RHEUMATOLOGY QUESTIONS COMPILED

MIDTERMS SEM1
1. Examination of the synovial fluid of the knee of a patient with osteoarthritis will reveal the following
except
A. Clear viscous fluid
B. Negative culture
C. WBC count of 200/hpf
D. (+) CPPD crystals
2. Inflammation of the 1st metatarsal joint due to MSU crystal is called
A. Bursitis
B. Podagra
C. Enthesitis
D. Tophi
3. The structure in the joint that is affected in osteoarthritis
A. Synovium
B. Capsule
C. Cartilage
D. Subchondral bone
4. One of the following is NOT a classification criteria in the diagnosis of Rheumatoid arthritis
A. Symmetric arthritis
B. Serum rheumatoid factor positivity
C. Radiographic change like erosion
D. Morning stiffness less than an hour
5. The earliest and consistent finding on x-ray of patient with ankylosing spondylitis:
A. Osteopenia
B. Osteophytes
C. Sacroilitis
D. Subchondral bone erosion
6. Crystal associated with pseudo gout
A. Monosodium urate
B. Calcium pyrophosphate dihydrate
C. Calcium oxalate
D. Uric acid
7. The most specific test in the diagnosis of SLE
A. ANA
B. ds DNA
C. Anti histone
D. Anti-sm
8. The major risk factor in the development of osteoarthritis
A. obesity
B. Aging
C. Trauma
D. Endocrine disorder
9. Bony hypertrophy of the distal interphalangeal joint is known as
A. Bouchard’s node
B. Boutonnieres deformity
C. Swan neck deformity
D. Heberden’s node

60. A 33 year old, female, is suffering from SLE for the last 5 years. A year ago,
proteinuria and hematuria were noted in her urinalysis. And subsequently her
serum creatinine slowly deteriorated. The progression of her renal failure is due to:
A. Nephrotoxicity C. Renal hypoperfusion
B. Reduction in renal mass D. Interstitial nephritis
61. One of the following is not a classification criteria in the diagnosis of Rheumatoid
arthritis:
A. Morning stiffness less than 1 hour
B. Radiographic change like erosion or decalcification of wrist bone
C. Serum rheumatoid factor positivity
D. Symmetric arthritis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885

62. One of the following statements is not true with regards to the epidemiology of
SLE:
A. Common in women of child bearing age
B. Males are spared
C. More common in blacks than in white
D. Prevalence is form 15 to 50/100,000 population
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874

Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain in the (R) knee
for a year; which is worst in the afternoon and after a long walk and improves with rest. On P.E. as bony
hypertrophy and worse crepitation.

63. The pain she is experiencing maybe due to any of the following EXCEPT:
A. Ligament insertion strain C. Muscle pain
B. Cartilage destruction D. Capsular stretching
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937

64. One of the following statement about TB arthritis is true:

A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases
B. Joint destruction is rapid
C. Polyarticular involvement is more common
D. Treatment includes administration of Nafcillin and gentamycin
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947

65. A 23-years old female patient consulted because of on and off pains, malar rash,
oral ulcers and increasing hairloss. A probable diagnosis of SLE was made
confirmed by:
 A. High ESR and (+) CRP
B. High titer dsDNA and hypocomplementemia
C. Leucopenia and anemia
D. Thrombocytosis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877

Carla, 18-years old student is being treated for pneumonia. On the 4th day of hospitalization she
noted swelling, redness and severe pain of the (L) knee. Aspiration of the knee revealed whitish,
purulent fluid consistent with septic arthritis.

66. The laboratory test you would request for the condition is:
A. Liver function test C. Culture and sensitivity of fluid
B. Urinalysis D. ANA
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1945

67. The probability of a CPPD disease will reveal crystals appearing as:
A. Highly birefringent, large flat
B. Negatively birefringent, needle shape
C. Positively birefringent, rod shaped
D. Spheroidal aggregation
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1942

68. The pain in osteoarthritis arise from the following structure EXCEPT:
A. Articular cartilage
B. Stretching of joint capsule
C. Stretching of periosteum covering osteophytes
D. Synovitis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1937

69. One of the following is not a classification criteria in the diagnosis of Rheumatoid
arthritis:
A. Morning stiffness less than 1 hour
B. Radiographic change like erosion or decalcification of wrist bone
C. Serum rheumatoid factor positivity
D. Symmetric arthritis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885

70. One of the following statements is not true with regards to the epidemiology of
SLE:
A. Common in women of child bearing age
B. Males are spared
C. More common in blacks than in white
D. Prevalence is form 15 to 50/100,000 population
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874

Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain in the (R) knee
for a year; which is worst in the afternoon and after a long walk and improves with rest. On P.E. as bony
hypertrophy and worse crepitation.
71. The pain she is experiencing maybe due to any of the following EXCEPT:
A. Ligament insertion strain C. Muscle pain
B. Cartilage destruction D. Capsular stretching
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937
72. One of the following statement about TB arthritis is true:
A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases
B. Joint destruction is rapid
C. Polyarticular involvement is more common
D. Treatment includes administration of Nafcillin and gentamycin
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947

73. A 23-years old female patient consulted because of on and off pains, malar rash,
oral ulcers and increasing hairloss. A probable diagnosis of SLE was made
confirmed by:
A. High ESR and (+) CRP
B. High titer dsDNA and hypocomplementemia
C. Leucopenia and anemia
D. Thrombocytosis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877

1. The characteristic clinical and serologic features in classic polyarteritis nodosa (PAN) include the
following, EXCEPT:
A. Hypertension
B. Slowly progressive renal insufficiency
C. Bland urine sediment with subnephrotic proteinuria
D. Presence of the characteristic anti neutrophilic cytoplasmic antibodies (ANCA)

2. Which of the following drugs is NOT associated with lupus or lupus-like conditions?
A. Isoniazid
B. Procainamide
C. D-penicillamine
D. Hydralazine

3. Which of the following immunosuppressive drugs is NOT used in the treatment of rheumatoid
arthritis?
A. Azathioprine
B. Cyclosporine
C. Chlorambucil
D. Cyclophosphamide

4. The Disease Modifying Anti rheumatic Drugs used in the treatment of rheumatoid arthritis
include the following, EXCEPT:
A. Cyclosporine
B. Methotrexate
C. D-penicillamine
D. Gold compounds
5. The 1982 Clinical Criteria for the diagnosis of SLE include the following, EXCEPT:
A. ANA
B. Malar rash
C. Leukopenia
D. ++ Proteinuria

6. The Clinical Criteria for the diagnosis of polymyositis include the following, EXCEPT:
A. + EMG
B. Elevated ESR
C. + Muscle biopsy
D. Symmetrical weakness

7. Which of the following is NOT associated with SLE?

A. Malar rash over the bridge of the nose
B. Leukopenia with lymphopenia <1 500
C. Erosive arthritis usually involving the hands and elbows
D. Proteinuria of > 300 grams per day or +3 per routine urinalysis

8. The drug most appropriate to lower serum urate in over producers, stone formers and patients
with advanced renal failure is:
A. Probenecid
B. Allopurinol
C. Benzbromarone
D. Low dose aspirin

9. The disease associated with an episodic inflammation of the joints is:

A. Fungal arthritis
B. Syphilitic arthritis
C. Tuberculous arthritis
D. Gonococcal arthritis
10. The most common form of arthritis characterized by progressive deterioration and loss of
articular cartilage:
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gouty arthritis
D. Septic arthritis

11. The characteristic feature of Rheumatoid arthritis is:

A. fibrotic changes of the skin
B. osteoporosis
C. persistent inflammatory synovitis
D. asymmetric involvement of large weight-bearing joints

12. Heberden’s nodes are found in

A. Systemic lupus erythematous (SLE)
B. Gouty arthritis
C. Osteoarthritis
D. Rheumatoid arthritis (RA)
13. The most powerful risk factor for osteoarthritis is:
A. Female sex
B. Obesity
C. Age
D. Prior inflammatory joint disease
Page 2037

14. Disabilility of patient with knee osteoarthritis is strongly associated with:

A. Radiographic severity of joint damage
B. Joint pain
C. Quadriceps muscle weakness
D. Obesity
Page 2037

15. Which of the following is the characteristic physical examination finding of patient with
osteoarthritis?
A. Localized tenderness
B. Swelling of bony and soft tissue
C. Periarticular muscle atrophy
D. Bony Crepitus
Page – 2039

16. Which of the following is considered as the most common form of idiopathic osteoarthritis
A. Bouchard’s nodes
B. Heberden’s nodes
C. Gelatinous dorsal cyst
D. Osler nodes
Page 2040

17. A 30 y/o female with SLE is noted to have a prolonged partial thromboplastin time. This
abnormality is associated with:
A. Leukopenia
B. Central nervous system vasculitis
C. Central nervous system hemorrhage
D. Deep venous thrombosis
Page 1964

18. The best screening test for the detection of SLE is:
A. Anti-Sm
B. Anti- dsDNA
C. Antinuclear antibodies
D. Anti-Ro
Page 1961

19. Diagnosis of gouty arthritis is base on the finding of crystals in the synovial fluid and which of the
following crystals is diagnostic of gout?
A. Apatite crystals
B. Birefringent needle-shaped crystals
 C. Rod-shaped weakly birefringent crystals
D. Rhomboid strongly birefrintent crystals
Page 2046-2049

20. The preferred treatment of acute gouty attack in elderly patient is:
A. Colchicine
B. NSAID
C. Intraarticular steroid infection
D. Oral steroid
Page 2046

21. Joint pain among patient with Rheumatoid arthritis is cause mainly by which of the following
mechanism?
A. Muscle spasm
B. Stretching of periostal nerve endings
C. Stretching of the joint’s ligaments
D. Distention of joint capsule
Page 1971

22. Axial (vertebra) joints involvement in Rheumatoid arthritis is usually limited to the:
A. Cervical vertebrae
B. Thoracic vertebrae
C. Lumbar vertebra
D. Sacral vertebrae
Page 1971
23. Evidence suggests that early aggressive treatment of rheumatoid arthritic patient with Disease-
Modifying Antirheumatic Drugs (DMARD) maybe effective at slowing the appearance of bone
erosions. Which of the DMARD is currently considered the best initial choice?
A. D-penicillamine
B. Gold compound
C. Methotrexate
D. Sulfasalazine
Page 1975