Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Systemic sclerosis?
A. Permanent vision loss
B. Pulmonary arterial hypertension or interstitial lung disease
C. Restrictive chest-wall disease and spinal ankylosis
D. B-cell lymphoma
Correct Answer: B
Pulmonary vascular and fibrotic lung disease are major causes of morbidity and mortality.
Medicine
Rheumatology
A patient is diagnosed with Systemic sclerosis. Which is the most appropriate management principle?
A. Use organ-specific therapy and close monitoring while managing Raynaud phenomenon and reflux
B. Use organ- and severity-specific immunomodulatory therapy with hydroxychloroquine for many patients when not contraindicated
C. Start high-dose glucocorticoid treatment promptly when strongly suspected
D. Use exercise and physiotherapy plus anti-inflammatory therapy; escalate to biologic therapy for persistent active disease when indicated
Correct Answer: A
No single therapy treats all manifestations; management is driven by organ involvement.
Medicine
Rheumatology
In a patient with suspected Systemic sclerosis, which investigation or diagnostic approach is most appropriate at this stage?
A. Synovial-fluid analysis when diagnosis is uncertain or septic arthritis must be excluded
B. ANA followed by more specific autoantibodies, complement and organ-directed testing
C. Inflammatory markers plus confirmatory temporal-artery imaging or biopsy as locally appropriate
D. Autoantibody testing and organ screening including lungs, heart and kidneys
Correct Answer: D
Systemic sclerosis requires assessment for interstitial lung disease, pulmonary hypertension and renal involvement.
Medicine
Rheumatology
A patient has Raynaud phenomenon, skin thickening of the fingers and reflux symptoms. What is the most likely diagnosis?
A. Osteoarthritis
B. Acute gout
C. Systemic sclerosis
D. Systemic lupus erythematosus (SLE)
Correct Answer: C
Raynaud phenomenon with sclerodactyly and internal-organ symptoms suggests systemic sclerosis.
Medicine
Rheumatology
Which extra-articular manifestation is classically associated with axial spondyloarthritis?
A. Cataract from birth
B. Acute anterior uveitis
C. Otitis externa
D. Isolated dental caries
Correct Answer: B
Acute anterior uveitis is a well-recognized extra-articular manifestation of spondyloarthritis.
Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Ankylosing spondylitis / axial spondyloarthritis?
A. Restrictive chest-wall disease and spinal ankylosis
B. B-cell lymphoma
C. Joint erosions and deformity
D. Progressive functional limitation
Correct Answer: A
Progressive axial fusion can limit spinal and chest-wall mobility.
Medicine
Rheumatology
A patient is diagnosed with Ankylosing spondylitis / axial spondyloarthritis. Which is the most appropriate management principle?
A. Use organ-specific therapy and close monitoring while managing Raynaud phenomenon and reflux
B. Use symptomatic eye and oral moisture therapy and treat systemic disease according to organ involvement
C. Start a disease-modifying antirheumatic drug early, commonly methotrexate when appropriate
D. Use exercise and physiotherapy plus anti-inflammatory therapy; escalate to biologic therapy for persistent active disease when indicated
Correct Answer: D
Regular exercise is central, and advanced therapy is used for inadequate control.
Medicine
Rheumatology
In a patient with suspected Ankylosing spondylitis / axial spondyloarthritis, which investigation or diagnostic approach is most appropriate at this stage?
A. Inflammatory markers plus confirmatory temporal-artery imaging or biopsy as locally appropriate
B. Autoantibody testing and organ screening including lungs, heart and kidneys
C. Sacroiliac imaging with inflammatory markers and HLA-B27 used selectively
D. Autoantibody testing with objective assessment of ocular and salivary gland function
Correct Answer: C
Imaging can demonstrate sacroiliitis; HLA-B27 supports but does not establish diagnosis alone.
Medicine
Rheumatology
A patient is a young adult with chronic inflammatory low-back pain that improves with exercise and morning stiffness. What is the most likely diagnosis?
A. Systemic lupus erythematosus (SLE)
B. Ankylosing spondylitis / axial spondyloarthritis
C. Giant cell arteritis
D. Systemic sclerosis
Correct Answer: B
Inflammatory back pain in a young adult suggests axial spondyloarthritis.
Medicine
Rheumatology
Which associated condition commonly occurs with giant cell arteritis?
A. Polymyalgia rheumatica
B. Cystic fibrosis
C. Myasthenia gravis
D. Ulcerative keratitis from contact lenses
Correct Answer: A
Giant cell arteritis and polymyalgia rheumatica frequently coexist in older adults.
Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Giant cell arteritis?
A. Progressive functional limitation
B. Tophaceous joint damage
C. Lupus nephritis
D. Permanent vision loss
Correct Answer: D
Arteritic anterior ischemic optic neuropathy can cause sudden irreversible blindness.
Medicine
Rheumatology
A patient is diagnosed with Giant cell arteritis. Which is the most appropriate management principle?
A. Start a disease-modifying antirheumatic drug early, commonly methotrexate when appropriate
B. Use exercise, weight management and symptom-directed analgesic therapy
C. Start high-dose glucocorticoid treatment promptly when strongly suspected
D. Use an NSAID, colchicine or corticosteroid for an acute flare when appropriate
Correct Answer: C
Immediate therapy is required to reduce risk of irreversible ischemic visual loss.
Medicine
Rheumatology
In a patient with suspected Giant cell arteritis, which investigation or diagnostic approach is most appropriate at this stage?
A. Autoantibody testing with objective assessment of ocular and salivary gland function
B. Inflammatory markers plus confirmatory temporal-artery imaging or biopsy as locally appropriate
C. Inflammatory markers, rheumatoid factor and anti-CCP antibodies with imaging as appropriate
D. Clinical assessment; plain radiography when diagnosis is uncertain or before major intervention
Correct Answer: B
Confirmatory testing is important, but treatment should not be delayed when visual-loss risk is high.
Medicine
Rheumatology
A patient is older than 50 with new temporal headache, scalp tenderness and jaw claudication. What is the most likely diagnosis?
A. Giant cell arteritis
B. Systemic sclerosis
C. Sjögren syndrome
D. Rheumatoid arthritis
Correct Answer: A
New cranial symptoms with jaw claudication in an older adult are highly concerning for giant cell arteritis.
Medicine
Rheumatology
Which laboratory marker may fall during active immune-complex SLE disease?
A. Serum sodium in every flare
B. Troponin in all patients
C. Ferritin as the defining marker
D. Complement levels
Correct Answer: D
Complement consumption can occur during active immune-complex disease, especially lupus nephritis.
Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Systemic lupus erythematosus (SLE)?
A. Permanent vision loss
B. Restrictive chest-wall disease and spinal ankylosis
C. Lupus nephritis
D. Pulmonary arterial hypertension or interstitial lung disease
Correct Answer: C
Immune-complex glomerulonephritis is a major cause of morbidity in SLE.
Medicine
Rheumatology
A patient is diagnosed with Systemic lupus erythematosus (SLE). Which is the most appropriate management principle?
A. Use an NSAID, colchicine or corticosteroid for an acute flare when appropriate
B. Use organ- and severity-specific immunomodulatory therapy with hydroxychloroquine for many patients when not contraindicated
C. Start high-dose glucocorticoid treatment promptly when strongly suspected
D. Use exercise and physiotherapy plus anti-inflammatory therapy; escalate to biologic therapy for persistent active disease when indicated
Correct Answer: B
SLE management is individualized; severe kidney or CNS disease requires more intensive specialist therapy.
Medicine
Rheumatology
In a patient with suspected Systemic lupus erythematosus (SLE), which investigation or diagnostic approach is most appropriate at this stage?
A. ANA followed by more specific autoantibodies, complement and organ-directed testing
B. Clinical assessment; plain radiography when diagnosis is uncertain or before major intervention
C. Synovial-fluid analysis when diagnosis is uncertain or septic arthritis must be excluded
D. Inflammatory markers plus confirmatory temporal-artery imaging or biopsy as locally appropriate
Correct Answer: A
ANA is sensitive; specific antibodies and complement levels help support diagnosis and assess organ involvement.
Medicine
Rheumatology
A patient has photosensitive rash, inflammatory arthritis, oral ulcers and proteinuria. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Acute gout
D. Systemic lupus erythematosus (SLE)
Correct Answer: D
Multisystem autoimmune disease involving skin, joints and kidneys is typical of SLE.
Medicine
Rheumatology
What crystal finding is typical of gout?
A. Rhomboid positively birefringent calcium pyrophosphate crystals
B. Cholesterol crystals as the defining finding
C. Needle-shaped negatively birefringent monosodium urate crystals
D. No crystals can ever be seen
Correct Answer: C
Monosodium urate crystals are needle-shaped and negatively birefringent under polarized light.