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Rheumatology exam for FCPS part 1 with Dr Sohrab
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Rheumatology exam for FCPS part 1 with Dr Sohrab
Rheumatology exam for FCPS part 1 with Dr Sohrab
1
Personal infomations
2
True and false
3
multiple choice
Name
*
Phone number
*
Email
X-ray signs of osteoarthritis a) Subchondral cysts b) Joint narrowing c) Intra articular panna formation d). Periarticular osteoporosis e) Subchondral sclerosis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Uric acid crystals characteristics a) Positive birefringence b) Strong light intensity c) Rhomboid d) Found in WBC e) Free in synovial fluid
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Alkaline phosphatase increases in a) Pagets disease l te b) Нypеграrathyroidism c) Osteomalacia d) Multiple myeloma -e) Renal osteodystrophy
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Patient came with you proximal muscle weakness, Which of the following inveștigation will in suggest-- a) AMA b) ANA c) Anti JO antibody d) Anti Ro antibody е) СРК
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A 60 years old male presented with fatiguability, back pain & difficulty in standing up from sitting position. To diagnose a case of osteomalacia, what are the laboratory findings? a) Serum PTH ↑ b) Serum Ca+↓ c) Vit D↓ d) Serum phosphadase ↑ e) Serum AL↓
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Chondrocytes contain a) Type l collagen b) Chondroitin sulphate c) Keratin sulphate d) Hyaluronon e) Gulatin
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding osteoblast -- a) Multinucleated b) Mononuclear c) Differentiated to osteocyte d) Causes bone resorption e) Stromal cell origin
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
What are the pro-inflammatory cytokines causing cartilage degradation? a) IL-1 b) TNF c) IL-2 d) Sclerostin e) RANKL
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding Gout --- a) MSU deposit in & around synovial joint b) Hyperuricaemia c) Between Attack, aspiration joint of 1" MTP reveals Crystals d) Lifestyle modification is not effective as drug therapy e) Febuxostat is the drug of 1s' choice
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding reactive arthritis -- a) May be presented with non-specific urethritis b) Occurs predominantly in old age c) Is the most common cause of arthritis in young age d) May be precipitated by shield e) HLA B" positive men are more prone to develop the condition
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Allopurinol ---- a) Can cause acute hyperuricemia b) Inhibits xanthine oxidase c) Cannot be given with NSAIDS d) Is contraindicated in renal failure e) Inhibits Azathioprine
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Anti-nuclear antibodies can be found in a) Autoimmune hepatitis b) Systemic sclerosis c) Dermatomyositis d) Rheumatoid arthritis e) Ankylosing spondyliti
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The following crystals are associated with inflammatory joint disease a) Monosodium urate b) Calcium pyrophosphate c) Lactate d) Pyruvate e) Basic calcium phosphate
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
C-reactive protein increased in a) Multiple myeloma b) Sjogren's syndrome c) Viral infection d) Rheumatoid arthritis e) Polymyalgia rheumatica
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Synovial fluid is --- a) Reddish is color b) Low viscosity c) Ultrafiltrate plasma d) Lubricate the joint e) Absent in facet
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Disease modifying anti-rheumatic drugs are a) Sulfinpyrazone b) D-penicillamine c) Sulphasalazene d) Chloroquine e) Probenecid
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
X-ray findings of osteoarthritis a) Reduction in joint space b) Ligamental calcification c) Syndesmophyte formation d) Osteophyte formation e) Loss of articular cartilage
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
The investigations performed in a patient suffering from Raynaud's phenomenon should include a) Assay of hemagglutinating antibodies b) Rheumatoid factor c) Antimitochondrial antibodies d) Serum potassium e) X-ray the root of the neck
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Regarding dermatomyositis -- a) Heliotrope rash b) Gatton's papules and violaceous plaques c) Cutaneous manifestation like ulceration, lipodystrophy and dystrophic calcification d) Raised CK and EMG may confirm the presence of myopathy and exclude neuropathy e) Strongly associated with internal malignancy like ovary, lung, pancreas, stomach and colorectal
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Synovial fluid a) Secreted from joint macrophage-A b) Very viscous in normal person c) Turbid in osteoarthritis d) Cloudy-in septic arthritis e) Low viscous in septic arthritis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Causes of hyperuricemia a) Phenylbutazone b) High dose aspirin c) Cytotoxic drug Rx in leukemia d) Diuretics e) Chronic pyelonephritis
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
X-ray findings of OA -- a) I Joint space b) Marginal osteophytes c) Syndesmophytes d) Sub chondral sclerosis e) Sub chondral erosion
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
DMARDS are -- a) Sulfasalazine b) Ketotifen c) Methotrexate d) Penicillamine e) Nimesulide
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
Abduction shoulder done by - a) Terse major b). Deltoid c) Supraspinatus d) Pectoralis major e) Terse Minor
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
COX-2 -- a) Constitutive or housekeeping enzyme b) Regulate gut mucosal integrity c) Inflammatory enzyme d) Upregulated at inflammatory site in CNS e) Cause platelet aggregation
Option a is true
Option a is false
Option b is true
Option b is false
Option c is true
Option c is false
Option d is true
Option d is false
Option e is true
Option e is false
A 29-year-old woman presents with early-onset systemic lupus erythematosus (SLE). She has suffered from a number of infections as a child and you wonder about inherited complement deficiency. Deficiency of which one of the following complement factors is most associated with early onset SLE?
C3
C4
C5
C6
C7
A 20-year-old man is seen in the clinic with a rash over his buttocks and lower legs and pain and swelling in both knees. Two weeks earlier, he had an upper respiratory tract infection. His blood pressure is 170/100 mmHg. Routine blood tests are unremarkable except for raised immunoglobulin A (IgA) levels and an erythrocyte sedimentation rate (ESR) of 62 mm/1st hour. Urinalysis shows evidence of proteinuria (2+. Blood 1+). What is the most likely diagnosis?
Diffuse cutaneous systemic sclerosis
Haemolytic-uraemic syndrome
Henoch–Schönlein purpura
Microscopic polyangiitis
Polyarteritis nodosa
A 23-year-old man presents with chronic lower back pain which is much worse in the morning. There is no history of bowel symptoms. Occasionally the pain seems to radiate to involve the buttocks and the backs of his thighs. On examination he appears to have some loss of lateral flexion. You suspect that he may have ankylosing spondylitis. Which one of the following is the most appropriate investigation to confirm the diagnosis ?
HLA testing for B27
CRP
CT lumbar spine
X-ray of the sacroiliac joints
MRI of the sacroiliac joints
A 67-year-old woman presents with a 3-month history of persistent malaise, anorexia, shoulder and hip pain and a weight loss of 7 kg. On examination there is mild painful limitation of the hip and shoulder movements, but no weakness and only minor muscle pain on palpation. What is the most likely diagnosis?
Fibromyalgia
Multiple sclerosis
Polymyalgia rheumatica
Polymyositis
Sarcoidosis
A 28-year-old woman who has taken up jogging comes to the Rheumatology Clinic for review. She has pain affecting the lateral aspect of her hip and outer thigh, worse on palpation and exacerbated by walking. The pain is also made worse by lying on the affected side. Examination reveals pain and stiffness at the extremes of external and internal rotation. Hip X-ray, including frog leg views, is entirely normal. Which of the following is the most likely diagnosis?
Iliotibial band syndrome
Lumbosacral radiculopathy
Osteoarthritis (OA) hip
Proximal myopathy
Trochanteric bursitis
A 66-year-old woman has sustained two vertebral fractures following minor trauma and is diagnosed with osteoporosis. Initially she is treated with bisphosphonate but the treatment is stopped because of sideeffects. You are considering raloxifene as an alternative therapy. In your advice to the patient you should inform her that this therapy can cause which one of the following?
Cause vaginal bleeding at the end of each month of therapy
Improve the bone mineral density in the spine and hip
Increase the high density lipoprotein (HDL) levels
Increase the risk of breast cancer
Increase the risk of clotting
A 26-year-old woman presents with a malar rash, photosensitivity and arthralgia. On examination she has oral ulcers and her urine dipstick shows haematuria and proteinuria. Given the suspected diagnosis, which antibody would be particularly specific for the disease?
Antimitochondrial antibody
Antinuclear antibody
Anti-dsDNA antibody
Nuclear U1 ribonucleoprotein (RNP)
Rheumatoid factor
A 35-year-old woman presents with swollen and tender knee joints. There is a history of morning stiffness for the past 4 months and pain in the fingers while typing on her computer. On examination she has a temperature of 39 °C and ulcerated lower limbs, with hyperpigmentation. There are nodules over her elbows. Her neutrophil count is measured at 0.7 x10^9/l. What is the probable diagnosis?
Felty’s syndrome
Osteoarthritis
Gouty arthritis
Reactive arthritis
Septic arthritis
A 35-year-old woman presents with increasing headache, nausea, vertigo, decreasing vision in both eyes and persistent fever. She also complains of pain in her legs when she goes jogging. Her blood pressure is 190/110 mmHg and her femoral pulses are weak, with a radio–femoral delay. What is the most likely diagnosis?
Coarctation of aorta
Giant-cell arteritis
Polyarteritis nodosa
Takayasu’s arteritis
Granulomatosis with polyangiitis
A 70-year-old woman presents with pain and swelling in both knees. An X-ray shows a rim of calcification of the lateral meniscus in both knees. What will be the characteristic finding in the joint aspirate?
Needle-shaped crystals
Neutrophils
No abnormality
Positively birefringent crystals
White turbid fluid
A 26-year-old woman complains that she has had a relapsing pain in her left ankle for the last 4–5 weeks. She also complains of a painful rash on the soles of her feet, and pain and swelling in her right toes. Over the last 2 weeks she has also developed low back pain. On further questioning she mentions that for the last few days she has noticed painless oral ulcers, which heal spontaneously. She also has a recent history of chlamydial urethritis in the last few months. Her full blood count and kidney and liver function tests are all normal. An autoimmune screen is negative. What is the most likely diagnosis?
Ankylosing spondylitis
Behçet's syndrome
Disseminated bacterial arthritis
Hypersensitivity vasculitis
Reactive arthritis
A 20-year-old man presents with a 4-day history of high spiking pyrexia, arthralgia and widespread rash. On examination his distal interphalangeal joints are swollen and hepatosplenomegaly is present. Despite a thorough examination you cannot detect a rash, despite the patient adamantly telling you that he has seen a widespread pink rash over the last four evenings. Blood tests show a CRP of 78mg/l. ESR was not performed. What is the most likely diagnosis?
Adult Still’s disease
Hepatitis C infection
Behçet’s disease
Infectious mononucleosis
Rheumatoid arthritis
A 69-year-old diabetic woman has chills and rigors and has a 1-day history of pain in her right knee. She is afebrile. Her blood tests show a CRP of 25mg/L, ESR 37mm/hr and a weakly positive rheumatoid factor. What clinical diagnosis should be considered most likely until excluded?
Gouty arthritis
Reactive arthritis
Pseudogout
Rheumatoid arthritis
Septic arthritis
A 70-year-old sheep farmer presents complaining of pain and restricted movements of his right groin for over a year. He also complains of early morning stiffness in the joint that lasts for about half an hour but the pain can get worse throughout the day. The stiffness and pain have been progressively increasing and now he finds it difficult to carry out his routine activities. On examination he appears physically fit. An X-ray of the hip shows some decrease in joint space and subchondral sclerosis. What is the most likely diagnosis?
Brucellosis
Rheumatoid arthritis
Gouty arthritis
Lyme disease
Osteoarthritis
A 65-year-old woman with a 30-year history of rheumatoid arthritis presents with severe right sided shoulder pain and pain during the middle portion of arm abduction. She also complains of weakness when lifting or rotating the right arm. She says the pain came on suddenly whilst reaching for a heavy cooking pan. An X-ray of the shoulder is normal. What is the most likely cause of her symptoms?
Adhesive capsulitis
Torn rotator cuff
Calcific tendonitis
Polymyalgia rheumatica
Rotator cuff tendonitis
A 31-year-old woman complains of pain in the fingers of both hands. Which additional finding would be most likely to confirm a diagnosis of rheumatoid arthritis?
Anti-CCP antibodies (ACPA)
Antinuclear antibodies
Crepitus
Rheumatoid Factor
Subcutaneous nodules
A 42-year-old woman with chronic arthritis complains of grittiness in her eyes and a dry mouth. Investigations reveal a positive Schirmer’s test. Rheumatoid factor is present, as are anti-Ro and anti-La antibodies. What is the most probable diagnosis?
Episcleritis
Felty's syndrome
Sjögren’s syndrome
Still's disease
Systemic lupus erythematosus
A 42-year-old obese woman with a 10-year history of rheumatoid arthritis has been on methotrexate 25mg weekly and prednisolone 2.5mg daily for a number of years. She presents with severe hip pain of relatively sudden onset with no obvious precipitant and is now unable to walk. What is the most probable diagnosis?
Avascular necrosis of the femoral head
Flare of rheumatoid arthritis
Meralgia paraesthetica
Osteoarthritis
Pathological fracture of the femoral neck
A 35-year-old woman, who has two children, and has had one stillbirth and one miscarriage, now presents with 8 weeks’ amenorrhoea. There is a history of Raynaud’s phenomenon and dysphagia. On examination her blood pressure is 170/120 mmHg. Ulcers are noted on the index and middle fingers of both hands. The doctor advises her not to continue with the pregnancy. Which one of the following is the most likely diagnosis?
Antiphospholipid syndrome
Autosomal dominant polycystic kidney disease
Diabetic nephropathy
Diffuse systemic sclerosis
Systemic lupus erythematosus
A 55-year-old man attends the clinic complaining of increasing pain and weakness of his lower limbs which is preventing him from getting up from a chair easily and from climbing the stairs. Blood tests show a creatinine kinase level of 14,500 IU/l. A chest X-ray reveals a large shadow in the right mid-zone and pulmonary function tests reveal evidence of pulmonary fibrosis. Which antibody is most strongly associated with this underlying disease?
Anti-centromere
Anti-Jo-1
Anti-dsDNA
Anti-RNP
Anti-Scl-70
A 45-year-old man complains of burning pain in his foot, with diminished sensation in the sole. He twisted his ankle a week earlier. Severe pain and paraesthesiae can be elicited by applying pressure behind the medial malleolus. What is the most likely cause of his presentation?
Atherosclerosis of the popliteal arteries
Compression of the posterior tibial nerve
Injury to the common peroneal nerve
Mononeuritis multiplex
Rupture of the Achilles tendon
A 39-year-old woman presents with episodes of tingling, numbness and burning of the fingers of both hands over the past year, with colour changes, especially in the cold. Her doctor thinks it could be Raynaud’s phenomenon. With which disease is this phenomenon most often seen?
Adult polymyositis
Cryoglobulinaemia
Polyarteritis nodosa
Systemic lupus erythematosus
Systemic sclerosis
A 35-year-old woman presents with swollen and painful finger joints in both hands. You suspect rheumatoid arthritis and want to test for the presence of rheumatoid factor. Which immunoglobulin is most commonly detected by routine testing?
IgA
IgD
IgE
IgG
IgM
A 22-year-old man complains of an acute onset of pain in his right elbow and both Achilles tendons. He also gives a history of dysuria, conjunctivitis and fever. He returned from holiday in the Far East 3 weeks ago, where he had unprotected sex. He has developed macules and pustules on his hands and feet. Investigations: ESR 42 mm/h and CRP 30 mg/l What is the most likely diagnosis?
Gonococcal arthritis
Reactive arthritis
Syphilitic arthritis
HIV
Psoriatic arthritis
A 27-year-old man presents with swelling and pain in the proximal interphalangeal joints of both hands. Both hands show ulnar deviation with pitting of the nails and onycholysis. What could be the cause of his condition?
Dermatophyte infection
Rheumatoid arthritis
Gonococcal arthritis
Psoriatic arthritis
Reactive arthritis
