Medicine
Rheumatology
A patient older than 50 has new temporal headache, jaw claudication and transient visual symptoms. What is the most important immediate action?
A. Wait for biopsy before any treatment
B. Give allopurinol
C. Prescribe only physiotherapy
D. Start urgent glucocorticoid treatment for suspected GCA
Correct Answer: D
Suspected GCA with ischemic symptoms is a medical emergency; glucocorticoids should not be delayed for diagnostic testing.
Medicine
Rheumatology
Which condition is strongly associated with polymyalgia rheumatica?
A. Giant cell arteritis
B. Gout
C. Osteoarthritis only
D. Reactive arthritis
Correct Answer: A
PMR and GCA overlap clinically and epidemiologically; patients should be assessed for symptoms of the other condition.
Medicine
Rheumatology
Which symptom pattern is typical of polymyalgia rheumatica?
A. Chronic low-back pain beginning at age 20
B. Bilateral shoulder and hip girdle aching with morning stiffness
C. Isolated DIP swelling
D. Podagra
Correct Answer: B
PMR causes proximal girdle pain and stiffness, usually with elevated inflammatory markers.
Medicine
Rheumatology
Polymyalgia rheumatica typically occurs in which age group?
A. Only teenagers
B. Only neonates
C. Adults older than 50 years
D. Children younger than 10 years
Correct Answer: C
PMR occurs almost exclusively in people older than 50 years.
Medicine
Rheumatology
Which symptom complex is summarized by the historical acronym CREST?
A. Cough, rash, edema, synovitis and thrombosis
B. Crystal arthritis, renal disease, eye disease, skin ulcer and tendonitis
C. Carditis, renal failure, erythema, stroke and thrombocytopenia
D. Calcinosis, Raynaud phenomenon, esophageal dysfunction, sclerodactyly and telangiectasia
Correct Answer: D
CREST summarizes classic manifestations of limited cutaneous systemic sclerosis.
Medicine
Rheumatology
Which vascular skin finding may occur in limited systemic sclerosis?
A. Telangiectasia
B. Erythema migrans
C. Gottron papules
D. Janeway lesions only
Correct Answer: A
Telangiectasias are part of the classic limited systemic sclerosis phenotype.
Medicine
Rheumatology
A systemic sclerosis patient has exertional dyspnea, a disproportionately low DLCO and relatively preserved lung volumes. Which complication should be suspected?
A. Septic arthritis
B. Pulmonary arterial hypertension
C. Gout
D. Carpal tunnel syndrome
Correct Answer: B
Disproportionate reduction in DLCO with dyspnea can be a clue to pulmonary vascular disease in systemic sclerosis.
Medicine
Rheumatology
Which neuropathy can be associated with Sjögren syndrome?
A. No neurologic manifestations occur
B. Congenital neuropathy only
C. Peripheral neuropathy
D. Only traumatic neuropathy
Correct Answer: C
Peripheral and small-fiber neuropathies are recognized extraglandular manifestations of Sjögren syndrome.
Medicine
Rheumatology
Which renal tubular disorder can occur in Sjögren syndrome?
A. Nephrotic syndrome in every patient
B. Polycystic kidney disease
C. Renal artery stenosis as a criterion
D. Distal renal tubular acidosis
Correct Answer: D
Tubulointerstitial disease in Sjögren syndrome can cause distal renal tubular acidosis.
Medicine
Rheumatology
Which dental complication is common in Sjögren syndrome?
A. Dental caries due to xerostomia
B. Supernumerary teeth
C. Jaw fracture in all patients
D. Fluorosis only
Correct Answer: A
Reduced salivary flow increases dental caries, oral infection and periodontal complications.
Medicine
Rheumatology
A patient with Sjögren syndrome develops persistent unilateral parotid enlargement and lymphadenopathy. What should be considered?
A. Ankylosing spondylitis
B. Lymphoma
C. Simple osteoarthritis
D. Gout
Correct Answer: B
Persistent gland enlargement, lymphadenopathy or systemic features should raise concern for lymphoma in Sjögren syndrome.
Medicine
Rheumatology
Which malignancy risk is increased in Sjögren syndrome?
A. Melanoma as the defining complication
B. Colon cancer in every patient
C. B-cell lymphoma
D. Osteosarcoma only
Correct Answer: C
Sjögren syndrome increases the risk of lymphoproliferative disease, particularly B-cell non-Hodgkin lymphoma.
Medicine
Rheumatology
Which antibodies are strongly associated with Sjögren syndrome?
A. Anti-CCP and anti-Scl-70
B. c-ANCA and p-ANCA
C. Anti-centromere and anti-Jo-1
D. Anti-Ro/SSA and anti-La/SSB
Correct Answer: D
Anti-Ro/SSA and anti-La/SSB are characteristic autoantibodies in Sjögren syndrome.
Medicine
Rheumatology
Which test objectively measures tear production in suspected Sjögren syndrome?
A. Schirmer test
B. Schober test
C. Phalen test
D. Allen test
Correct Answer: A
The Schirmer test measures tear production and can help objectively document ocular dryness.
Medicine
Rheumatology
Which physical finding is typical of systemic sclerosis?
A. Gottron papules
B. Sclerodactyly
C. Heberden nodes only
D. Tophi only
Correct Answer: B
Sclerodactyly describes tightening and thickening of the skin of the fingers and is typical of systemic sclerosis.
Medicine
Rheumatology
Which gastrointestinal problem is common in systemic sclerosis?
A. Pyloric stenosis
B. Achalasia in every patient
C. Gastroesophageal reflux from esophageal dysmotility
D. Appendicitis as a defining feature
Correct Answer: C
Esophageal dysmotility and reflux are common gastrointestinal manifestations of systemic sclerosis.
Medicine
Rheumatology
Which test is commonly used to screen for pulmonary hypertension in systemic sclerosis?
A. Skull radiography
B. Electroencephalography
C. Barium enema
D. Echocardiography
Correct Answer: D
Echocardiography is commonly used in screening pathways for pulmonary hypertension in systemic sclerosis, with right-heart catheterization required for definitive hemodynamic diagnosis.
Medicine
Rheumatology
Which pulmonary complication is a major cause of morbidity in systemic sclerosis?
A. Interstitial lung disease
B. Simple viral rhinitis
C. Isolated pleural plaque only
D. Pneumothorax in every patient
Correct Answer: A
Interstitial lung disease is a major organ manifestation of systemic sclerosis and contributes substantially to morbidity and mortality.
Medicine
Rheumatology
What is a first-line treatment for Raynaud phenomenon in systemic sclerosis?
A. Bisphosphonate
B. Dihydropyridine calcium-channel blocker such as nifedipine
C. Allopurinol
D. Methotrexate for immediate vasodilation
Correct Answer: B
EULAR recommendations support dihydropyridine calcium-channel blockers, usually nifedipine, as first-line therapy for SSc-related Raynaud phenomenon.
Medicine
Rheumatology
Which medication exposure can increase the risk of scleroderma renal crisis and should be used cautiously?
A. Paracetamol
B. Calcium supplements
C. High-dose glucocorticoids
D. Topical emollients
Correct Answer: C
Higher-dose glucocorticoid exposure is associated with scleroderma renal crisis risk and requires caution.