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.
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.