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.
Medicine
Rheumatology
For knee osteoarthritis, which intervention is a core non-pharmacologic treatment?
A. Prolonged immobilization
B. Bed rest for months
C. High-dose steroids for every patient
D. Exercise and weight management when appropriate
Correct Answer: D
Exercise, strengthening and weight management are core evidence-based interventions for knee osteoarthritis.
Medicine
Rheumatology
Bouchard nodes occur at which joints?
A. Proximal interphalangeal joints
B. Distal interphalangeal joints
C. Wrists only
D. Atlantoaxial joint
Correct Answer: A
Bouchard nodes are bony enlargements of PIP joints in hand osteoarthritis.
Medicine
Rheumatology
Heberden nodes occur at which joints?
A. Sacroiliac joints
B. Distal interphalangeal joints
C. Metacarpophalangeal joints
D. Shoulders only
Correct Answer: B
Heberden nodes are bony enlargements of DIP joints; Bouchard nodes affect PIP joints.
Medicine
Rheumatology
Which radiographic combination is most typical of osteoarthritis?
A. Bamboo spine
B. Sacral insufficiency fracture only
C. Joint-space narrowing, osteophytes and subchondral sclerosis
D. Marginal erosions with periarticular osteopenia only
Correct Answer: C
Osteoarthritis commonly produces non-uniform joint-space loss, osteophytes, subchondral sclerosis and cysts.
Medicine
Rheumatology
Which cytokine pathway is an important therapeutic target in psoriatic arthritis and axial spondyloarthritis?
A. Erythropoietin pathway
B. Aldosterone pathway
C. Calcitonin pathway
D. IL-17 pathway
Correct Answer: D
IL-17 inhibition is an established targeted treatment option in PsA and axSpA.
Medicine
Rheumatology
Which spinal complication requires special caution after trauma in advanced ankylosing spondylitis?
A. Unstable vertebral fracture
B. Simple lumbar strain only
C. Scoliosis in every patient
D. Disc prolapse as the only concern
Correct Answer: A
An ankylosed spine is rigid and osteoporotic, making fractures more likely and potentially unstable even after minor trauma.
Medicine
Rheumatology
Which cardiac complication is recognized in longstanding ankylosing spondylitis?
A. Ventricular septal defect
B. Aortic regurgitation
C. Tetralogy of Fallot
D. Mitral stenosis as a defining feature
Correct Answer: B
Aortitis with aortic root disease can cause aortic regurgitation in longstanding ankylosing spondylitis.
Medicine
Rheumatology
A patient with active axial spondyloarthritis remains highly symptomatic despite appropriate NSAID therapy. Which class may be considered next under specialist care?
A. Bisphosphonate only
B. Antibiotics indefinitely
C. Biologic or targeted therapy such as TNF or IL-17 inhibition
D. Urate-lowering therapy
Correct Answer: C
ASAS-EULAR recommendations support biologic/targeted therapy in persistently active axSpA despite conventional management.
Medicine
Rheumatology
In axial spondyloarthritis, conventional DMARDs such as methotrexate are generally:
A. Curative for axial disease
B. Mandatory before exercise
C. Used to dissolve syndesmophytes
D. Not effective for purely axial disease
Correct Answer: D
Conventional DMARDs have limited benefit for purely axial disease, though some may help peripheral arthritis.
Medicine
Rheumatology
Which gastrointestinal disease is associated with enteropathic spondyloarthritis?
A. Inflammatory bowel disease
B. Irritable bowel syndrome alone
C. Peptic ulcer disease alone
D. Gallstones
Correct Answer: A
Crohn disease and ulcerative colitis can be associated with peripheral and/or axial spondyloarthritis.
Medicine
Rheumatology
Heel pain at the Achilles insertion in a patient with psoriasis is most suggestive of:
A. Tophus in every case
B. Enthesitis
C. Carpal tunnel syndrome
D. Scleritis
Correct Answer: B
Achilles insertion pain is a common enthesitis site in spondyloarthritis.
Medicine
Rheumatology
Enthesitis most directly refers to inflammation at which site?
A. Bone marrow only
B. Peripheral nerve sheath
C. Tendon or ligament insertion into bone
D. Synovial fluid only
Correct Answer: C
An enthesis is the site where a tendon, ligament or capsule inserts into bone; inflammation there is enthesitis.
Medicine
Rheumatology
Which triad is historically associated with reactive arthritis?
A. Arthritis, jaundice and hemoptysis
B. Myositis, nephritis and deafness
C. Fever, murmur and clubbing
D. Arthritis, urethritis and conjunctivitis
Correct Answer: D
The historical triad is arthritis, urethritis and conjunctivitis, although many patients do not have all three.
Medicine
Rheumatology
Reactive arthritis most often follows which type of preceding event?
A. Gastrointestinal or genitourinary infection
B. Isolated migraine
C. Bone fracture
D. Cataract surgery
Correct Answer: A
Reactive arthritis typically occurs after certain enteric infections or genitourinary infection, classically Chlamydia.
Medicine
Rheumatology
Which feature helps distinguish psoriatic arthritis from rheumatoid arthritis?
A. Morning stiffness alone
B. Dactylitis and nail pitting
C. Symmetric MCP synovitis only
D. Positive CRP only
Correct Answer: B
Dactylitis, nail disease, DIP involvement and enthesitis are strong clues to psoriatic arthritis.