Medicine
Rheumatology
A woman with rheumatoid arthritis is planning pregnancy. Which drug is contraindicated because of teratogenicity?
A. Sulfasalazine with folate
B. Paracetamol
C. Methotrexate
D. Hydroxychloroquine
Correct Answer: C
Methotrexate is teratogenic and must be discontinued before conception according to specialist guidance.
Medicine
Rheumatology
Which adverse effect is particularly important to monitor during methotrexate therapy?
A. Hyperthyroidism only
B. Retinal detachment only
C. Severe hypernatremia
D. Hepatotoxicity and cytopenias
Correct Answer: D
Methotrexate can cause liver injury, marrow suppression and other toxicities; blood counts and liver tests are routinely monitored.
Medicine
Rheumatology
A patient taking methotrexate for rheumatoid arthritis should usually receive which supplement to reduce selected adverse effects?
A. Folic acid
B. Vitamin K
C. Iron in all cases
D. Potassium chloride
Correct Answer: A
Folic acid supplementation reduces several methotrexate-related toxicities such as mucosal and gastrointestinal adverse effects.
Medicine
Rheumatology
Which conventional synthetic DMARD is commonly used as the anchor drug for rheumatoid arthritis?
A. Alendronate
B. Methotrexate
C. Colchicine
D. Allopurinol
Correct Answer: B
Methotrexate is a core first-line conventional DMARD for many patients with RA, depending on contraindications and disease context.
Medicine
Rheumatology
What is the preferred general strategy after a confident diagnosis of active rheumatoid arthritis?
A. Use antibiotics as long-term therapy
B. Treat only with opioids
C. Delay treatment until erosions appear
D. Start a DMARD promptly
Correct Answer: D
International recommendations emphasize early initiation of DMARD therapy to control inflammation and prevent structural damage.
Medicine
Rheumatology
Which hand deformity is classically associated with rheumatoid arthritis?
A. Mallet finger from trauma only
B. Dupuytren contracture
C. Trigger thumb only
D. Swan-neck deformity
Correct Answer: D
Swan-neck and boutonniere deformities result from chronic inflammatory damage in rheumatoid arthritis.
Medicine
Rheumatology
A patient with longstanding rheumatoid arthritis develops neck pain and neurologic symptoms. Which complication should be suspected?
A. Atlantoaxial subluxation
B. Lumbar spondylolisthesis only
C. Achilles rupture
D. Carpal coalition
Correct Answer: A
Cervical spine involvement in RA can cause atlantoaxial instability and spinal cord compression.
Medicine
Rheumatology
Which joints are characteristically spared in classic rheumatoid arthritis?
A. Wrists
B. Metacarpophalangeal joints
C. Proximal interphalangeal joints
D. Distal interphalangeal joints
Correct Answer: D
Classic RA predominantly affects MCP, PIP and wrist joints; DIP involvement suggests alternative diagnoses such as osteoarthritis or psoriatic arthritis.
Medicine
Rheumatology
Which antibody has the highest specificity for rheumatoid arthritis among the following?
A. Anti-centromere antibody
B. Anti-Jo-1 antibody
C. Anti-CCP antibody
D. ANA
Correct Answer: C
Anti-cyclic citrullinated peptide antibodies are highly specific for rheumatoid arthritis and may predict erosive disease.
Medicine
Rheumatology
Which imaging modality is most sensitive for early sacroiliac inflammation before definite radiographic changes appear?
A. MRI of the sacroiliac joints
B. Ultrasound of the thyroid
C. DEXA of the forearm
D. Plain chest radiograph
Correct Answer: A
MRI can detect active bone-marrow edema and sacroiliitis before structural changes are visible on plain radiographs.
Medicine
Rheumatology
Which finding is a classic extra-articular clue to a systemic rheumatic disease?
A. Heberden nodes only
B. Raynaud phenomenon
C. Isolated plantar wart
D. Simple ankle sprain
Correct Answer: B
Raynaud phenomenon can accompany systemic sclerosis, SLE, mixed connective-tissue disease and other autoimmune rheumatic disorders.
Medicine
Rheumatology
Before starting a biologic immunosuppressive agent, which screening is commonly required because treatment can reactivate latent infection?
A. Skin-prick allergy testing
B. Latent tuberculosis screening
C. Serum amylase only
D. Audiometry only
Correct Answer: B
Biologic and targeted immunosuppressive therapies can reactivate latent infections, particularly tuberculosis; screening is standard before treatment.
Medicine
Rheumatology
What is the principal purpose of disease-modifying antirheumatic drugs (DMARDs) in inflammatory arthritis?
A. Increase serum urate
B. Replace physiotherapy in all patients
C. Provide immediate anesthesia
D. Reduce structural damage and control disease activity
Correct Answer: D
DMARDs target the disease process and reduce inflammation, disability and long-term structural damage.
Medicine
Rheumatology
Which pattern best describes inflammatory back pain?
A. Improves with exercise and is worse after rest
B. Always associated with radicular weakness
C. Occurs only after trauma
D. Onset after age 60 and worse with movement
Correct Answer: A
Inflammatory back pain typically begins at a younger age, improves with exercise, worsens with rest and may cause night pain and morning stiffness.
Medicine
Rheumatology
Which synovial-fluid profile is most consistent with a non-inflammatory effusion such as osteoarthritis?
A. Low white-cell count with predominance of mononuclear cells
B. Very high neutrophil count with positive Gram stain
C. Needle-shaped negatively birefringent crystals
D. Marked leukocytosis with low glucose
Correct Answer: A
Osteoarthritis usually produces non-inflammatory synovial fluid with a relatively low leukocyte count.
Medicine
Rheumatology
A patient presents with a single acutely swollen knee and fever. What is the most important immediate diagnostic procedure?
A. Hand radiography
B. DEXA scan
C. Arthrocentesis with synovial fluid analysis
D. Serum ANA
Correct Answer: C
Acute monoarthritis with possible infection requires urgent joint aspiration for cell count, Gram stain, culture and crystal analysis.
Medicine
Rheumatology
Which statement about antinuclear antibody (ANA) testing is most accurate?
A. ANA is sensitive for SLE but lacks specificity
B. ANA is usually absent in connective-tissue disease
C. A positive ANA alone establishes SLE
D. ANA is highly specific for rheumatoid arthritis
Correct Answer: A
ANA is very sensitive for SLE but is not specific; positive results occur in other autoimmune diseases and in some healthy people.
Medicine
Rheumatology
Which laboratory test is most useful as a nonspecific marker of current systemic inflammation in many rheumatic diseases?
A. C-reactive protein
B. Rheumatoid factor
C. Antinuclear antibody
D. Serum uric acid
Correct Answer: A
CRP rises with systemic inflammation and can be followed over time, although it is not disease-specific.
Medicine
Rheumatology
A patient has warm, swollen metacarpophalangeal joints with morning stiffness lasting 90 minutes. Which finding most strongly supports inflammatory rather than mechanical arthritis?
A. Pain worsens after prolonged use
B. Prolonged morning stiffness
C. Bony enlargement without warmth
D. Pain relieved only by rest
Correct Answer: B
Inflammatory arthritis typically causes prolonged morning stiffness, synovial swelling and warmth; mechanical pain is usually activity-related with brief stiffness.
Medicine
Rheumatology
Which antibody is commonly associated with Sjögren syndrome?
A. Anti-GBM as the classic marker
B. Anti-mitochondrial antibody only
C. Anti-centromere antibody in every patient
D. Anti-Ro/SSA
Correct Answer: D
Anti-Ro/SSA and anti-La/SSB are commonly associated with Sjögren syndrome.