate the pathogen from the synovial fluid
c) it is most commonly caused by mycoplasma and pneumococci
d) we find HLA-B27 in the majority of patients

Answer 126

a) occurs after infection of the urogenital, gastrointestinal or respiratory tract
d) we find HLA-B27 in the majority of patients

Question 127

What is true for reactive arthritis?
a. arhritis usually presents at the same time as infection
b. arthritis presents 1-4 weeks after infecion
c. arthritis is usually assymetric, oligoarticular, more common on
lower limbs (small joints in the foot, ankle, knee)
d. dactilytis presents at the same time

Answer 127

b. arthritis presents 1-4 weeks after infecion
c. arthritis is usually assymetric, oligoarticular, more common on
lower limbs (small joints in the foot, ankle, knee)
d. dactilytis presents at the same time

Question 128

What is true for reactive arthritis?
a. approximately 40% of patients had involvement of the axial
skeleton
b. Arthritis occurs 1-4 weeks after infection
c. Arthritis is generally asymmetric, oligoartikularen more common
in the lower extremities (small joints feet, ankles, knees).
d. at the same time can lead to inflammation of tendon fleksorja -
formed dactylitis

Answer 128

All of them

Question 129

What is true for reactive arthritis?
e. the history is indicative of painful micturition, gastrointestinal
or respiratory infection and prostatitis, balanitis and in case of
women ulcers on the outer genitalia
f. hyperkeratosis may be found on the hands and feet
g. the nails are rarely affected (thickened and ridged)
h. the most common ophthalmological complication is
conjunctivitis

Answer 129

All of them

Question 130

In a younger male patient with a seronegative, non-symmetrical
oligoarthritis of the lower limbs, the differential diagnosis is:
a. serologically negative rheumatoid arthritis
b. psoriatic arthritis
c. reactive arthritis
d. arthrosis

Answer 130

b. psoriatic arthritis
c. reactive arthritis

Question 131

For diagnostic procedures of reactive arthritis applies?
a) on X-ray imaging of impaired joints there is no erosive changes
and reactive growth of bone tissue is present (linear periostitis)
b) MRI is investigation of choice in acute phase
c) Sacroiliitis can be present in patients with chronic disease
d) HLA-B27 have to be present for diagnosis of reactive arthritis

Answer 131

a) on X-ray imaging of impaired joints there is no erosive changes
and reactive growth of bone tissue is present (linear periostitis)
c) Sacroiliitis can be present in patients with chronic disease

Question 132

For diagnostic procedures of reactive arthritis applies?
a) on X-ray imaging of impaired joints there is no erosive changes
and reactive growth of bone tissue is present (linear periostitis)
b) MRI is investigation of choice in acute phase
c) Sacroiliitis can be present in patients with chronic disease
d) HLA-B27 have to be present for diagnosis of reactive arthritis

Answer 132

a) on X-ray imaging of impaired joints there is no erosive changes
and reactive growth of bone tissue is present (linear periostitis)
b) MRI is investigation of choice in acute phase
c) Sacroiliitis can be present in patients with chronic disease

Question 133

What is true for treatment of reactive arthritis?
a) we treat it with high-dose of NSAID
b) ultrasound guided injection of intralesional glucocorticoids in
inflamed joint and tendon
c) when the therapy with NSAID is insufficient to relieve the pain, we
add alopurinol
d) we should always prescribe antibiotic therapy for Chlamydia spec.
(e.g. azithromycin)

Answer 133

a) we treat it with high-dose of NSAID
b) ultrasound guided injection of intralesional glucocorticoids in
inflamed joint and tendon

Question 134

The outcome of reactive arthritis is worse in:
A. children and adolescent
B. RA associated with urogenital infection
C. HLA-B27 negative individuals
D. women
E. rheumatoid factors serum negative patient

Answer 134

B. RA associated with urogenital infection

Question 135

Risk factors for osteoarthrosis are:
a) age and mechanical stress
b) excessively flexible joints
c) obesity
d) young women

Answer 135

a) age and mechanical stress
b) excessively flexible joints
c) obesity

Question 136

Primary osteoarthrosis:
a) is accompanied by sinusitis
b) IL-1 acts destructively on joint cartilage
c) inflammation of the synovial membrane is important cause of the
disease
d) joint cartilage stays intact for a long time throughout the course of the
disease, destruction mostly affects subchondral bone

Answer 136

b) IL-1 acts destructively on joint cartilage
c) inflammation of the synovial membrane is important cause of the
disease

Question 137

Secondary osteoarthrosis:
A. Occurs because of crystal build-up in joint cartilage
B. Occurrence depends on the history of inflammation in the joint
C. it can be the result of previous trauma (joint fracture, joint
dislocation)
D. Occurs in the haemophilic patients who have the history of joint
bleeding

Answer 137

All of them

Question 138

Osteoarthrosis:
A. prolonged rigidity (>1 hour)
B. Presence of joint crepitations
C. Non-erosive arthrosis
D. joint surrounding structures (tendons, joint membrane and muscles)
are not affected

Answer 138

B. Presence of joint crepitations

Question 139

In primary osteoarthrosis: i dont know if this is correct… it was in red
colour
a. distal interphalangeal joints of arms and knees are most
commonly affected
b. Heberden’s osteoarthrosis, rhizarthrosis and Bouchard’s
osteoarthrosis can be present
c. small joints of lower limbs are most commonly affected
d. hard knots, palpable at the border of the joint, are called synovial
cysts

Answer 139

a. distal interphalangeal joints of arms and knees are most
commonly affected
b. Heberden’s osteoarthrosis, rhizarthrosis and Bouchard’s
osteoarthrosis can be present

Question 140

In osteoarthrosis of the knee:
a. pain is usually intermittent, gait-bound and can be obtuse
or burning in character
b. osteoarthrosis affects both genders
c. effusion in the joint can be shown in progression of the
disease
d. the disease progresses slowly

Answer 140

All of them

Question 141

In osteoarthrosis of the hip:
a. it is more common in obese
b. pain is present in the inguinal region, buttocks and thighs
c. inner rotation of the joint is decreased
d. it usually affects the upper part of the joint, consequently
aseptic necrosis of the head of the femur is very common

Answer 141

b. pain is present in the inguinal region, buttocks and thighs
c. inner rotation of the joint is decreased
d. it usually affects the upper part of the joint, consequently
aseptic necrosis of the head of the femur is very common

Question 142

In osteoarthrosis of the spine:
a. anatomic changes we find in radiology are correlated with
clinical presentation
b. on the intervertebral disc the first changes are in the
nucleus pulposus, later there are fractures in fibrous shell
c. in later stages disc protrusion and intervertebral dics prolaps
can happen
d. the most common is postero-lateral prolaps

Answer 142

b. on the intervertebral disc the first changes are in the
nucleus pulposus, later there are fractures in fibrous shell
c. in later stages disc protrusion and intervertebral dics prolaps
can happen
d. the most common is postero-lateral prolaps

Question 143

Degenerative changes of the spinal osteoarthrosis are:
a. chondrosis
b. osteochondrosis
c. Schmorl hernia
d. spondyloarthrosis

Answer 143

a. chondrosis
b. osteochondrosis
c. Schmorl hernia
d. spondyloarthrosis

Question 144

In the case of osteoarthrosis we can find
a. in cervicocephalic syndrome symptoms caused by cervical
osteoarthrosis, sympathetic nervous system and vertebral arteries
b. osteoarthrosis affects, similar as rheumatoid arthritis, especially
upper two cervical vertebrae
c. lumbar spine is most frequently affected in L3-S1 level
d. claudication, caused by spinal canal stenosis, stops immediately
after resting

Question 145

For diagnosis of osteoarthritis we:
a. perform X-ray examination of both joints
b. ankylosis of joints is not specific for osteoarthritis
c. separating the primary from the secondary arthrosis has only
epidemiological significance because it does not affect neither the
treatment neither prognosis
d. laboratory tests so usually within the normal range

Answer 145

a. perform X-ray examination of both joints
d. laboratory tests so usually within the normal range

Question 146

Diagnosis of osteoarthritis is a less likely when you find the following :
a. an isolated involvement of the shoulder joint
b. isolated involvement of the hip joint
c. RF, ACPA, Hep2 are negative and there is no systemic signs
d. the elevated procalcitonin

Question 147

What is true for treating of osteoarthrosis?
a. walking stick should be used on the same side as the affected joint
is
b. obese patients should lose weight
c. the basic nonfarmacologic treatment is kineziotherapy
d. adding glucosamine and chondroitin sulfate per os leads to
improvment of syptoms and the quality of life

Answer 147

b. obese patients should lose weight
c. the basic nonfarmacologic treatment is kineziotherapy
d. adding glucosamine and chondroitin sulfate per os leads to
improvment of syptoms and the quality of life

Question 148

Intraarticular application of hyaluronic acid in the treatment of
osteoarthrosis :
a. the effect lasts longer comparing to glucocorticoids
b. it blocks the inflammation of the joint
c. it stimulates the procution of chondral matrix
d. it decreases the level of viscositiy of the joint fluid

Answer 148

All of them