Medicine
Rheumatology
A patient with suspected septic arthritis also has a history of gout. Which statement is correct?
A. Finding urate crystals does not exclude concomitant infection
B. Urate crystals completely rule out infection
C. Culture is unnecessary if crystals are seen
D. Antibiotics are never required
Correct Answer: A
Crystal arthritis and septic arthritis can coexist; synovial culture remains important when infection is clinically possible.
Medicine
Rheumatology
A patient with SLE has proteinuria, hematuria and red-cell casts. What complication is most likely?
A. Lupus nephritis
B. Osteoarthritis
C. Fibromyalgia
D. Septic bursitis
Correct Answer: A
Proteinuria with active urinary sediment and RBC casts in SLE strongly suggests immune-mediated glomerulonephritis due to lupus nephritis.
Medicine
Rheumatology
A patient with rheumatoid arthritis has persistent active disease despite an adequate methotrexate trial. Before starting a biologic DMARD, which screening is especially important?
A. Latent tuberculosis and hepatitis risk assessment
B. Routine colonoscopy in all ages
C. Exercise stress test in every patient
D. No infection screening is needed
Correct Answer: A
Biologic and targeted therapies can reactivate latent infections, so TB and relevant hepatitis screening are important before treatment.
Medicine
Rheumatology
A patient with Sjögren syndrome has dry eyes and dry mouth. Which long-term complication has increased risk?
A. B-cell lymphoma
B. Colon polyps only
C. Acute appendicitis
D. Aortic dissection
Correct Answer: A
Sjögren syndrome is associated with an increased risk of B-cell non-Hodgkin lymphoma, especially with persistent gland enlargement or systemic features.
Medicine
Rheumatology
A patient with antiphospholipid syndrome has recurrent venous thrombosis. What is the key long-term treatment principle?
A. Long-term anticoagulation when indicated
B. Routine platelet transfusion
C. No treatment after the first event
D. Long-term antibiotics
Correct Answer: A
Thrombotic antiphospholipid syndrome generally requires sustained anticoagulation, with regimen tailored to thrombosis type and patient risk.
Medicine
Rheumatology
A 30-year-old man has chronic inflammatory back pain that improves with exercise, reduced chest expansion and bilateral sacroiliitis. What is the most likely diagnosis?
A. Axial spondyloarthritis
B. Mechanical lumbar strain
C. Polymyalgia rheumatica
D. Osteoarthritis of hands
Correct Answer: A
Inflammatory back pain in a young adult with sacroiliitis and reduced spinal mobility is typical of axial spondyloarthritis.
Medicine
Rheumatology
A patient with pseudogout is most likely to have which crystal type?
A. Calcium pyrophosphate crystals
B. Monosodium urate crystals
C. Cystine crystals
D. Calcium oxalate urinary crystals only
Correct Answer: A
CPPD causes rhomboid, weakly positively birefringent calcium pyrophosphate crystals in synovial fluid.
Medicine
Rheumatology
A patient with acute podagra has severe pain and swelling of the first MTP joint. Which synovial crystal finding confirms gout?
A. Needle-shaped negatively birefringent monosodium urate crystals
B. Rhomboid positively birefringent calcium pyrophosphate crystals
C. Cholesterol crystals only
D. No crystals can be present
Correct Answer: A
Monosodium urate crystals are needle-shaped and show strong negative birefringence under polarized light.
Medicine
Rheumatology
A patient with systemic sclerosis has abrupt severe hypertension and rapidly rising creatinine. Which treatment is essential?
A. ACE inhibitor
B. High-dose NSAID
C. Thiazide alone
D. Methotrexate alone
Correct Answer: A
Scleroderma renal crisis is treated urgently with ACE inhibition, even if kidney function initially worsens.
Medicine
Rheumatology
A patient has proximal muscle weakness, elevated CK and a violaceous periorbital rash. What is the most likely diagnosis?
A. Dermatomyositis
B. Fibromyalgia
C. Polymyalgia rheumatica
D. Gout
Correct Answer: A
Dermatomyositis combines inflammatory proximal myopathy with characteristic cutaneous findings such as heliotrope rash and Gottron papules.
Medicine
Rheumatology
A young woman has recurrent oral ulcers, genital ulcers and uveitis. Which disease is most likely?
A. Behçet syndrome
B. Rheumatoid arthritis
C. Osteoarthritis
D. Gout
Correct Answer: A
Recurrent oral and genital ulceration with ocular inflammation is a classic presentation of Behçet syndrome.
Medicine
Rheumatology
A patient with polymyalgia rheumatica is most likely to have which symptom pattern?
A. Bilateral shoulder and hip girdle pain with prolonged morning stiffness
B. Distal weakness with absent reflexes
C. Acute monoarthritis of first MTP only
D. Painless joint deformity
Correct Answer: A
Polymyalgia rheumatica causes aching and morning stiffness in the shoulder and hip girdles in older adults.
Medicine
Rheumatology
A 70-year-old has new unilateral headache, scalp tenderness and jaw claudication with ESR 95 mm/hr. What should be done immediately if giant cell arteritis is suspected?
A. Start high-dose glucocorticoids
B. Wait for biopsy before treatment
C. Give allopurinol
D. Start colchicine only
Correct Answer: A
Treatment for suspected giant cell arteritis should begin immediately to reduce the risk of irreversible visual loss; diagnostic confirmation can follow.
Medicine
Rheumatology
A patient with rheumatoid arthritis develops neck pain, occipital headache and neurologic symptoms. Which complication must be excluded before airway manipulation?
A. Atlantoaxial subluxation
B. Lumbar disc herniation
C. Carpal tunnel syndrome only
D. Achilles tendinopathy
Correct Answer: A
Long-standing RA can cause atlantoaxial instability, which is important to recognize before intubation or neck manipulation.
Medicine
Hematology
A patient with beta-thalassemia major receiving repeated transfusions is at risk for which long-term complication?
A. Iron overload
B. Vitamin C deficiency only
C. Severe thrombocytosis always
D. Hypercoagulability never occurs
Correct Answer: A
Chronic transfusions cause iron accumulation that can damage the heart, liver and endocrine organs unless appropriately monitored and chelated.
Medicine
Hematology
A pregnant woman with prior unprovoked DVT requires anticoagulation. Which agent is generally preferred during pregnancy?
A. Low-molecular-weight heparin
B. Warfarin throughout pregnancy
C. A direct oral anticoagulant as first choice
D. Aspirin alone
Correct Answer: A
LMWH is commonly preferred for treatment and prevention of venous thromboembolism during pregnancy because it does not cross the placenta.
Medicine
Hematology
A patient with polycythemia vera is most likely to have which mutation?
A. JAK2 mutation
B. BCR-ABL1
C. Factor V Leiden only
D. HFE C282Y only
Correct Answer: A
Most patients with polycythemia vera have a JAK2 driver mutation causing constitutive signaling.
Medicine
Hematology
Which finding suggests hemolysis?
A. High LDH, low haptoglobin and indirect hyperbilirubinemia
B. Low LDH and high haptoglobin
C. Direct hyperbilirubinemia only with normal reticulocytes
D. Low reticulocyte count in all cases
Correct Answer: A
Red-cell destruction releases LDH and hemoglobin, lowers haptoglobin and increases unconjugated bilirubin; reticulocytes usually rise if marrow function is intact.
Medicine
Hematology
A patient has bone pain, anemia, renal impairment, hypercalcemia and a monoclonal protein. What is the most likely diagnosis?
A. Multiple myeloma
B. Polycythemia vera
C. ITP
D. Thalassemia trait
Correct Answer: A
The CRAB features—hyperCalcemia, Renal dysfunction, Anemia and Bone disease—are classic for symptomatic multiple myeloma.
Medicine
Hematology
A patient with acute promyelocytic leukemia is at high risk for DIC. Which targeted agent should be started promptly when APL is suspected?
A. All-trans retinoic acid
B. Imatinib only
C. Rituximab
D. Hydroxyurea alone
Correct Answer: A
APL is a hematologic emergency; ATRA should be initiated promptly because it reduces coagulopathy-related mortality.