Medicine
Rheumatology
Which radiographic deformity is classically associated with severe psoriatic arthritis?
A. Atlantoaxial subluxation only
B. Chondrocalcinosis only
C. Pencil-in-cup deformity
D. Bamboo spine only
Correct Answer: C
Erosive change with bone proliferation can produce a pencil-in-cup appearance in psoriatic arthritis.
Medicine
Rheumatology
A patient with psoriasis has arthritis affecting DIP joints and nail pitting. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Polymyalgia rheumatica
C. Scleroderma renal crisis
D. Psoriatic arthritis
Correct Answer: D
DIP arthritis with nail dystrophy in a patient with psoriasis strongly supports psoriatic arthritis.
Medicine
Rheumatology
Which disease is most characteristically associated with dactylitis?
A. Psoriatic arthritis
B. Osteoarthritis only
C. Giant cell arteritis
D. Polymyalgia rheumatica
Correct Answer: A
Dactylitis, or a sausage digit, is characteristic of psoriatic arthritis and other spondyloarthritides.
Medicine
Rheumatology
Which non-pharmacologic intervention is particularly important in axial spondyloarthritis?
A. Avoidance of all physical activity
B. Regular exercise and physiotherapy
C. Prolonged bed rest
D. Complete spinal immobilization
Correct Answer: B
Exercise, posture work and physiotherapy are core components of axSpA management.
Medicine
Rheumatology
What is first-line pharmacologic therapy for pain and stiffness in active axial spondyloarthritis, assuming no contraindication?
A. Methotrexate for axial symptoms in every patient
B. Long-term opioid monotherapy
C. NSAID
D. Allopurinol
Correct Answer: C
ASAS-EULAR guidance uses NSAIDs as first-line drug treatment for axial pain and stiffness, alongside non-pharmacologic care.
Medicine
Rheumatology
Which bedside test is commonly used to assess lumbar flexion in suspected ankylosing spondylitis?
A. Tinel test
B. Phalen test
C. Finkelstein test
D. Modified Schober test
Correct Answer: D
The modified Schober test assesses lumbar flexion and may be reduced in axial spondyloarthritis.
Medicine
Rheumatology
A young man with inflammatory back pain has recurrent painful red photophobic eyes. Which extra-musculoskeletal manifestation is likely?
A. Acute anterior uveitis
B. Retinal detachment from trauma
C. Glaucoma as a defining feature
D. Cataract only
Correct Answer: A
Acute anterior uveitis is a classic extra-musculoskeletal manifestation of axial spondyloarthritis.
Medicine
Rheumatology
Which radiographic feature is classically seen in advanced ankylosing spondylitis?
A. Chondrocalcinosis
B. Bamboo spine
C. Pencil-in-cup deformity
D. Hook-like osteophytes at MCP joints
Correct Answer: B
Bridging syndesmophytes and vertebral fusion can produce the classic bamboo-spine appearance.
Medicine
Rheumatology
Which HLA allele is strongly associated with axial spondyloarthritis?
A. HLA-DQ2
B. HLA-A3
C. HLA-B27
D. HLA-DR4 only
Correct Answer: C
HLA-B27 is strongly associated with axial spondyloarthritis, although its presence alone is not diagnostic.
Medicine
Rheumatology
What is the preferred long-term objective of modern SLE management?
A. Chronic high-dose glucocorticoids in all patients
B. No laboratory monitoring
C. Complete avoidance of immunization
D. Remission or low disease activity with prevention of organ damage
Correct Answer: D
Current international recommendations emphasize remission or low disease activity, prevention of flares and organ damage, and minimizing glucocorticoid exposure.
Medicine
Rheumatology
A patient with SLE has painless oral ulcers and inflammatory polyarthritis. Which additional finding would most strongly suggest active systemic disease?
A. New proteinuria
B. Stable bunion
C. Old healed fracture
D. Isolated callus
Correct Answer: A
New proteinuria suggests organ involvement and possible lupus nephritis, which is clinically important active disease.
Medicine
Rheumatology
Which vascular phenomenon is common in SLE and other connective-tissue diseases?
A. Aortic coarctation
B. Raynaud phenomenon
C. Buerger disease in every patient
D. Varicose veins as a criterion
Correct Answer: B
Raynaud phenomenon is common across several connective-tissue diseases, including SLE.
Medicine
Rheumatology
In SLE, the presence of proteinuria, hematuria and reduced complement should raise the greatest concern for:
A. Plantar fasciitis
B. Mechanical back pain
C. Lupus nephritis
D. Osteoarthritis
Correct Answer: C
This combination strongly suggests active renal involvement from immune-complex lupus.
Medicine
Rheumatology
Which drug is generally avoided in pregnancy because of teratogenicity in patients with SLE?
A. Hydroxychloroquine
B. Azathioprine when clinically indicated
C. Low-dose aspirin when indicated
D. Mycophenolate mofetil
Correct Answer: D
Mycophenolate is teratogenic and is generally avoided in pregnancy; medication planning should be done before conception.
Medicine
Rheumatology
A patient with SLE develops fever, chest pain and a pericardial rub. Which diagnosis is most likely?
A. Lupus pericarditis
B. Gout
C. Osteoarthritis
D. Achilles tendinopathy
Correct Answer: A
Pericarditis is a recognized serosal manifestation of SLE.
Medicine
Rheumatology
Which advice is particularly important for a patient with photosensitive cutaneous lupus?
A. Stop all vaccines
B. Regular photoprotection
C. Increase ultraviolet exposure
D. Avoid all exercise permanently
Correct Answer: B
Photoprotection helps reduce ultraviolet-triggered cutaneous lupus activity.
Medicine
Rheumatology
Which neurologic manifestation can occur in SLE?
A. Congenital deafness only
B. Parkinson disease as a diagnostic criterion
C. Seizures
D. Only peripheral traumatic neuropathy
Correct Answer: C
Neuropsychiatric SLE can include seizures, psychosis, cerebrovascular disease, neuropathy and other manifestations.
Medicine
Rheumatology
Which urinalysis finding is especially suggestive of glomerulonephritis?
A. Calcium oxalate crystals only
B. Squamous epithelial cells
C. Urate crystals after dehydration
D. Red blood cell casts
Correct Answer: D
RBC casts indicate glomerular bleeding and support an inflammatory glomerulonephritis such as lupus nephritis.
Medicine
Rheumatology
A woman with SLE has recurrent pregnancy losses and a previous unprovoked DVT. Which associated disorder is most likely?
A. Antiphospholipid syndrome
B. Polymyalgia rheumatica
C. Reactive arthritis
D. Fibromyalgia
Correct Answer: A
Thrombosis plus characteristic pregnancy morbidity in a patient with antiphospholipid antibodies suggests antiphospholipid syndrome.
Medicine
Rheumatology
Which antibody is associated with neonatal lupus and congenital heart block?
A. c-ANCA only
B. Anti-Ro/SSA
C. Anti-CCP
D. Anti-Scl-70
Correct Answer: B
Maternal anti-Ro/SSA, and sometimes anti-La/SSB, can cross the placenta and are associated with neonatal lupus and congenital heart block.