Medicine
Rheumatology
Long-term systemic glucocorticoid therapy increases the risk of:
A. Increased bone strength
B. Reduced fracture risk
C. Osteoporosis
D. Gout cure
Correct Answer: C
Glucocorticoids accelerate bone loss and increase fracture risk, so bone protection should be assessed when prolonged therapy is used.
Medicine
Rheumatology
Which fracture is considered a classic fragility fracture?
A. Femur fracture in a high-speed collision
B. Open tibial fracture from machinery
C. Skull fracture after major trauma
D. Hip fracture after a fall from standing height
Correct Answer: D
Fragility fractures occur after low-energy trauma and commonly involve the hip, vertebrae, wrist or proximal humerus.
Medicine
Rheumatology
A T-score of -2.5 or lower at a validated skeletal site is consistent with:
A. Osteoporosis
B. Normal bone density
C. Gout
D. Rheumatoid arthritis
Correct Answer: A
A DXA T-score of -2.5 or lower is a densitometric definition of osteoporosis in appropriate adults.
Medicine
Rheumatology
Which investigation is standard for measuring bone mineral density in osteoporosis assessment?
A. Schirmer test
B. Dual-energy X-ray absorptiometry (DEXA/DXA)
C. MRI brain
D. Temporal artery biopsy
Correct Answer: B
DXA is the standard imaging test for bone mineral density and is central to osteoporosis evaluation.
Medicine
Rheumatology
Sarcoidosis can present with arthritis, erythema nodosum and bilateral hilar lymphadenopathy in which syndrome?
A. CREST syndrome
B. Trousseau syndrome
C. Löfgren syndrome
D. Felty syndrome
Correct Answer: C
Löfgren syndrome is an acute sarcoid presentation with erythema nodosum, bilateral hilar lymphadenopathy and ankle/periarticular inflammation.
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.