Medicine
Rheumatology
What is the treatment of choice for scleroderma renal crisis?
A. High-dose NSAID
B. Allopurinol
C. Colchicine
D. ACE inhibitor
Correct Answer: D
Prompt ACE-inhibitor therapy, classically captopril, is central to treatment of scleroderma renal crisis.
Medicine
Rheumatology
Which antibody is associated with an increased risk of scleroderma renal crisis?
A. Anti-RNA polymerase III
B. Anti-Jo-1
C. Anti-CCP
D. Anti-Ro
Correct Answer: A
Anti-RNA polymerase III antibodies are associated with diffuse systemic sclerosis and higher renal-crisis risk.
Medicine
Rheumatology
Which autoantibody is associated with diffuse systemic sclerosis and interstitial lung disease?
A. Anti-mitochondrial antibody
B. Anti-topoisomerase I (Scl-70)
C. Anti-Ro only
D. Anti-CCP
Correct Answer: B
Anti-topoisomerase I is associated with diffuse disease and increased risk of interstitial lung disease.
Medicine
Rheumatology
Which autoantibody is associated with limited cutaneous systemic sclerosis?
A. Anti-Jo-1 antibody
B. Anti-dsDNA antibody
C. Anti-centromere antibody
D. Anti-CCP antibody
Correct Answer: C
Anti-centromere antibodies are strongly associated with limited cutaneous systemic sclerosis and pulmonary arterial hypertension risk.
Medicine
Rheumatology
Which medication class may increase serum urate and gout risk?
A. Proton pump inhibitors
B. Topical emollients
C. Inhaled saline
D. Thiazide diuretics
Correct Answer: D
Thiazide and loop diuretics can increase urate levels and may contribute to gout in susceptible patients.
Medicine
Rheumatology
Which lifestyle factor is strongly associated with hyperuricemia and gout risk?
A. High alcohol intake, especially beer and spirits
B. Routine walking
C. Adequate hydration
D. Normal body weight
Correct Answer: A
Alcohol, excess weight and some high-purine or fructose exposures can increase gout risk, though pharmacologic urate lowering is central when indicated.
Medicine
Rheumatology
A patient with gout has an acutely swollen joint and fever. Why may arthrocentesis still be necessary even if gout is known?
A. Crystals sterilize the joint
B. Septic arthritis can coexist with crystal arthritis
C. Gout prevents infection
D. Serum urate excludes infection
Correct Answer: B
Crystal arthritis and septic arthritis can coexist; infection must be excluded when clinically suspected.
Medicine
Rheumatology
Which metabolic disorder is associated with CPPD and should be considered in a younger patient with chondrocalcinosis?
A. Hyperthyroidism only
B. Celiac disease only
C. Hemochromatosis
D. Type 1 diabetes only
Correct Answer: C
CPPD at a young age should prompt evaluation for associated disorders such as hemochromatosis, hyperparathyroidism, hypomagnesemia and hypothyroidism.
Medicine
Rheumatology
An older adult develops acute knee swelling. Synovial fluid shows rhomboid positively birefringent crystals. What is the diagnosis?
A. Gout
B. Rheumatoid arthritis
C. Polymyalgia rheumatica
D. Acute CPP crystal arthritis
Correct Answer: D
Rhomboid weakly positive calcium pyrophosphate crystals indicate acute CPP crystal arthritis, formerly called pseudogout.
Medicine
Rheumatology
Which radiographic finding supports calcium pyrophosphate deposition disease?
A. Chondrocalcinosis
B. Bamboo spine
C. Marginal erosions at MCP joints only
D. Pencil-in-cup deformity
Correct Answer: A
Chondrocalcinosis, especially in fibrocartilage or hyaline cartilage, is a classic imaging clue to CPPD.
Medicine
Rheumatology
Calcium pyrophosphate deposition disease typically shows which crystals?
A. Cystine hexagons
B. Rhomboid, weakly positively birefringent crystals
C. Needle-shaped, strongly negatively birefringent crystals
D. Cholesterol plates only
Correct Answer: B
CPP crystals are classically rhomboid and weakly positively birefringent.
Medicine
Rheumatology
Which clinical finding suggests chronic tophaceous gout?
A. Gottron papules
B. Sclerodactyly
C. Firm urate deposits around ears or joints
D. Malar rash
Correct Answer: C
Tophi are deposits of monosodium urate in soft tissues and are a feature of chronic gout.
Medicine
Rheumatology
The usual serum urate treatment target for most patients receiving urate-lowering therapy is:
A. Above 10 mg/dL
B. Exactly 8.5 mg/dL
C. Serum urate is never monitored
D. Below 6 mg/dL
Correct Answer: D
A treat-to-target approach generally aims for serum urate below 6 mg/dL, with individualized lower targets sometimes used in severe disease.
Medicine
Rheumatology
Which drug is a first-line urate-lowering therapy for many patients with chronic gout?
A. Allopurinol
B. Ibuprofen only
C. Prednisone indefinitely
D. Hydroxychloroquine
Correct Answer: A
ACR guidance supports allopurinol as preferred first-line urate-lowering therapy for most patients, including many with CKD, with appropriate dosing and monitoring.
Medicine
Rheumatology
Which medicine is used to treat acute gout inflammation but does not lower total body urate?
A. Probenecid
B. Colchicine
C. Allopurinol
D. Febuxostat
Correct Answer: B
Colchicine is anti-inflammatory for acute gout and prophylaxis; it is not a urate-lowering drug.
Medicine
Rheumatology
Which statement about serum urate during an acute gout attack is correct?
A. It establishes the diagnosis without aspiration
B. It is never useful in long-term management
C. It may be normal
D. It is always above 15 mg/dL
Correct Answer: C
Serum urate can be normal during a flare, so a normal value does not exclude acute gout.
Medicine
Rheumatology
Which joint is classically involved in podagra?
A. Temporomandibular joint
B. Sternoclavicular joint
C. Atlantoaxial joint
D. First metatarsophalangeal joint
Correct Answer: D
Podagra is acute gout affecting the first MTP joint.
Medicine
Rheumatology
Monosodium urate crystals are typically:
A. Needle-shaped and strongly negatively birefringent
B. Rhomboid and weakly positively birefringent
C. Square and non-birefringent
D. Hexagonal cystine crystals
Correct Answer: A
Gout crystals are needle-shaped and strongly negatively birefringent under compensated polarized light.
Medicine
Rheumatology
What is the definitive way to identify gout in an acutely inflamed joint?
A. Elevated rheumatoid factor
B. Demonstration of monosodium urate crystals in synovial fluid
C. Serum urate alone
D. ANA positivity
Correct Answer: B
Joint aspiration showing monosodium urate crystals is definitive; serum urate can be normal during an acute flare.
Medicine
Rheumatology
Which joint is commonly affected in primary osteoarthritis of the hand?
A. MCP joints symmetrically in all patients
B. Atlantoaxial joint only
C. First carpometacarpal joint
D. Elbow only
Correct Answer: C
The thumb-base first CMC joint is a common site of hand osteoarthritis.