Medicine
Rheumatology
Which renal finding should prompt evaluation for lupus nephritis?
A. Isolated glycosuria after a meal
B. Transient ketonuria during fasting
C. Asymptomatic bacteriuria only
D. Proteinuria with active urinary sediment
Correct Answer: D
Proteinuria, hematuria and cellular casts can indicate lupus nephritis and require prompt assessment.
Medicine
Rheumatology
Which complement pattern is often seen during active immune-complex SLE?
A. Low C3 and/or C4
B. Persistently high C3 and C4 in every flare
C. Absent IgG only
D. High haptoglobin only
Correct Answer: A
Complement consumption can lower C3 and C4 during active SLE, especially nephritis.
Medicine
Rheumatology
Which antibody level often correlates with lupus nephritis activity?
A. Anti-Jo-1
B. Anti-double-stranded DNA
C. Anti-mitochondrial antibody
D. Anti-CCP
Correct Answer: B
Rising anti-dsDNA titers and falling complement can accompany active immune-complex lupus, particularly nephritis.
Medicine
Rheumatology
Which autoantibody is most specific for systemic lupus erythematosus?
A. Anti-CCP antibody
B. Anti-centromere antibody
C. Anti-Smith antibody
D. Rheumatoid factor
Correct Answer: C
Anti-Smith antibody is highly specific for SLE, although it is less sensitive than ANA.
Medicine
Rheumatology
A rheumatoid arthritis patient on immunosuppression presents with a hot swollen knee and fever. What diagnosis must be excluded urgently?
A. Simple fibromyalgia flare
B. Osteoporosis
C. Carpal tunnel syndrome
D. Septic arthritis
Correct Answer: D
Immunosuppressed RA patients are at increased risk of joint infection; septic arthritis requires urgent aspiration and treatment.
Medicine
Rheumatology
Which feature favors rheumatoid arthritis over hand osteoarthritis?
A. Symmetric MCP swelling with prolonged morning stiffness
B. Heberden nodes at DIP joints
C. Pain mainly after use with brief stiffness
D. First CMC bony enlargement
Correct Answer: A
Symmetric inflammatory MCP/PIP synovitis with prolonged stiffness is characteristic of RA.
Medicine
Rheumatology
What does a treat-to-target approach in rheumatoid arthritis primarily aim for?
A. Stopping all monitoring
B. Persistent moderate disease activity
C. Remission or low disease activity
D. A fixed ESR regardless of symptoms
Correct Answer: C
Treat-to-target strategies adjust therapy toward remission or, when not achievable, low disease activity.
Medicine
Rheumatology
Which ocular complication may be associated with rheumatoid arthritis?
A. Central retinal artery occlusion as a defining feature
B. Congenital cataract
C. Scleritis
D. Retinitis pigmentosa
Correct Answer: C
RA can cause episcleritis and scleritis; scleritis may indicate significant systemic inflammation.
Medicine
Rheumatology
A rheumatoid arthritis patient develops numbness in the thumb, index and middle fingers. What is the likely cause?
A. Ulnar neuropathy at the elbow
B. Radial nerve palsy
C. Meralgia paresthetica
D. Carpal tunnel syndrome
Correct Answer: D
Wrist synovitis in RA can compress the median nerve and produce carpal tunnel syndrome.
Medicine
Rheumatology
Which finding suggests high disease activity rather than irreversible mechanical damage in rheumatoid arthritis?
A. Active synovitis with elevated CRP
B. Fixed joint deformity without swelling
C. Old radiographic erosions alone
D. Chronic tendon shortening alone
Correct Answer: A
Active synovitis and elevated inflammatory markers support ongoing inflammatory disease activity.
Medicine
Rheumatology
Before initiating a TNF inhibitor, which infection is especially important to exclude or treat if latent?
A. Dental caries only
B. Tuberculosis
C. Tinea pedis only
D. Otitis externa only
Correct Answer: B
TNF inhibition can reactivate latent tuberculosis, so screening and appropriate management are required.
Medicine
Rheumatology
Which cytokine is a major therapeutic target in rheumatoid arthritis?
A. Insulin
B. Calcitonin
C. Tumor necrosis factor alpha
D. Erythropoietin
Correct Answer: C
TNF-alpha is a major inflammatory cytokine targeted by several biologic DMARDs.
Medicine
Rheumatology
Which radiographic finding is typical of established rheumatoid arthritis?
A. Pencil-in-cup deformity only
B. Chondrocalcinosis
C. Subchondral sclerosis without erosions only
D. Marginal erosions and joint-space narrowing
Correct Answer: D
RA commonly causes periarticular osteopenia, uniform joint-space loss and marginal erosions.
Medicine
Rheumatology
Felty syndrome is classically defined by rheumatoid arthritis, splenomegaly and which additional finding?
A. Neutropenia
B. Polycythemia
C. Eosinophilia
D. Thrombocytosis only
Correct Answer: A
Felty syndrome consists of longstanding RA, splenomegaly and neutropenia, increasing infection risk.
Medicine
Rheumatology
Which extra-articular pulmonary manifestation can occur in rheumatoid arthritis?
A. Congenital bronchiectasis only
B. Interstitial lung disease
C. Isolated pneumothorax in every patient
D. Pulmonary embolism as a defining feature
Correct Answer: B
RA can involve the lungs, including interstitial lung disease, pleural disease and rheumatoid nodules.
Medicine
Rheumatology
A woman with rheumatoid arthritis is planning pregnancy. Which drug is contraindicated because of teratogenicity?
A. Sulfasalazine with folate
B. Paracetamol
C. Methotrexate
D. Hydroxychloroquine
Correct Answer: C
Methotrexate is teratogenic and must be discontinued before conception according to specialist guidance.
Medicine
Rheumatology
Which adverse effect is particularly important to monitor during methotrexate therapy?
A. Hyperthyroidism only
B. Retinal detachment only
C. Severe hypernatremia
D. Hepatotoxicity and cytopenias
Correct Answer: D
Methotrexate can cause liver injury, marrow suppression and other toxicities; blood counts and liver tests are routinely monitored.
Medicine
Rheumatology
A patient taking methotrexate for rheumatoid arthritis should usually receive which supplement to reduce selected adverse effects?
A. Folic acid
B. Vitamin K
C. Iron in all cases
D. Potassium chloride
Correct Answer: A
Folic acid supplementation reduces several methotrexate-related toxicities such as mucosal and gastrointestinal adverse effects.
Medicine
Rheumatology
Which conventional synthetic DMARD is commonly used as the anchor drug for rheumatoid arthritis?
A. Alendronate
B. Methotrexate
C. Colchicine
D. Allopurinol
Correct Answer: B
Methotrexate is a core first-line conventional DMARD for many patients with RA, depending on contraindications and disease context.
Medicine
Rheumatology
What is the preferred general strategy after a confident diagnosis of active rheumatoid arthritis?
A. Use antibiotics as long-term therapy
B. Treat only with opioids
C. Delay treatment until erosions appear
D. Start a DMARD promptly
Correct Answer: D
International recommendations emphasize early initiation of DMARD therapy to control inflammation and prevent structural damage.