Medicine
Rheumatology
Which statement about vaccination in patients receiving immunosuppressive rheumatology treatment is most accurate?
A. Only live vaccines are preferred during intense immunosuppression
B. Vaccination status is irrelevant
C. Vaccination planning should be reviewed, and live vaccines may be contraindicated with significant immunosuppression
D. All vaccines are permanently forbidden
Correct Answer: C
Vaccination is an important preventive strategy; timing and use of live vaccines depend on the degree and type of immunosuppression.
Medicine
Rheumatology
Which symptom best suggests temporomandibular joint inflammation rather than isolated dental disease?
A. Dental caries visible on one tooth
B. Gum bleeding only
C. Tongue ulcer only
D. Preauricular pain with restricted jaw movement and joint tenderness
Correct Answer: D
TMJ inflammation can produce preauricular pain, tenderness and restricted or painful jaw movement.
Medicine
Rheumatology
What is the main purpose of nailfold capillaroscopy in rheumatology?
A. Assess microvascular changes in Raynaud phenomenon and systemic sclerosis
B. Diagnose gout crystals
C. Measure bone density
D. Assess lumbar flexion
Correct Answer: A
Nailfold capillaroscopy can identify a scleroderma-pattern microangiopathy and help assess secondary Raynaud phenomenon.
Medicine
Rheumatology
Which finding suggests secondary rather than primary Raynaud phenomenon?
A. No tissue injury
B. Digital ulcers and abnormal nailfold capillaries
C. Symptoms beginning in adolescence with normal examination
D. Symmetric mild episodes only
Correct Answer: B
Digital ischemic injury, late onset, asymmetry, abnormal capillaroscopy or systemic features suggest an underlying connective-tissue disease.
Medicine
Rheumatology
Which condition is characterized by episodic color changes of the fingers triggered by cold or stress?
A. Livedo from heat exposure
B. Tophus formation
C. Raynaud phenomenon
D. Erythema nodosum
Correct Answer: C
Raynaud phenomenon causes episodic digital vasospasm with color changes, often triggered by cold or emotional stress.
Medicine
Rheumatology
A patient with recurrent episodes of painful red ears, but sparing of the lobules, also has hoarseness. Which diagnosis is most likely?
A. Gout
B. Rheumatoid arthritis
C. Osteoarthritis
D. Relapsing polychondritis
Correct Answer: D
Auricular chondritis with lobule sparing plus laryngotracheal symptoms is characteristic of relapsing polychondritis.
Medicine
Rheumatology
Which cardiac lesion is classically associated with chronic rheumatic heart disease?
A. Mitral stenosis
B. Atrial septal defect
C. Tetralogy of Fallot
D. Coarctation of the aorta
Correct Answer: A
Chronic rheumatic heart disease most classically causes mitral valve disease, especially mitral stenosis.
Medicine
Rheumatology
Acute rheumatic fever follows infection with:
A. Hepatitis C virus
B. Group A Streptococcus
C. Staphylococcus aureus
D. Mycobacterium tuberculosis
Correct Answer: B
Acute rheumatic fever is an immune-mediated complication following group A streptococcal pharyngitis.
Medicine
Rheumatology
Which finding is part of the Jones criteria framework for acute rheumatic fever?
A. Sclerodactyly
B. Dactylitis from psoriasis
C. Migratory polyarthritis
D. Tophus formation
Correct Answer: C
Migratory polyarthritis is a major manifestation used in the diagnostic framework for acute rheumatic fever.
Medicine
Rheumatology
A serious hyperinflammatory complication of systemic juvenile idiopathic arthritis is:
A. Carpal tunnel syndrome
B. Podagra
C. Dupuytren contracture
D. Macrophage activation syndrome
Correct Answer: D
Macrophage activation syndrome is a life-threatening complication with fever, cytopenias, liver dysfunction, coagulopathy and very high ferritin.
Medicine
Rheumatology
Systemic juvenile idiopathic arthritis is characteristically associated with:
A. Quotidian fever and evanescent salmon-colored rash
B. Tophi
C. Sclerodactyly
D. Bamboo spine
Correct Answer: A
Systemic JIA can cause daily spiking fevers, an evanescent salmon rash, arthritis and systemic inflammation.
Medicine
Rheumatology
Children with certain forms of juvenile idiopathic arthritis require regular screening for which potentially silent complication?
A. Scleroderma renal crisis
B. Anterior uveitis
C. Gout
D. Aortic aneurysm in every child
Correct Answer: B
Chronic anterior uveitis can be asymptomatic in JIA, especially ANA-positive oligoarticular disease, making screening essential.
Medicine
Rheumatology
Which feature is typical of juvenile idiopathic arthritis?
A. Always positive rheumatoid factor
B. Always sacroiliitis
C. Arthritis beginning before age 16 and lasting at least 6 weeks after other causes are excluded
D. Only adult-onset disease
Correct Answer: C
JIA is a group of chronic arthritides beginning before age 16, defined by persistent arthritis after exclusion of other causes.
Medicine
Rheumatology
A sexually active young adult has migratory polyarthralgia, tenosynovitis and pustular skin lesions. Which infection should be considered?
A. Hepatitis A
B. Tetanus
C. Malaria
D. Disseminated gonococcal infection
Correct Answer: D
The arthritis-dermatitis syndrome of disseminated gonococcal infection can cause migratory pain, tenosynovitis and pustular lesions.
Medicine
Rheumatology
Which organism is the most common cause of septic arthritis in adults overall?
A. Staphylococcus aureus
B. Mycoplasma pneumoniae
C. Helicobacter pylori
D. Clostridium tetani
Correct Answer: A
Staphylococcus aureus is the most common cause of native-joint septic arthritis in adults.
Medicine
Rheumatology
The most important diagnosis to exclude in an acutely hot swollen native joint with fever is:
A. Polymyalgia rheumatica
B. Septic arthritis
C. Fibromyalgia
D. Osteoporosis
Correct Answer: B
Septic arthritis can rapidly destroy a joint and cause sepsis; urgent aspiration and antibiotics after cultures are critical.
Medicine
Rheumatology
Which laboratory pattern is compatible with vitamin D deficiency osteomalacia?
A. Positive anti-CCP
B. Low CK only
C. Low phosphate with elevated alkaline phosphatase
D. High urate only
Correct Answer: C
Osteomalacia may show low phosphate, secondary hyperparathyroidism and elevated alkaline phosphatase, depending on severity and cause.
Medicine
Rheumatology
Which vitamin deficiency can contribute to osteomalacia?
A. Vitamin C excess
B. Vitamin B12 excess
C. Vitamin K excess
D. Vitamin D deficiency
Correct Answer: D
Vitamin D deficiency can impair mineralization and cause osteomalacia in adults.
Medicine
Rheumatology
Which rare complication is associated with long-term potent antiresorptive therapy and is relevant to dental procedures?
A. Osteonecrosis of the jaw
B. Temporal arteritis
C. Uveitis in every patient
D. Scleroderma renal crisis
Correct Answer: A
Medication-related osteonecrosis of the jaw is rare but clinically important, particularly with higher-dose antiresorptive therapy.
Medicine
Rheumatology
Which medication class is commonly used as first-line antiresorptive therapy for osteoporosis when appropriate?
A. TNF inhibitors
B. Bisphosphonates
C. Colchicine
D. Hydroxychloroquine
Correct Answer: B
Bisphosphonates are commonly used first-line antiresorptive agents for osteoporosis in suitable patients.