CHAPTER 8 7.

Aspirin in divided doses is the most satisfactory

RHEUMATOLOGY drug for helping suppress JRA. What aspirin dosage
range is most often recommended? C
Directions: Each of the questions or incomplete A. 5-15 mg/kg daily
statements below is followed by five suggested B. 30-60 mg/kg daily
answer or completions. Select the single BEST C. 90-130 mg/kg daily
D. 250-300 mg/kg daily
1. Juvenile rheumatoid arthritis (JRA) differs from the E. 310-340 mg/kg daily
adult form of rheumatoid arthritis in that D. 8. After 10 years of JRA what percentage of patients
A. high fever, rash and uveitis are more have regained an excellent level of function? D
common in JRA A. 10-20%
B. subcutaneous nodules and rheumatoid B. 30-40%
factor are more common in JRA C. 50-60%
C. marked leukocytosis in JRA D. 70-80%
D. only A and C E. 90-100%
E. all of the above
9. What most typifies the subcutaneous nodule found
2. The onset of JRA may E in rheumatoid arthritis? B
A. be polyarticular with four or more joints A. synovial tissue
involved B. chronic inflammatory
B. be acute or fulminating with systemic C. nodular areas of glycogen deposition
manifestations but without arthritis D. absence of necrosis
C. involve one joint or only a few joints E. necrotic muscle in the nodule
D. only A and C
E. all of the above 10. Subcutaneous nodules are associated with
rheumatoid arthritis. In what percentage of patients
3. Common initial sites of involvement in JRA include with classical rheumatoid arthritis do rheumatoid
the A subcutaneous nodules develops? C
A. knees, wrists, ankles, and neck A. 3 to 7%
B. hip, elbows, shoulders and sacroiliac joints B. 10 to 15%
C. hands, feet and temporomandibular joints C. 20 to 25%
D. costovertebral joints and facet joints of spine D. 50 to 60%
E. JRA randomly involves the joints and there E. 85 to 90%
are no most common sites of initial
involvement 11.Nerve compression syndromes may occur in
rheumatoid arthritis. Which is the most common?
4. Asymptomatic sacro-iliitis may occur as an x-ray B
finding in about 24% of patients with JRA. The A. ulnar nerve compression at Guyon’s canal
presence of sacro-iliitis correlates with E B. carpal tynnel syndrome
A. disease onset after 10 years of age C. tarsal tunnel syndrome
B. hip involvement D. ulnar nerve compression at the elbow
C. presence of rheumatoid factor E. thoracic outlet syndrome
D. only A and C
E. all of the above 12. A useful laboratory test for following the progress
of a case of rheumatoid arthritis is the A
5. A possible major complication of JRA that must be A. sedimentation rate
considered in evaluating each patients is A B. latex fuxation test
A. iridocyclitic C. serum iron concentration
B. subcutaneous nodules D. leukocytosis
C. skin rash E. none of the above are useful in following the
D. encephalitis course of the disease
E. peripheral neuropathy
13. A 40-year-old female with rheumatoid arthritis is
6. The approximately incidence of positive rheumatoid able to perform all of her daily activities with the
factor detection in JRA is A exception of lifting her heavy bags of groceries. She is
A. 20% also unable to continue her golfing and bowli8ng, into
B. 40% which functional class of the ARA (American
C. 60% Rheumatism Association) might this patient fall? B
D. 80% A. I
E. 100% B. II
C. III
D. IV
 E. None of the above 20. A patient with osteoarthritis has undergone a total
hip replacement. Which physical modality should not
14. A 53-year-old male with rheumatoid arthritis be used over the joint implant? D
demonstrates the following findings: (1) osteoporosis A. short wave diathermy
seen on x-rays: and (2) no joint deformities, but B. ultrasound
limitation of mobility in the hand and elbows. Into C. microwave
which anatomical stage of the ARA classification does D. both A and C
this patient fall? B E. all of the above
A. I early
B. II moderate 21. A patient with arthritis is advised to take regular
C. III severe hot tub baths to help diminish stiffness and pain. The
D. IV terminal approximate water temperature that should be used is
E. None of the above C
A. 60F
15. The nonmedicinal management of the patient with B. 80F
rheumatoid arthritis which of the following? E C. 100F
A. Systemic rest D. 120F
B. Articular rest E. 140F
C. Physical rest
D. Proper nutrition 22. One of the most useful modalities for treating the
E. None of the above rheumatoid hand involves A
A. paraffin
16. In the treatment of rheumatoid arthritis with B. hot warm bottles
salicylates, salicylism is used as a guideline in helping C. ultrasound given under water
to individualize the dose. In an adult, the usual first D. short wave diathermy
manifestation of salicylism is E E. heating pads
A. peptic ulcer
B. anemia 23. Which of the below exercises is not indicated for
C. centrally induced hyperventilation used in the average arthritic patient? C
D. psychosis A. passive range motion
E. tinnitus B. active range of motion
C. rapidly performed coordination
17. Physical therapy modalities can be useful for the D. isometric strengthening
arthritic patient at home. The patient should be E. active-assistive
instructed in how to properly use these treatment
modalities. What is the major and most frequent 24. Which physical heating modality might be of most
hazard encountered in the home treatment program? benefit to the arthritic patient with painful degenerative
D arthritis to the hip? C
A. fractures from too vigorous exercise A. short wave diathermy
B. skin infection from improper use of massage B. microwave
C. neck dislocation of improper use of traction C. ultrasound
D. burns from improper use of heat D. hot packs
E. deformities aggravated by homemade splints E. ultraviolet

18. What might be a useful treatment for the arthritic 25. The common deformities seen in the arthritic knee
patients to help alleviate morning stiffness? D include: E
A. sleeping on a heating pad A. knee flexion contractures
B. taking a hot bath before retiring for bed B. subluxation
C. sleeping with hot water bottles C. external rotation
D. using an electric blanket D. both A and C
E. none of the above E. all of the above

19. A patient with osteoarthritis develops a knee 26. The most common age period for onset of
effusion. Which physical therapy modality should not ankylosing spondylitis is C
be used over the knee? D A. birth to 5 years
A. hot packs B. 5 to 20 years
B. ice massage C. 20 to 40 years
C. infrared D. 40 to 60 years
D. microwave E. over 60 years
E. ultrasound
27. The joints which usually first show x-ray
abnormalities in ankylosing spondylitis are the D
 A. vertebral facet joints 34. Approximately what percentage of patients with
B. metacarpophalangeal joints psoriasis develop arthritis? A
C. interphalangeal joints A. 5%
D. sacroiliac joints B. 25%
E. hip joints C. 50%
D. 75%
28. What percentage of cases of ankylosing E. 95%
spondylitis have involvement of the peripheral joints at
some stage in the disease? C 35. The joints most commonly involved in psoriatic
A. 0% arthritis are the D
B. 15% A. hip joints
C. 35% B. knee joints
D. 75% C. sacroiliac joints
E. 100% D. distal interphalangeal joints of the fingers
and toes
29. At times the onset of ankylosing spondylitis is in E. carpormetacarpal joints
the peripheral joints. In what percentage of cases
does this occur? C 36. Which of the following medications is
A. 5% contraindicated in the treatment of psoriatic arthritis?
B. 10% D
C. 20% A. systemic coritcosteriods
D. 50% B. gold
E. less than 1% C. intraarticular corticosteriods
D. antimalarials
30. A patient with ankylosing spondylitis complains of E. methotrexate
pain radiating into the lower extremities. A likely
explanation for this symptoms is B 37. What is the most serious complication of
A. the patient has probably herniated a nucleus rheumatic fever? A
pulposus and has nerve root pain A. carditis
B. the pain is probably originating from the B. arthritis
sacroliac joint. C. chorea
C. A bone spur is probably causing pressure on D. pharyngitis
a nerve root in the back E. pneumonitis
D. Both A and C
E. All of the above 38. How commonly do arthritis and arthralgia occur at
some time in the course of systemic lupus
31. In what percentage of cases of ankylosing erythematosus (SLE)? E
spondylitis is the course of the disease relatively A. in less than 5% of cases
benign over 1—20 year period? C B. in 20% of cases
A. 5% C. in 50% of cases
B. 20% D. in 75% of cases
C. 40% E. in 90% of cases
D. 80%
E. 95% 39. The most frequent cause of death in the patient
with SLE is E
32. In what percentage of patients with ankylosing A. pericarditis
spondylitis is there rapid progression to severe B. stroke
disability? B C. myocardial infraction
A. less than 1% D. malignancy
B. 5% E. nephritis
C. 25%
D. 50% 40. patients with SLE occasionally develop
E. 70% psychoses. In what percentage of cases of SLE would
psychosis at some time be present? D
33. Usually the most appropriate analgesic for use in A. less than 1%
patients with ankylosing spondylitis is A B. 5%
A. salicylates C. 20%
B. indomethacin D. 50%
C. acetaminophen E. 90%
D. codeine
E. meperidine 41. In patients with rheumatoid arthritis, lupus
erythematous (LE) cells may occasionally be
demonstrated. Which of the following statements is D. 85%
true about this group of patients? E E. 100%
A. most go on to develop the typical lupus
nephrtiis 48. Which of the following are features of the
B. many develop the typical lupus vasculitis peripheral neuritis found in polyarteritis? A
C. the lupus dermatitis is common in these 1. paresthesias
patients 2. burning pains
D. all of the above 3. absence of motor weakness
E. these patients do not generally go on to 4. primary involvement of the upper
develop features of SLE extremities
5. asymmetry
42. The prognosis of drug-induced SLE B
A. is the same as for SLE A. only 1,2, and 5
B. is better than that for SLE B. only 3.4 and 5
C. is worse than that for SLE C. only 1,2,3 and 4
D. is quite variable, with the prognosis D. only 4
depending on the severity of the renal E. all are correct
involvement
E. is quite variable depending on the amount of 49. The major cause of death in polyartheritis is D
cardiac disease present A. cardiac disease
B. stroke
43. A patient being treated with procainamide C. pneumonia
develops arthritis and hepatosplenomegaly after six D. renal disease
months of using the drug. A likely explanation is D. E. gastrointestinal bleeding
A. the patient has developed rheumatoid
arthritis 50. The most frequent initial symptom in polymyositis
B. the patient is suffering from a viral arthralgia and dermatomyositis is B
secondary to hepatitis A. skin rash
C. the patient suffers from a drug-induces B. weakness of the legs
psoriatic arthritis C. joint and muscular pain
D. the patient has develop drug-induced SLE D. weakness of the arms
E. none of the above E. dysphagia

44. the 10years survival rate after a diagnosis of SLE 51. The most consistently weak muscle in
has been made is approximately D polymyositis are the B
A. less than 10% A. neck flexor
B. 15% B. proximal muscles of the lower extremities
C. 25% C. facial muscles
D. 50% D. hand intrinsic muscles
E. 80% E. extrocular muscles

45. the prevalence of renal disease in polyartheritis is 52. In what percentage of cases of polymyositis and
D dermatomyositis would one expect to see the
A. 5% presence of Raynaud’s phenomenon? C
B. 25% A. 0%-if it occurs, it indicates that the diagnosis
C. 50% was in error
D. 75% B. 5%
E. 100% C. 30%
D. 75%
46. The most frequent area of heart involvement in E. 100% - if it is not present, the diagnosis must
polyartheritis is in the B be reevaluated
A. endocardium
B. myocardium 53. A nearly pathognomonic rash seen in
C. pericardium dermatomyositic is D
D. there is equal involvement of all of the above A. a butterfly rash on the face
E. polyartheritis does not involve the heart B. anerythematous rash on the elbows
C. a scaly rash on the anterior chest wall
47. What percentage of cases of polyartheritis will D. a dusky lilac suffusion on the upper eyelids
develop a peripheral neuritis? C E. a periungual erythematous and scaly rash
A. 5%
B. 25%
C. 50%
54. In a 40 years old male with dermatomyositis what B. renal
is the probability of eventually discrovering a C. rectal
malignant lesion? C D. neurological
A. 100% E. esophageal
B. 75%
C. 50% 62. Osteoarthritis is D
D. 25% A. an inflammatory disease of bone
E. 5% B. a degenerative disease of bone
C. an inflammatory disease of articular cartilage
55. The initial treatment of choice for polymyositis is E D. a degenerative disease of articular cartilage
A. methotrexate E. all of the above
B. salicylates
C. gold 63. On of the least involved portions of the joint in
D. phenylbutazone osteiarthritis is the A
E. croticosteriods A. synovial tissue
B. bone
56. The most common form of onset of sclerodema A C. cartilage
A. Raynaud’s phenomenon or swelling and D. ligaments
thickening of hands and fingers E. tendons
B. Arthralgias
C. Severe muscle weakness 64. The term Heberden’s node refers to the
D. Visceral involvement (dysphagia and osteoarthritic changes occurring at which joint? E
intestinal involvement) A. metacarpophageal
E. Renal disease B. tarsal-metatarsal
C. proximal interphalangeal
57. What is the proper sequence of skin changes in D. carpometacarpal of the thumb
sclerodema (earliest to latest)?C E. distal interphalangeal
A. indurative, atrophic, and edematous
B. atrophic, indurative and edematous 65. Bony enlargement of the proximal interphalangeal
C. edematous, indurative and atrophic joint of finger is prenent in a patient with advanced
D. indurative, edematous, and atrophic osteoarthritis. The name of this enlargement would be
E. edematous, atrophic, and indurative aC
A. Heberden’s node
58. The incidence of Raynaud’s phenomenon on B. Schmori’s node
patient with sclerodema is approximately A C. Bouchard’s node
A. 90% D. Fibro-osseus node of Schmidt
B. 70% E. There is no specific name for the nodular
C. 50% enlargement
D. 30%
E. 10% 66. Degenerative changes in joints become more
frequent with advancing age. Generally at what age
59. The most frequent x-ray feature seen in may degenerative changed first be seen in joints
sclerodema is C autopsy?B
A. narrowing of the intervertebral disc A. first decade of life
B. erosion of the carpal bones B. second decade of life
C. absoption of the tufts of the distal phalanges C. third decade of life
D. spotty osteoporosis underlying areas of skin D. fourth decade of life
changes E. fifth decade of life
E. loss of articular cartilage of involved joints
67. The chief symptom of osteoarthritis is usually D
60. A patient with sclerodema develops proximal A. edema
muscle wekanes. A likely explanation is that the B. fever
patient has developed A C. muscular weakness
A. sclerodematomyositis D. pain
B. limb-girgle muscular dystrophy E. joint deformity
C. duchenne muscular dystrophy
D. viral myositis 68. The pain osteoarthritis is usually B
E. myotonic dystrophy A. a burning sensation
B. aching in character
61. The most common form of visceral involvement in C. a sharo, well localized pain
sclerodema is E D. a sharp, radiating pain
A. cardiac E. a combination of all of the above
 B. measuring serum uric acid levels
69. The most consistency helpful laboratory C. measuring urate excretion in the feces
abnormality in confirming the diagnosis of D. examining the synovial fluid
osteoarthritis is E E. assessing dietary habits
A. an elevated sedimentation arte
B. leukocytosis 77. The synovial fluid a patient with possible acute
C. a normocytic, normochronic anemia gouty arthritis contains no monosodium urate crystals.
D. rheumatoid factor Your next move is to D
E. none of the above A. evaluate the patient for other causes of
acute arthritis
70. X-ray changed seen in osteoarthritis include E B. begin the patient on salicylate therapy
A. joint space narrowing C. reassure the patient and have him return for
B. marginal osteophyte formation a recheck in one week
C. subchondrial bony sclerosis D. aspirate more synovial fluid for examination
D. both A and C E. get anteroposterior and lateral x-rays of the
E. all of the above involved joints.

71. The acute attack of gouty arthritis is triggered by E 78. Which would probably be the preferred oral
A. a food allergy medication for the treatment of acute gouty arthritis?
B. periarticular vasoscpasm D
C. hyperuricemia A. aspirin
D. a decrease in the blood glucose level B. cochicine
E. sodium urate crystals C. allopurinol
D. phenylbutazone
72. A patient with chronic gouty arthritis develops E. methotrexate
carpal tunnel syndrome. A likely explanation is that B
A. a urate vascular plaque is compressing the 79. The drug allopurinol is used in the treatment of
median nerve hyperuricemia. What is its mechanisms of action? D
B. a tophus is compressing the median nerve A. it increases uric acid excretion in the urine
C. the patient has diabetic neuritis secondary to B. it increases uric acid excretion in the feces
the gout C. it increase the solubility of uric acid in the
D. the patient has satumine gout serum
E. none of the above D. it inhibits xanthine oxidase
E. it inhibits white cells migration to urate
73. The major component of a tophus in gout is A crystals
A. sodium urate crystals
B. lipid 80. A 40 year old male develops dermatomyositis. He
C. collagen should be also closely evaluated for the presence of
D. calcium monohydrate D
E. bile salts A. diabetes
B. hyperparathyroidism
74. A patient being treated for hypertension develops C. Addison’s disease
acute gout. A likely cause is that C D. Malignant tumor
A. the antihypertensive medication decreased E. Hypertriglyceridemia
the uric solubility
B. the patient also had leukemia 81. A patient presents with complaints of stiffness and
C. the diuretics used to treat the hypertension discomfort in the low back. The patient’s urine has
D. in an attempt to food a low-sodium diet, the been noted to turn black upon standing. Also x-rays of
patient ate foods with excessive amount of the spine show calcification of the intervertebral discs.
purines The likely disganosis is E
E. none of the above A. ankylosing syndrome
B. Reiter’s syndrome
75. the male female ration in primary gout is C. Wilson’s disease
approximately A D. Pseudogout
A. 9:1 E. Ochronosis
B. 3:1
C. 1:1 82. The organism most often found to cause
D. 1:3 infectious pyogenic arthritis in children is A
E. 1:9 A. Staphylococcus aureus
B. Diplococcus pneumonia
76. The best way to diagnose gout is by D C. Streptococcus pyogenes
A. history D. Neisseria gonorrhea
 E. Hemophilus influenzae Directions: for each one of the incomplete statements
or questions below, ONE or MORE of the numbered
83. The organism most often found to cuse infectious completions is correct. In each case select.
pyogenic arthritis in the adult is D A. if only 1,2 and 3 are correct
A. Staphylococcus aureus B. if only 1 and 3 are correct
B. Diplococcus pneumonia C. if only 2 and 4 are correct
C. Streptococcus pyogenes D. if only 4 is correct
D. Neisseria gonorrhea E. if all are correct
E. Hemophilus influenzae
89. The treatment program in juvenile rheumatoid
84. A male develops fever, polyarticular arthritis arthritis includes E
urethritis and conjunctivitis. A lkely diagnosis would 1. joint rest during acute attacks
be C 2. splints to correct deformities
A. gonococcal arthritis 3. heart
B. rheumatoid arthritis 4. exercises
C. Reiter’s syndrome
D. Ankylosing spondylitis 90. characteristics of the anemia found in rheumatoid
E. Psoriatic arthritis arthritis include C
1. a good response to the
85. A knee x-ray is taken several months following administration of vitamin B-12
acute trauma to the knee. A calcific density is noted in 2. failure to response to the
the area of the medical collateral ligament. A likely administration of iron
diagnosis is D 3. association with macrocytic red
A. juvenile rheumatoid arthritis blood cells
B. ankylosing spondylitis 4. association with normochronic red
C. chrondrocalcinosis blood cells
D. tuberculosis of the spine
E. the renal disease found in gout 91. Which statements about the sedimentation rate
are true? A
86. A patient presents with chest pain, tenderness 1. the sedimentation rate normally
and firm swelling in the area of the left third rises slightly in the process of aging
costochrondral junction. No history of trauma can be 2. the sedimentation rate is usually
obtained. Deep breathing increases the pain . a likely normal in primary osteoarthrtis
diagnosis is A 3. the disorder polymyagia rhematica
A. dermatomyositis is distinguished by a moderately to
B. sclerodema markedly elevated sedimentation
C. Chrondrocalcinosis rate
D. Pellegrini-Steieda syndrome 4. the sedimentation rate is elevated
E. Jaccoud’s arthritis in fibrositis

92. The LE phenomenon and antinuclear factors are

87. A patient presents with chest pain, tenderness characteristics of SLE. Which of the following are
and firm swelling in the area of the left third true? C
costochrondral junction. No history of trauma can be 1. antinuclear factors and the LE
obtained. Deep breathing increases the pain. A likely phenomenon are not found in
diagnosis is A patients with rheumatoid arthritis
A. Tietze’s syndrome 2. as a group, rheumatoid arthritis
B. Atypical angina patient with a positive LE cell test
C. Pneumonitis tend to have more pronounced
D. Rib fracture systemic involvement
E. Scheuemann’s disease 3. the LE phenomenon in a patient will
go on to develop features of SLE
88. In acute arthritis of the wrist, what form of 4. antinuclear factors have been
therapeutic exercise should be utilized? A reported in various disorders
A. passive range of motion characterized by chronic
B. isometric strengthening inflammation
C. isotonic strengthening
D. isokinetic strengthening 93. Which statements about the serum complement
E. none of the above is indicated in acute level are true? E
arthritis 1. it is usually normal or somewhat
elevated in rheumatoid arthritis
 2. it is decreased in patients with
vasculitits
3. it is often elevated early in the
course of rheumatic fever
4. it is reduced in most patients with
SLE
94. Which of the following are useful clinical features
in helping to make the diagnosis of rheumatoid
arthritis? A
1. slowly progressive, symmetrical
polyarthritis
2. prolonged early morning stiffness
3. periarticular swelling of soft tissues
4. weakness of the trunk musculature
95. A patient with rheumatoid arthritis develops acute
arthritis of the wrist. Which of the following measures
might be indicated in the treatment? A
1. daily passive range of motion
exercise
2. superficial heat
3. salicylate analgesic
4. articular rest by placing the forearm
and hand in a plaster cast for two
weeks
96. Which of the following statements is true about
the use of gold therapy in rheumatoid arthritis? C
1. gold therapy can occasionally
reverse some of the damage done
by the arthritis
2. gold therapy should not be used in
the patient with SLE
3. the most serious toxic side effect of
gold therapy is dermatitis
4. the best results from gold therapy
occur when the drug is used
relatively early in the course of the
illness
97. Systemic corcosteriods are occasionally useful in
controlling rheumatoid arthritis. Which of the following
statements are true concerning the use of
corticosteriods? B
1. patient who are candidates for
steroids therapy are those with
active disease who are not
responding to the usual measures
of treatments
2. corticosteroids therapy can
occasionally reverse some of the
damage caused by the arthritis
process
3. severe rheumatoid vasculitis and
hypersplenism are relative
indication for the use of systemic
corticosteriods
4. the dosage of corticosteriod used in
rheumatoid arthritis should
generally be rather large.
98. Which of the following are potential side effects to
the use of systemic corticosteriods? E
1. gastrointestinal ulcerations
2. fatty deposition
3. osteoporosis
4. carbohydrate intolerance
99. Intraarticular corticosteroid injection is
occasionally use in treating the patient with
rheumatoid arthritis. Which of the following are
indications for considering the use of intraarticular
corticosteriod injections? C
1. infection in or near the joint
2. inflammation of one or only a few
peripheral joint
3. severe juxtaarticular osteoporosis
4. contraindication of systemic gold,
cortisone, or other therapy
100. The objectives for the use of physical therapy in
arthritis include E
1. helping to relive symptoms
2. shortening the period of disability
from the disease
3. preventing or helping to correct
deformities
4. improving function
101. A patient with rheumatoid arthritis is referred to
the physical therapy department with a prescription,
which reads “physical therapy daily’. What is your
response to his prescription? D
1. the prescription is satisfactory in
that it gives the therapist freedom to
develop the most adequate therapy
program
2. the prescription is inadequate in
that the patient should be treated
on a twice daily basis
3. the prescription is adequate as far
as it goes but occupational therapy
should also be specified.
4. the prescription lacks sufficient
detail to be acceptable
102. Some indication for the use of therapeutic
exercise in arthritis include E
1. preservation or improvement of joint
range of motion
2. preservation or improvement of
muscular strength and endurance
3. maintenance of useful ambulation
for as long as possible
4. maintenance of upper extremity
function
103. In a patient with ankylosing spondylitis, which
exercise are most indicated? C
1. knee-chest exercises
2. back hyperextension exercises
3. hip range of motion exercises
4. deep breathing exercises

104. Some areas in which the occupational therapist
can help the arthritic patient include E
1. providing appropriate splints for the
upper extremities
2. helping the patient maintain or
regain upper extremity strength and
range of motion
3. helping to evaluate the patient’s
vocational potential
4. helping the patient to achieve
independence in activities of daily
living
105. Which of the following statements about
ankylosing spondylitis are true? D
1. ankylosing spondylitis is most
common in females
2. the eitiology of ankylosing
spondylitis is thought to be
infectious
3. the onset of symptoms is often
abrupt
4. the earliest symptom is usually low
back pain
106. With cervical spine involvement in ankylosing
spondylitis, which of the following are potential
problems? A
1. cervical radiculopathy
2. cervical spine fractures
3. spinal cord injury
4. cauda equina injury
107. Which of the following are typical x-ray changes
seen in akylosing spondylitis
1. slight to moderate narrowing of the
disc spaces
2. squarinf of the vertebral bodies
3. ossification of the connective tissue
around the vertebrae
4. ossification of the nucleus pulposus
108. Sacroiliac x-ray changes are characteristic of
ankylosing spondylitis but can laso seen in other
disorder. Which of the following disorders can
occasionally produce sacroiliac x-ray changes? A
1. psoriasis
2. ulcerative colitis
3. reiter’s disease
4. gout
109. X-ray therapy can provide symptomatic relief in
about 60% of patients with ankylosing spondylitis yet
is rarely used as a dorm of treatment for this disorder.
Why is this? B
1. bone marrow aplasia follows the x-
ray therapy
2. radiation burns are common in
patients treated with the x-ray
therapy
3. there is a higher risk of developing
leukemia following the irradiation
4. while the x-ray therapy may help up
to 60% of patients, it may cause the
disease to flare up to 30% of the
other treated patients.
110. Which of the following statements about psoriatic
arthritis are true? D
1. tests for rheumatoid factor are
usually positive
2. subcutaneous nodules are found in
the majority of cases
3. x-ray features are identical to those
seen with rheumatoid arthritis
4. the spine and sacroiliac joints can
be involved
111. Laboratory test that are commonly found to be
abnormal in psoriatic arthritis include C
1. rheumatoid factor
2. uric acid
3. IgG levels
4. sedimentation rate
112. Which of the following are true about the arthritis
seen in rheumatoid fever? B
1. joint involvement becomes more
common in the older group of
patients with rheumatic fever
2. carditis and chorea parallel the
presence of arthritis
3. the arthritis usually occur early in
the course of the illness
4. the arthritis often results in mild joint
deformities
113. Which of the following can be seen in Sjogren’s
syndrome? A
1. rheumatoid arthritis
2. myopathy
3. the sicca complex
4. predominance of the disease in
males
114. The fibrositis syndrome B
1. is characteristic by areas of
localized point tenderness over
muscles
2. is associated with increased in the
sedimentation rate
3. often presents complaints of pain
and stiffness
4. is a wastebasket term that has little
clinical value.
115. Which of the following are typical of the fibrositis
syndrome? A
1. increase in symptoms in damp and
cool weather
2. complaints of chronic fatigue
 3. relief of symptoms with the use of
heat
4. constant level of discomfort
persisting for periods of several
weeks
116. Features consistent with the diagnosis of
polymyalgia rheumatica include C
1. patients usually in the 20 to 40
years age group
2. markedly elevated sedimentation
rate
3. pain in the proximal joints
4. relief of symptoms with the use of
systemic corticosteriods
117. Which of the following are consistent with the
diagnosis of polymyalgia rheumatica? B
1. pain on motion
2. muscle weakness
3. abrupt onset
4. usually a normal hemoglobin level
118. Which of the following are features of SLE? A
1. most commonly found in females
2. usually begins in the third to fourth
decades
3. may present with a highly variable
clinical picture
4. follows a stereotyped pattern after
its onset
119. Very common initial manifestation of SLE include
E disease
1. fever
2. fatigue and malaise
3. acute polyarthritis
4. erythematous skin eruption
120. Which of the following are typical of the arthritis
seen in SLE? D
1. absence of morning stiffness
2. ankylosis and contracture
3. absence of subcutaneous nodules
4. frequent involvement of the
proximal interphalangeal and
metacarpophalangeal joints of the
hands
121. Neurologic involvement which can occur in SLE
includes E
1. peripheral neuritis
2. seizures
3. cerebral infraction
4. transverse myelitis
122. Laboratory abnormalities in the patient with
systemic lupus erythematous can include E
1. normochronic normocytic anemia
2. presence of LE cells
3. reduced levels of serum
complement
4. presence of antinuclear antibodies
123. Certain drugs have been implicated as inducing
a clinical picture typical of SLE. Which of the following
drugs can produce a drug-associated SLE? E
1. hydralazine
2. diphenylhydantoin
3. procainamide
4. methyldopa
124. Which o the following statements are true about
polyarteritis? D
1. females comprise the majority of
cases
2. the disease mainly involves large
arteries
3. the disease occurs primarily in the
elderly
4. the disease most frequently
involves the kidneys and heart
125. The initial symptoms of polyarteritis may include
E
1. fever of unknown etiology
2. renal disease
3. cardiac disease
4. peripheral neuritis
126. Which of the following statements are true about
polymyositis and dermatomyositis? E
1. women are involved twice as often
as men
2. may be associated with malignant
3. may occur at almost any age
4. may occur in conjunction with one
of the other connective tissue
diseases
127. Patients with polymyositis occasionally complain
of pain. What are the most common sites of pain? B
1. shoulders
2. calves
3. upper back
4. lower back
128. Which of the following are true about
polymyositis dermatomyositis? D
1. contractures are relatively common
early in the course of the disease
2. severe atrophy of muscles is
common
3. the typical skin rash is present in
5% of cases
4. calsinosis of the muscles occurs
most often in children
129. Features which can occur when dermatomyositis
is associated with malignant tumor included E
1. generally poor therapeutic response
to corticosteriods
 2. age of over 40 years for most
patients
3. the muscle disease takes the form
of a florid dermatomyositis
4. the neoplasm is usually a
carcinoma
130. Which of the following statements is true about
scaleroderma? E
1. females are affected two to three
times as often as males
2. it is more common in coal miners
3. it is relatively uncommon in
childhood
4. there are no significant racial
differences in incidence
131. Esophagela abnormalities seen in
cinefluoroscopic examination of the patient with
scleroderma include A
1. decrease or absence of peristaltic
action
2. gastroesophageal reflux
3. dilatation of the lower portion of the
esophagus
4. constriction of the upper portion of
the esophagus
132. What are the major forms of new bone formation
seen in osteoarthritis? C
1. ectopic muscular calcification
2. subchondral eburnation
3. intraarticular ossification
4. marginal osteophytes
133. Subchondral bone ‘cysts” may develop in
osteoarthritis and on x-ray may appear similar to the
lesions seen in C
1. diabetes
2. gout
3. pernicious anemia
4. hemophilia
134. Which statements about osteoarthritis are true?
A appropriate treatments? A
1. under the age of 45 years, males
are involved more frequently than
females
2. osteoarthritis is related to the
presence of obesity
3. after the age of 55, the hands in
females are more involved than
those in males
4. whites have a higher incidence of
osteoarthritis than black do.
142. Which of the following is true about the initial attack
135. systemic findings common in osteoarthritis
include D
1. fever
2. anemia
3. nausea and vomiting
4. none of the above
136. Which of the following statements are true about
Heberden’s nodes? A
1. they may develop gradually with
little or no pain
2. they may develop rather rapidly
with associated redness, swelling
tenderness and aching
3. they are more common in women
4. they are seen in the proximal
interphalangeal joints
137. joints commonly involved in degenerative
arthritis (osteoarthritis include the) C
1. shoulders
2. cervical spine
3. wrists
4. hips
138. Joints frequently involved in degenerative
arthritis (osteoarthritis) include the E
1. elbows
2. wrists
3. shoulders
4. first metacarpophalangeal joints
139. Which of the following are true about
osteoarthritis? A
1. symptoms are uncommon before
the age of 40 years
2. stiffness is usually of short duration
3. bony ankylosing is uncommon
4. joint effusions are relatively
common
140. Which of the following are true about
osteoarthritis? E
1. diet
2. medication
3. physical therapy
4. joint rest
141. A patient with painful osteoarthritis of the right
hip is referred for physical therapy. What would be
1. use of ultrasound encouraging the
patient to lose weight if he is overweight
2. encouraging the patient to lose weight
if he is overweight
3. range of motion exercises to the
involved hip
4.using a cane in the right hand to unload
stress from the hip
of gout? A
1. onset is usually abrupt
2. often involves the great toe
3. may last a few days to a few weeks
4. recovery is seldom complete
143. Common sites for the development of gouty tophi
include the A
1. ear
2. tendons
3. patellar and olecranon bursae
4. aorta

144. Which of the following is true about the renal disease

associated with gout? E
1. other than arthritis, it is the most
common complication of gout
2. it is usually slowly progressive
3. the incidence of proteinuria varies
from 20 to 40%
4. renal failure is the cause of death in
about one fourth of patients with
gout

145. Secondary forms of gout can occur with E

1. severe alcoholism
2. starvation
3. renal disease
4. leukemia

146. Which of the following drugs can alter the serum

urate levels? A
1. salicylates
2. thiazide diuretics
3. phenylbutazone
4. colchicines

147. The Charcot neuropathic joint may occur with E

1. diabetes mellitus
2. syringomyelia
3. myelomeningocele
4. tabes dorsalis

148. Characteristic of the Charcot joint include B

1. hypermobility of the joint
2. usually severe pain
3. possible combinations of
destructive and hypertrophic
changes on x-rays
4. the patients neurological
examination will be normal.