Medicine
Rheumatology
Which feature helps distinguish relapsing polychondritis auricular inflammation from cellulitis?
A. Presence of podagra
B. Positive anti-CCP in every case
C. Always bilateral hearing loss
D. Sparing of the earlobe
Correct Answer: D
Auricular chondritis classically affects cartilage while sparing the non-cartilaginous lobule.
Medicine
Rheumatology
Relapsing polychondritis primarily causes recurrent inflammation of:
A. Cartilage, especially ears and respiratory tract
B. Only synovial fluid
C. Only renal glomeruli
D. Only skeletal muscle
Correct Answer: A
Relapsing polychondritis affects cartilaginous structures such as the auricles, nose and tracheobronchial tree.
Medicine
Rheumatology
Which management approach is most appropriate for fibromyalgia?
A. Antibiotics indefinitely
B. Education, graded exercise, sleep management and selected symptom-directed therapy
C. Long-term high-dose glucocorticoids
D. DMARDs for all patients
Correct Answer: B
Fibromyalgia management is multimodal and non-inflammatory; routine immunosuppression is not indicated.
Medicine
Rheumatology
Which symptom commonly accompanies fibromyalgia?
A. Digital gangrene
B. Jaw claudication
C. Non-restorative sleep
D. Hemoptysis
Correct Answer: C
Fibromyalgia often includes fatigue, sleep disturbance and cognitive symptoms alongside widespread pain.
Medicine
Rheumatology
Which feature favors fibromyalgia over active inflammatory arthritis?
A. Warm swollen joints
B. Elevated inflammatory markers with erosions
C. RBC casts
D. Widespread tenderness without objective synovitis
Correct Answer: D
Fibromyalgia causes widespread pain and tenderness but does not itself cause synovitis, erosions or systemic inflammatory marker elevation.
Medicine
Rheumatology
Which combination is typical of mixed connective-tissue disease?
A. Features overlapping SLE, systemic sclerosis and inflammatory myopathy
B. Only gout and CPPD
C. Only osteoarthritis
D. Only septic arthritis
Correct Answer: A
MCTD combines clinical features of several connective-tissue diseases, often with Raynaud phenomenon and swollen hands.
Medicine
Rheumatology
Mixed connective-tissue disease is strongly associated with which antibody?
A. Anti-GBM antibody
B. Anti-U1 RNP
C. Anti-CCP
D. Anti-mitochondrial antibody
Correct Answer: B
High-titer anti-U1 RNP is characteristic of mixed connective-tissue disease.
Medicine
Rheumatology
Which skin finding may occur in antiphospholipid syndrome?
A. Sclerodactyly only
B. Tophi
C. Livedo reticularis
D. Gottron papules only
Correct Answer: C
Livedo reticularis or livedo racemosa can be associated with antiphospholipid antibodies and APS.
Medicine
Rheumatology
Why can the term 'lupus anticoagulant' be misleading?
A. It always causes severe bleeding
B. It is an anticoagulant drug
C. It is found only in SLE
D. It is associated with thrombosis in vivo despite prolonging phospholipid-dependent clotting tests in vitro
Correct Answer: D
Lupus anticoagulant prolongs certain laboratory clotting assays but is associated clinically with thrombosis rather than bleeding.
Medicine
Rheumatology
Antiphospholipid syndrome is defined clinically by thrombosis and/or characteristic pregnancy morbidity together with:
A. Persistent antiphospholipid antibodies
B. A positive ANA only
C. Hyperuricemia
D. Elevated CK
Correct Answer: A
APS requires compatible clinical events plus persistent laboratory evidence of antiphospholipid antibodies.
Medicine
Rheumatology
Which autoantibody is included among laboratory criteria for antiphospholipid syndrome?
A. Anti-Jo-1
B. Lupus anticoagulant
C. Anti-CCP
D. Anti-Scl-70
Correct Answer: B
APS laboratory criteria include lupus anticoagulant, anticardiolipin antibodies and anti-beta-2-glycoprotein I antibodies when persistently positive.
Medicine
Rheumatology
Which feature is typical of inclusion body myositis?
A. Rapid response to all immunosuppression
B. Only ocular muscle weakness
C. Older age with finger-flexor and quadriceps weakness
D. Childhood onset with malar rash
Correct Answer: C
IBM commonly affects older adults and characteristically involves quadriceps and finger flexors, often asymmetrically.
Medicine
Rheumatology
Dermatomyositis in an adult should prompt age-appropriate evaluation for:
A. Only gout
B. Only osteoporosis
C. Only tuberculosis
D. Malignancy
Correct Answer: D
Adult dermatomyositis is associated with increased malignancy risk, so appropriate screening is important.
Medicine
Rheumatology
Which pulmonary complication is particularly important in antisynthetase syndrome?
A. Interstitial lung disease
B. Spontaneous pneumothorax in every patient
C. Pulmonary embolism as the defining feature
D. Pleural calcification
Correct Answer: A
Interstitial lung disease is a major manifestation and can dominate the clinical picture in antisynthetase syndrome.
Medicine
Rheumatology
Which autoantibody is associated with antisynthetase syndrome?
A. Anti-dsDNA
B. Anti-Jo-1
C. Anti-centromere
D. Anti-CCP
Correct Answer: B
Anti-Jo-1 is an antisynthetase antibody associated with myositis, interstitial lung disease, arthritis and mechanic's hands.
Medicine
Rheumatology
A violaceous discoloration around the eyelids in dermatomyositis is called:
A. Erythema nodosum
B. Livedo reticularis
C. Heliotrope rash
D. Malar rash
Correct Answer: C
A heliotrope rash is a violaceous periorbital eruption associated with dermatomyositis.
Medicine
Rheumatology
Which skin finding is characteristic of dermatomyositis?
A. Heberden nodes
B. Tophi
C. Erythema migrans
D. Gottron papules
Correct Answer: D
Gottron papules are violaceous papules over extensor surfaces of the MCP and IP joints.
Medicine
Rheumatology
Which enzyme is commonly elevated in active inflammatory myositis?
A. Creatine kinase
B. Amylase only
C. Troponin in every patient
D. Alkaline phosphatase only
Correct Answer: A
Creatine kinase is commonly elevated when skeletal muscle inflammation and injury are active.
Medicine
Rheumatology
Which muscle pattern is typical of inflammatory myopathy?
A. Pain without objective weakness in every case
B. Symmetric proximal muscle weakness
C. Isolated sensory loss
D. Distal weakness only after trauma
Correct Answer: B
Inflammatory myopathies classically cause symmetric proximal weakness affecting activities such as climbing stairs or rising from a chair.
Medicine
Rheumatology
Which vascular event can occur in Behçet disease?
A. No vascular involvement
B. Aortic coarctation as a defining feature
C. Venous thrombosis
D. Only capillary bleeding
Correct Answer: C
Behçet disease can cause venous and arterial thrombosis as well as aneurysmal disease.