Medicine
Rheumatology
A patient with suspected septic arthritis also has a history of gout. Which statement is correct?
A. Finding urate crystals does not exclude concomitant infection
B. Urate crystals completely rule out infection
C. Culture is unnecessary if crystals are seen
D. Antibiotics are never required
Correct Answer: A
Crystal arthritis and septic arthritis can coexist; synovial culture remains important when infection is clinically possible.
Medicine
Rheumatology
A patient with SLE has proteinuria, hematuria and red-cell casts. What complication is most likely?
A. Lupus nephritis
B. Osteoarthritis
C. Fibromyalgia
D. Septic bursitis
Correct Answer: A
Proteinuria with active urinary sediment and RBC casts in SLE strongly suggests immune-mediated glomerulonephritis due to lupus nephritis.
Medicine
Rheumatology
A patient with rheumatoid arthritis has persistent active disease despite an adequate methotrexate trial. Before starting a biologic DMARD, which screening is especially important?
A. Latent tuberculosis and hepatitis risk assessment
B. Routine colonoscopy in all ages
C. Exercise stress test in every patient
D. No infection screening is needed
Correct Answer: A
Biologic and targeted therapies can reactivate latent infections, so TB and relevant hepatitis screening are important before treatment.
Medicine
Rheumatology
A patient with Sjögren syndrome has dry eyes and dry mouth. Which long-term complication has increased risk?
A. B-cell lymphoma
B. Colon polyps only
C. Acute appendicitis
D. Aortic dissection
Correct Answer: A
Sjögren syndrome is associated with an increased risk of B-cell non-Hodgkin lymphoma, especially with persistent gland enlargement or systemic features.
Medicine
Rheumatology
A patient with antiphospholipid syndrome has recurrent venous thrombosis. What is the key long-term treatment principle?
A. Long-term anticoagulation when indicated
B. Routine platelet transfusion
C. No treatment after the first event
D. Long-term antibiotics
Correct Answer: A
Thrombotic antiphospholipid syndrome generally requires sustained anticoagulation, with regimen tailored to thrombosis type and patient risk.
Medicine
Rheumatology
A 30-year-old man has chronic inflammatory back pain that improves with exercise, reduced chest expansion and bilateral sacroiliitis. What is the most likely diagnosis?
A. Axial spondyloarthritis
B. Mechanical lumbar strain
C. Polymyalgia rheumatica
D. Osteoarthritis of hands
Correct Answer: A
Inflammatory back pain in a young adult with sacroiliitis and reduced spinal mobility is typical of axial spondyloarthritis.
Medicine
Rheumatology
A patient with pseudogout is most likely to have which crystal type?
A. Calcium pyrophosphate crystals
B. Monosodium urate crystals
C. Cystine crystals
D. Calcium oxalate urinary crystals only
Correct Answer: A
CPPD causes rhomboid, weakly positively birefringent calcium pyrophosphate crystals in synovial fluid.
Medicine
Rheumatology
A patient with acute podagra has severe pain and swelling of the first MTP joint. Which synovial crystal finding confirms gout?
A. Needle-shaped negatively birefringent monosodium urate crystals
B. Rhomboid positively birefringent calcium pyrophosphate crystals
C. Cholesterol crystals only
D. No crystals can be present
Correct Answer: A
Monosodium urate crystals are needle-shaped and show strong negative birefringence under polarized light.
Medicine
Rheumatology
A patient with systemic sclerosis has abrupt severe hypertension and rapidly rising creatinine. Which treatment is essential?
A. ACE inhibitor
B. High-dose NSAID
C. Thiazide alone
D. Methotrexate alone
Correct Answer: A
Scleroderma renal crisis is treated urgently with ACE inhibition, even if kidney function initially worsens.
Medicine
Rheumatology
A patient has proximal muscle weakness, elevated CK and a violaceous periorbital rash. What is the most likely diagnosis?
A. Dermatomyositis
B. Fibromyalgia
C. Polymyalgia rheumatica
D. Gout
Correct Answer: A
Dermatomyositis combines inflammatory proximal myopathy with characteristic cutaneous findings such as heliotrope rash and Gottron papules.
Medicine
Rheumatology
A young woman has recurrent oral ulcers, genital ulcers and uveitis. Which disease is most likely?
A. Behçet syndrome
B. Rheumatoid arthritis
C. Osteoarthritis
D. Gout
Correct Answer: A
Recurrent oral and genital ulceration with ocular inflammation is a classic presentation of Behçet syndrome.
Medicine
Rheumatology
A patient with polymyalgia rheumatica is most likely to have which symptom pattern?
A. Bilateral shoulder and hip girdle pain with prolonged morning stiffness
B. Distal weakness with absent reflexes
C. Acute monoarthritis of first MTP only
D. Painless joint deformity
Correct Answer: A
Polymyalgia rheumatica causes aching and morning stiffness in the shoulder and hip girdles in older adults.
Medicine
Rheumatology
A 70-year-old has new unilateral headache, scalp tenderness and jaw claudication with ESR 95 mm/hr. What should be done immediately if giant cell arteritis is suspected?
A. Start high-dose glucocorticoids
B. Wait for biopsy before treatment
C. Give allopurinol
D. Start colchicine only
Correct Answer: A
Treatment for suspected giant cell arteritis should begin immediately to reduce the risk of irreversible visual loss; diagnostic confirmation can follow.
Medicine
Rheumatology
A patient with rheumatoid arthritis develops neck pain, occipital headache and neurologic symptoms. Which complication must be excluded before airway manipulation?
A. Atlantoaxial subluxation
B. Lumbar disc herniation
C. Carpal tunnel syndrome only
D. Achilles tendinopathy
Correct Answer: A
Long-standing RA can cause atlantoaxial instability, which is important to recognize before intubation or neck manipulation.
Medicine
Rheumatology
Which infection-risk screening is commonly considered before substantial immunosuppression in rheumatology, depending on drug and patient factors?
A. Only throat swab
B. Hepatitis B status
C. Only stool culture
D. Only malaria smear
Correct Answer: B
Hepatitis B screening is important before several immunosuppressive regimens because reactivation can occur, particularly with B-cell-depleting and other potent therapies.
Medicine
Rheumatology
Which statement about vaccination in patients receiving immunosuppressive rheumatology treatment is most accurate?
A. Only live vaccines are preferred during intense immunosuppression
B. Vaccination status is irrelevant
C. Vaccination planning should be reviewed, and live vaccines may be contraindicated with significant immunosuppression
D. All vaccines are permanently forbidden
Correct Answer: C
Vaccination is an important preventive strategy; timing and use of live vaccines depend on the degree and type of immunosuppression.
Medicine
Rheumatology
Which symptom best suggests temporomandibular joint inflammation rather than isolated dental disease?
A. Dental caries visible on one tooth
B. Gum bleeding only
C. Tongue ulcer only
D. Preauricular pain with restricted jaw movement and joint tenderness
Correct Answer: D
TMJ inflammation can produce preauricular pain, tenderness and restricted or painful jaw movement.
Medicine
Rheumatology
What is the main purpose of nailfold capillaroscopy in rheumatology?
A. Assess microvascular changes in Raynaud phenomenon and systemic sclerosis
B. Diagnose gout crystals
C. Measure bone density
D. Assess lumbar flexion
Correct Answer: A
Nailfold capillaroscopy can identify a scleroderma-pattern microangiopathy and help assess secondary Raynaud phenomenon.
Medicine
Rheumatology
Which finding suggests secondary rather than primary Raynaud phenomenon?
A. No tissue injury
B. Digital ulcers and abnormal nailfold capillaries
C. Symptoms beginning in adolescence with normal examination
D. Symmetric mild episodes only
Correct Answer: B
Digital ischemic injury, late onset, asymmetry, abnormal capillaroscopy or systemic features suggest an underlying connective-tissue disease.
Medicine
Rheumatology
Which condition is characterized by episodic color changes of the fingers triggered by cold or stress?
A. Livedo from heat exposure
B. Tophus formation
C. Raynaud phenomenon
D. Erythema nodosum
Correct Answer: C
Raynaud phenomenon causes episodic digital vasospasm with color changes, often triggered by cold or emotional stress.