Rheumatology(36) Flashcards
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
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.
REU - 3
What medicine is NOT used to treat rheumatoid arthritis?
A) Methotrexate
B) Leflunomide
C) Methylprednisolone
D) Diclofenac
E) Colchicine
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.
REU - 4
Which of the following is an interleukin-6 R-inhibitor biological drug?
A) Etanercept
B) Adalimumab
C) Tocilizumab
D) Infliximab
E) Rituximab
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.
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
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.
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
D) Pneumoconiosis
EXPLANATION
Pneumoconiosis is part of Caplan’s syndrome, the other four symptoms are characteristic of Felty’s syndrome.
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
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.
systemic onset juvenile idiopathic arthritis, is a rare systemic inflammatory disorder characterized by inflammatory polyarthritis, daily fever, and a transient salmon-pink maculopapular rash
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
ANSWER
C) Erosive arthritis
EXPLANATION
The disease could be characterized by non-erosive arthritis.
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
ANSWER
B) Rheumatoid arthritis
EXPLANATION
Prevalence of RA (0.5-1%) far exceeds other autoimmune disorders’ prevalence.
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
ANSWER
C) Rheumatoid arthritis
EXPLANATION
Subcutaneous rheumatoid nodules occur only in RA and not in the other listed diseases.
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
ANSWER
A) Ankylosing spondylitis
EXPLANATION
Only ankylosing spondylitis dominates in men, the other diseases listed are more common in women.
REU - 12
What is the base (first-line) therapy for rheumatoid arthritis?
A) Sulfasalazine
B) Cyclophosphamide
C) Methotrexate
D) Chloroquine
E) Azathioprine
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.
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
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.
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
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.
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
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.
REU - 16
Symptoms of sarcoidosis, EXCEPT:
A) Granulomatous systemic process
B) Bilateral hilaris lymphadenopathy
C) Erythema nodosum
D) Arthritis
E) Polychondritis
ANSWER
E) Polychondritis
EXPLANATION
Polychondritis does not occur in sarcoidosis.
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
ANSWER
A) Polyarthritis
EXPLANATION
The polyarthritis subgroup may show seropositivity, the rest mostly doesn’t.
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
ANSWER
E) Association of avascular necrosis of femoral head
EXPLANATION
Avascular necrosis of femoral head is characteristic to another juvenile osteochondritis, Perthes’ disease.
Scheuermann kyphosis, also known as Scheuermann disease, juvenile kyphosis, or juvenile discogenic disease, is a condition of hyperkyphosis that involves the vertebral bodies and discs of the spine identified by anterior wedging of greater than or equal to 5 degrees in 3 or more adjacent vertebral bodies.
REU - 19
It does NOT belong to seronegative spondyloarthritis:
A) Ankylosing spondylitis
B) Reactive arthritis
C) Enteropathic arthritis
D) Polymyalgia rheumatica
E) Psoriatic arthritis
ANSWER
D) Polymyalgia rheumatica
EXPLANATION
Polymyalgia rheumatica does not belong to this group due to having different characteristics.
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
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.
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
ANSWER
E) Effectiveness of methotrexate therapy
EXPLANATION
Infliximab and sulfasalazine are effective in IBD however methotrexate isn’t.
REU - 23
Which pathogen causes Lyme disease?
A) Campylobacter jejuni
B) Klebsiella pneumoniae
C) Borrelia burgdorferi
D) Coxsackie virus
E) Epstein-Barr virus
ANSWER
C) Borrelia burgdorferi
EXPLANATION
Only Borrelia burgdorferi causes Lyme disease.
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
ANSWER
E) Severe gastrointestinal symptoms
EXPLANATION
Severe gastrointestinal symptoms are extremely rare in Lyme disease, oppositely to the others.
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
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.
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
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.
