Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Systemic lupus erythematosus (SLE)?
A. Permanent vision loss
B. Restrictive chest-wall disease and spinal ankylosis
C. Lupus nephritis
D. Pulmonary arterial hypertension or interstitial lung disease
Correct Answer: C
Immune-complex glomerulonephritis is a major cause of morbidity in SLE.
Medicine
Rheumatology
A patient is diagnosed with Systemic lupus erythematosus (SLE). Which is the most appropriate management principle?
A. Use an NSAID, colchicine or corticosteroid for an acute flare when appropriate
B. Use organ- and severity-specific immunomodulatory therapy with hydroxychloroquine for many patients when not contraindicated
C. Start high-dose glucocorticoid treatment promptly when strongly suspected
D. Use exercise and physiotherapy plus anti-inflammatory therapy; escalate to biologic therapy for persistent active disease when indicated
Correct Answer: B
SLE management is individualized; severe kidney or CNS disease requires more intensive specialist therapy.
Medicine
Rheumatology
In a patient with suspected Systemic lupus erythematosus (SLE), which investigation or diagnostic approach is most appropriate at this stage?
A. ANA followed by more specific autoantibodies, complement and organ-directed testing
B. Clinical assessment; plain radiography when diagnosis is uncertain or before major intervention
C. Synovial-fluid analysis when diagnosis is uncertain or septic arthritis must be excluded
D. Inflammatory markers plus confirmatory temporal-artery imaging or biopsy as locally appropriate
Correct Answer: A
ANA is sensitive; specific antibodies and complement levels help support diagnosis and assess organ involvement.
Medicine
Rheumatology
A patient has photosensitive rash, inflammatory arthritis, oral ulcers and proteinuria. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Acute gout
D. Systemic lupus erythematosus (SLE)
Correct Answer: D
Multisystem autoimmune disease involving skin, joints and kidneys is typical of SLE.
Medicine
Rheumatology
What crystal finding is typical of gout?
A. Rhomboid positively birefringent calcium pyrophosphate crystals
B. Cholesterol crystals as the defining finding
C. Needle-shaped negatively birefringent monosodium urate crystals
D. No crystals can ever be seen
Correct Answer: C
Monosodium urate crystals are needle-shaped and negatively birefringent under polarized light.
Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Acute gout?
A. Pulmonary arterial hypertension or interstitial lung disease
B. Tophaceous joint damage
C. B-cell lymphoma
D. Joint erosions and deformity
Correct Answer: B
Persistent hyperuricemia can cause tophi, chronic arthritis and structural damage.
Medicine
Rheumatology
A patient is diagnosed with Acute gout. Which is the most appropriate management principle?
A. Use an NSAID, colchicine or corticosteroid for an acute flare when appropriate
B. Use exercise and physiotherapy plus anti-inflammatory therapy; escalate to biologic therapy for persistent active disease when indicated
C. Use organ-specific therapy and close monitoring while managing Raynaud phenomenon and reflux
D. Use symptomatic eye and oral moisture therapy and treat systemic disease according to organ involvement
Correct Answer: A
Acute gout is treated with anti-inflammatory therapy; long-term urate lowering is managed separately.
Medicine
Rheumatology
In a patient with suspected Acute gout, which investigation or diagnostic approach is most appropriate at this stage?
A. Inflammatory markers plus confirmatory temporal-artery imaging or biopsy as locally appropriate
B. Sacroiliac imaging with inflammatory markers and HLA-B27 used selectively
C. Autoantibody testing and organ screening including lungs, heart and kidneys
D. Synovial-fluid analysis when diagnosis is uncertain or septic arthritis must be excluded
Correct Answer: D
Needle-shaped negatively birefringent monosodium urate crystals confirm gout.
Medicine
Rheumatology
A patient develops abrupt severe pain, erythema and swelling of the first metatarsophalangeal joint. What is the most likely diagnosis?
A. Systemic lupus erythematosus (SLE)
B. Giant cell arteritis
C. Acute gout
D. Ankylosing spondylitis / axial spondyloarthritis
Correct Answer: C
Acute podagra is a classic presentation of crystal-induced gout.
Medicine
Rheumatology
Which feature favors osteoarthritis over rheumatoid arthritis?
A. Prolonged inflammatory morning stiffness with swollen MCP joints
B. Pain worsens with use and morning stiffness is brief
C. Systemic vasculitis
D. Markedly elevated inflammatory markers in every case
Correct Answer: B
Osteoarthritis typically causes mechanical activity-related pain with short-lived stiffness.
Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Osteoarthritis?
A. Progressive functional limitation
B. Joint erosions and deformity
C. Tophaceous joint damage
D. Lupus nephritis
Correct Answer: A
Advanced osteoarthritis can substantially impair mobility and daily activity.
Medicine
Rheumatology
A patient is diagnosed with Osteoarthritis. Which is the most appropriate management principle?
A. Use symptomatic eye and oral moisture therapy and treat systemic disease according to organ involvement
B. Start a disease-modifying antirheumatic drug early, commonly methotrexate when appropriate
C. Use an NSAID, colchicine or corticosteroid for an acute flare when appropriate
D. Use exercise, weight management and symptom-directed analgesic therapy
Correct Answer: D
Nonpharmacologic treatment is foundational and improves pain and function.
Medicine
Rheumatology
In a patient with suspected Osteoarthritis, which investigation or diagnostic approach is most appropriate at this stage?
A. Autoantibody testing and organ screening including lungs, heart and kidneys
B. Autoantibody testing with objective assessment of ocular and salivary gland function
C. Clinical assessment; plain radiography when diagnosis is uncertain or before major intervention
D. Inflammatory markers, rheumatoid factor and anti-CCP antibodies with imaging as appropriate
Correct Answer: C
Osteoarthritis is often a clinical diagnosis; X-rays can show joint-space narrowing and osteophytes.
Medicine
Rheumatology
A patient has chronic knee pain worse with use, brief morning stiffness and bony enlargement without systemic inflammation. What is the most likely diagnosis?
A. Ankylosing spondylitis / axial spondyloarthritis
B. Osteoarthritis
C. Systemic sclerosis
D. Sjögren syndrome
Correct Answer: B
Mechanical pain, short stiffness and bony changes are typical of osteoarthritis.
Medicine
Rheumatology
Which joint pattern is most characteristic of rheumatoid arthritis?
A. Symmetric MCP and PIP involvement with prolonged morning stiffness
B. Isolated first MTP attack only
C. DIP-predominant bony enlargement only
D. Acute monoarthritis after trauma
Correct Answer: A
RA classically affects small joints symmetrically and usually spares the DIP joints.
Medicine
Rheumatology
Which complication or major adverse outcome is particularly associated with Rheumatoid arthritis?
A. Lupus nephritis
B. Permanent vision loss
C. Restrictive chest-wall disease and spinal ankylosis
D. Joint erosions and deformity
Correct Answer: D
Untreated synovitis causes progressive cartilage and bone destruction.
Medicine
Rheumatology
A patient is diagnosed with Rheumatoid arthritis. Which is the most appropriate management principle?
A. Use an NSAID, colchicine or corticosteroid for an acute flare when appropriate
B. Use organ- and severity-specific immunomodulatory therapy with hydroxychloroquine for many patients when not contraindicated
C. Start a disease-modifying antirheumatic drug early, commonly methotrexate when appropriate
D. Start high-dose glucocorticoid treatment promptly when strongly suspected
Correct Answer: C
Early DMARD therapy reduces joint damage; NSAIDs alone do not prevent progression.
Medicine
Rheumatology
In a patient with suspected Rheumatoid arthritis, which investigation or diagnostic approach is most appropriate at this stage?
A. Clinical assessment; plain radiography when diagnosis is uncertain or before major intervention
B. Inflammatory markers, rheumatoid factor and anti-CCP antibodies with imaging as appropriate
C. Synovial-fluid analysis when diagnosis is uncertain or septic arthritis must be excluded
D. ANA followed by more specific autoantibodies, complement and organ-directed testing
Correct Answer: B
Anti-CCP is relatively specific and helps prognosis, but diagnosis remains clinical with supportive investigations.
Medicine
Rheumatology
A patient has symmetric small-joint pain and swelling with prolonged morning stiffness. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Sjögren syndrome
C. Osteoarthritis
D. Acute gout
Correct Answer: A
Symmetric inflammatory polyarthritis affecting MCP and PIP joints is typical of rheumatoid arthritis.
Medicine
Respiratory Medicine
Which symptom is particularly characteristic of clinically significant OSA?
A. Persistent hematuria
B. Isolated jaundice
C. Severe unilateral leg weakness
D. Excessive daytime sleepiness with witnessed nocturnal apneas
Correct Answer: D
Recurrent nocturnal obstruction fragments sleep and commonly causes daytime somnolence.