I85PREP
⌘ K
ESTER Reumatologia study materials
ESTER Reumatologia study resources

ESTER Reumatologia practice questions

One question at a time. Build your ESTER Reumatologia understanding.

First 50 of 199 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Rheumatology (general)

Which autoantibody is most characteristic of systemic sclerosis with diffuse cutaneous involvement and interstitial lung disease?

  1. Anti-U1 RNP antibody
  2. Anti-Jo-1 antibody
  3. Anti-topoisomerase I (anti-Scl-70) antibody Correct answer.
  4. Anti-centromere antibody

Explanation

Anti-topoisomerase I antibodies associate with diffuse cutaneous systemic sclerosis and a higher risk of interstitial lung disease. Anti-centromere antibodies instead mark limited cutaneous disease with pulmonary hypertension risk.

Question 2Rheumatology (general)

A 55-year-old woman has symmetric small-joint polyarthritis, morning stiffness over one hour, and elevated anti-CCP antibodies. Which diagnosis is most likely?

  1. Fibromyalgia
  2. Rheumatoid arthritis Correct answer.
  3. Psoriatic arthritis
  4. Osteoarthritis

Explanation

Symmetric small-joint involvement with prolonged morning stiffness and positive anti-CCP antibodies strongly supports rheumatoid arthritis. Anti-CCP is highly specific for this disease and predicts erosive progression.

Question 3Rheumatology (general)

Which finding on synovial fluid analysis most suggests septic arthritis rather than an inflammatory arthritis flare?

  1. Synovial white cell count of 2,000 cells per microliter
  2. Synovial white cell count above 50,000 cells per microliter with neutrophilic predominance Correct answer.
  3. Positive antinuclear antibody in the fluid
  4. Presence of monosodium urate crystals

Explanation

Septic synovial fluid typically shows a markedly elevated white cell count, often above 50,000 cells per microliter, with neutrophil predominance. Gram stain and culture remain essential because no cell count threshold is fully diagnostic.

Question 4Rheumatology (general)

Which pattern of joint involvement is most typical of osteoarthritis of the hands?

  1. Symmetric metacarpophalangeal synovitis
  2. Dactylitis with pencil-in-cup erosions
  3. Painless fixed flexion of the fourth and fifth fingers
  4. Distal interphalangeal and first carpometacarpal involvement Correct answer.

Explanation

Osteoarthritis of the hand classically affects the distal interphalangeal joints and the first carpometacarpal joint. Heberden nodes reflect distal interphalangeal osteophytes.

Question 5Rheumatology (general)

Which laboratory finding is a recognized classification criterion for systemic lupus erythematosus?

  1. Elevated creatine kinase
  2. Anti-double-stranded DNA antibodies Correct answer.
  3. Anti-histone antibodies in isolation
  4. Rheumatoid factor

Explanation

Anti-double-stranded DNA antibodies are part of the classification criteria for systemic lupus erythematosus and correlate with renal involvement. Titers may fluctuate with disease activity.

Question 6Rheumatology (general)

Which agent is first-line pharmacologic therapy for acute gout flare in a patient without contraindications?

  1. Febuxostat
  2. Probenecid
  3. Colchicine, a nonsteroidal anti-inflammatory drug, or glucocorticoids Correct answer.
  4. Allopurinol at high dose

Explanation

Acute gout is treated with anti-inflammatory therapy such as colchicine, nonsteroidal anti-inflammatory drugs, or glucocorticoids. Urate-lowering drugs are not used to abort an acute flare.

Question 7Rheumatology (general)

Which clinical feature best distinguishes polymyalgia rheumatica from rheumatoid arthritis?

  1. Symmetrical small-joint erosions
  2. Positive anti-CCP antibody
  3. Shoulder and hip girdle pain with markedly elevated inflammatory markers and rapid response to low-dose glucocorticoids Correct answer.
  4. Dactylitis

Explanation

Polymyalgia rheumatica causes proximal girdle pain and stiffness with high erythrocyte sedimentation rate or C-reactive protein and dramatic response to low-dose prednisone. It does not cause erosive small-joint disease.

Question 8Rheumatology (general)

Which antibody is most strongly associated with neonatal lupus and congenital heart block?

  1. Anti-Ro/SSA antibody Correct answer.
  2. Anti-Sm antibody
  3. Anti-Jo-1 antibody
  4. Anti-ribosomal P antibody

Explanation

Maternal anti-Ro/SSA antibodies can cross the placenta and cause neonatal lupus, including congenital complete heart block. Anti-La/SSB may coexist and carries similar risk.

Question 9Rheumatology (general)

A 30-year-old man has chronic low back pain improved by exercise, bilateral sacroiliitis on imaging, and a history of anterior uveitis. Which diagnosis is most likely?

  1. Systemic lupus erythematosus
  2. Rheumatoid arthritis
  3. Gout
  4. Ankylosing spondylitis Correct answer.

Explanation

Inflammatory back pain, bilateral sacroiliitis, and recurrent anterior uveitis form a classic presentation of axial spondyloarthritis such as ankylosing spondylitis. Human leukocyte antigen B27 testing supports the diagnosis.

Question 10Rheumatology (general)

Which human leukocyte antigen allele is most strongly associated with ankylosing spondylitis?

  1. HLA-B27 Correct answer.
  2. HLA-DR4
  3. HLA-B51
  4. HLA-DQ2

Explanation

HLA-B27 is present in the majority of patients with ankylosing spondylitis and is the strongest known genetic risk factor. Its presence supports but does not by itself establish the diagnosis.

Question 11Rheumatology (general)

Which feature is required for the diagnosis of fibromyalgia under current criteria?

  1. Positive antinuclear antibody
  2. Synovial hypertrophy on ultrasound
  3. Elevated erythrocyte sedimentation rate
  4. Chronic widespread pain with associated fatigue and sleep disturbance in the absence of inflammatory disease Correct answer.

Explanation

Fibromyalgia is a centralized pain disorder diagnosed by widespread pain with fatigue, cognitive symptoms, or sleep disturbance and no alternative inflammatory explanation. Laboratory tests are typically normal.

Question 12Rheumatology (general)

A patient with established rheumatoid arthritis develops new cervical pain and paresthesias. Which complication should be evaluated?

  1. Atlantoaxial subluxation Correct answer.
  2. Achilles tendinopathy
  3. Carpal tunnel syndrome
  4. Plantar fasciitis

Explanation

Chronic synovitis of the cervical spine can erode the transverse ligament and cause atlantoaxial instability. New neck pain with neurologic symptoms warrants cervical imaging before procedures such as intubation.

Question 13Rheumatology (general)

Which medication used in rheumatoid arthritis requires regular monitoring of the complete blood count and liver enzymes because of hepatotoxicity and myelosuppression?

  1. Prednisone
  2. Sulfasalazine
  3. Hydroxychloroquine
  4. Methotrexate Correct answer.

Explanation

Methotrexate can cause bone marrow suppression and hepatic injury, so blood counts and liver enzymes are monitored periodically. Folic acid supplementation reduces mucosal and hematologic toxicity.

Question 14Rheumatology (general)

Which finding best supports a diagnosis of gout over pseudogout in an acutely swollen knee?

  1. Elevated serum ferritin
  2. Calcium pyrophosphate deposition on radiography
  3. Negatively birefringent needle-shaped crystals under polarized light Correct answer.
  4. Positively birefringent rhomboid crystals

Explanation

Monosodium urate crystals are needle-shaped and show negative birefringence under compensated polarized light. Calcium pyrophosphate crystals are rhomboid and positively birefringent.

Question 15Rheumatology (general)

Which extra-articular manifestation is most characteristic of psoriatic arthritis?

  1. Malar rash
  2. Dactylitis and nail pitting Correct answer.
  3. Sicca symptoms
  4. Raynaud phenomenon

Explanation

Psoriatic arthritis commonly involves dactylitis and nail changes such as pitting and onycholysis. These features reflect enthesitis and skin-nail involvement.

Question 16Rheumatology (general)

A patient with systemic sclerosis develops new exertional dyspnea. Which screening test is recommended annually to detect pulmonary arterial hypertension in this population?

  1. Sputum culture
  2. Transthoracic echocardiography Correct answer.
  3. Chest radiograph
  4. Bone densitometry

Explanation

Annual echocardiography estimates pulmonary artery pressure and screens for pulmonary arterial hypertension in systemic sclerosis. Right heart catheterization confirms the diagnosis when suspicion arises.

Question 17Rheumatology (general)

Which feature is most consistent with a diagnosis of Sjögren syndrome?

  1. Anti-Jo-1 antibody with mechanic hands
  2. HLA-B27 with sacroiliitis
  3. Anti-Ro/SSA and anti-La/SSB antibodies with keratoconjunctivitis sicca Correct answer.
  4. Anti-topoisomerase I antibody with skin thickening

Explanation

Sjögren syndrome causes dry eyes and mouth with anti-Ro/SSA and anti-La/SSB antibodies and a positive labial salivary gland biopsy. Lymphocytic infiltration of exocrine glands underlies the sicca symptoms.

Question 18Rheumatology (general)

Which agent is used for induction therapy in severe lupus nephritis with proliferative lesions?

  1. Hydroxychloroquine alone
  2. Allopurinol
  3. Colchicine
  4. Intravenous cyclophosphamide or mycophenolate mofetil, combined with glucocorticoids Correct answer.

Explanation

Proliferative lupus nephritis requires induction with glucocorticoids plus either cyclophosphamide or mycophenolate mofetil. Hydroxychloroquine is continued as background therapy but is insufficient alone for severe nephritis.

Question 19Rheumatology (general)

A patient on chronic prednisone therapy should receive which preventive measures?

  1. Annual colonoscopy
  2. High-dose methotrexate
  3. Routine anticoagulation
  4. Calcium and vitamin D supplementation with bone density assessment Correct answer.

Explanation

Chronic glucocorticoid therapy increases fracture risk, so calcium, vitamin D, and bone density monitoring are recommended. Bisphosphonates may be added for high-risk patients.

Question 20Rheumatology (general)

Which pattern of muscle involvement and antibodies suggests antisynthetase syndrome?

  1. Proximal muscle weakness with anti-Jo-1 antibodies, interstitial lung disease, and mechanic hands Correct answer.
  2. Distal weakness with anti-SRP antibodies
  3. Painless proximal weakness with anti-acetylcholine receptor antibodies
  4. Episodic weakness with hypokalemia

Explanation

Antisynthetase syndrome combines myositis, interstitial lung disease, arthritis, mechanic hands, and anti-aminoacyl-tRNA synthetase antibodies such as anti-Jo-1. Lung involvement often dominates the clinical course.

Question 21Rheumatology (general)

A young man presents with recurrent oral and genital ulcers, erythema nodosum, and uveitis. Which diagnosis is most likely?

  1. Reactive arthritis
  2. Behçet disease Correct answer.
  3. Granulomatosis with polyangiitis
  4. Dermatomyositis

Explanation

Recurrent oral and genital ulceration with uveitis and erythema nodosum is characteristic of Behçet disease. The pathergy test and HLA-B51 may support the diagnosis.

Question 22Rheumatology (general)

Which pattern of antineutrophil cytoplasmic antibody is most associated with granulomatosis with polyangiitis?

  1. Perinuclear pattern targeting myeloperoxidase
  2. Nuclear pattern targeting histones
  3. Cytoplasmic pattern targeting proteinase 3 Correct answer.
  4. Atypical pattern targeting elastase

Explanation

Granulomatosis with polyangiitis is strongly associated with cytoplasmic antineutrophil cytoplasmic antibodies directed against proteinase 3. Perinuclear antibodies against myeloperoxidase are more typical of microscopic polyangiitis.

Question 23Rheumatology (general)

A patient with known rheumatoid arthritis develops sudden monocular vision loss with a painful red eye. Which extra-articular complication should be considered?

  1. Cataract
  2. Pinguecula
  3. Scleritis with corneal melt Correct answer.
  4. Keratoconjunctivitis sicca

Explanation

Severe rheumatoid arthritis can cause necrotizing scleritis with corneal thinning and perforation, threatening vision. Urgent ophthalmologic evaluation is required.

Question 24Rheumatology (general)

Which mechanism best explains the increased cardiovascular risk in chronic systemic lupus erythematosus?

  1. Accelerated atherosclerosis driven by chronic inflammation and glucocorticoid exposure Correct answer.
  2. Isolated hyperthyroidism
  3. Vitamin D excess
  4. Direct bacterial invasion of coronary arteries

Explanation

Chronic inflammation, immune-complex deposition, and long-term glucocorticoid use accelerate atherosclerosis in lupus. Cardiovascular risk assessment is therefore an important part of long-term care.

Question 25Rheumatology (general)

A patient with suspected giant cell arteritis has jaw claudication and visual symptoms. What is the most appropriate immediate management?

  1. Start methotrexate alone
  2. Start high-dose glucocorticoids immediately and arrange temporal artery biopsy Correct answer.
  3. Observe with serial inflammatory markers
  4. Wait for biopsy results before starting glucocorticoids

Explanation

Giant cell arteritis with visual symptoms is an emergency requiring immediate high-dose glucocorticoids to prevent irreversible blindness. Biopsy can still be performed shortly after starting steroids.

Question 26Rheumatology (general)

Which joint pattern is most typical of early rheumatoid arthritis?

  1. Symmetrical small-joint polyarthritis of the hands and wrists Correct answer.
  2. Painless effusion of a single knee with chondrocalcinosis on radiograph
  3. Symmetrical involvement of the distal interphalangeal joints with nail pitting
  4. Asymmetrical monoarthritis of the first metatarsophalangeal joint

Explanation

Rheumatoid arthritis classically begins as a symmetrical inflammatory polyarthritis that favors the small joints of the hands, wrists, and feet, with morning stiffness lasting more than an hour. Sparing of the distal interphalangeal joints is characteristic and helps separate it from osteoarthritis and psoriatic disease. Persistent untreated synovitis leads to marginal erosions and deformities.

Question 27Rheumatology (general)

Which laboratory finding is most specific for systemic lupus erythematosus when present in high titer?

  1. Rheumatoid factor
  2. Antinuclear antibody
  3. Anti-double-stranded DNA antibody Correct answer.
  4. C-reactive protein

Explanation

Anti-double-stranded DNA antibodies are highly specific for systemic lupus erythematosus and their titer tends to track with disease activity, particularly lupus nephritis. Antinuclear antibody is sensitive but appears in many connective tissue diseases and in healthy people, so it is used mainly as a screening test. Rheumatoid factor and C-reactive protein are nonspecific markers of inflammation.

Question 28Rheumatology (general)

Which clinical feature is most characteristic of dermatomyositis on physical examination?

  1. Livedo reticularis with digital ulceration
  2. Diffuse skin thickening with sclerodactyly
  3. Painless subcutaneous nodules over extensor surfaces
  4. Heliotrope rash and Gottron papules Correct answer.

Explanation

Dermatomyositis produces pathognomonic cutaneous findings, notably a violaceous periorbital heliotrope rash and erythematous papules over the knuckles known as Gottron papules. Proximal muscle weakness accompanies these skin changes. The other listed findings belong to different connective tissue diseases.

Question 29Rheumatology (general)

Which infection is classically associated with reactive arthritis?

  1. Staphylococcus aureus skin infection
  2. Chlamydia trachomatis urethritis Correct answer.
  3. Epstein-Barr virus mononucleosis
  4. Borrelia burgdorferi tick bite

Explanation

Reactive arthritis follows a genitourinary or gastrointestinal infection, and Chlamydia trachomatis is the best-recognized trigger in sexually acquired cases. It presents as an asymmetric oligoarthritis with enthesitis, often weeks after the infection. The other organisms cause septic arthritis, viral arthralgia, or Lyme disease rather than reactive arthritis.

Question 30Rheumatology (general)

A 55-year-old woman has dry eyes, dry mouth, and bilateral parotid enlargement. Which test is most appropriate to confirm the diagnosis?

  1. Serum complement levels
  2. Salivary gland biopsy showing focal lymphocytic sialadenitis Correct answer.
  3. Serum angiotensin-converting enzyme
  4. Blood cultures

Explanation

Sjögren syndrome is confirmed with a labial salivary gland biopsy demonstrating focal lymphocytic sialadenitis, or with positive anti-SSA/Ro antibodies plus objective ocular or oral dryness. The biopsy is the most specific single test. Complement levels, cultures, and angiotensin-converting enzyme do not establish the diagnosis.

Question 31Rheumatology (general)

A 68-year-old man has new temporal headache, scalp tenderness, and an erythrocyte sedimentation rate of 95 mm/h. What is the immediate next step in management?

  1. Obtain magnetic resonance angiography of the brain
  2. Start methotrexate monotherapy
  3. Arrange temporal artery biopsy before any treatment
  4. Start high-dose glucocorticoids without waiting for biopsy Correct answer.

Explanation

Giant cell arteritis threatens vision through anterior ischemic optic neuropathy, so high-dose glucocorticoids must begin immediately when clinical suspicion is high. Temporal artery biopsy should still be arranged, but treatment is never delayed to obtain it because steroid therapy does not abolish the histologic findings for several days. Methotrexate is a later steroid-sparing option, not acute therapy.

Question 32Rheumatology (general)

A 40-year-old woman with systemic lupus erythematosus reports recurrent pregnancy losses and a prior deep vein thrombosis. Which antibody should be measured?

  1. Antiphospholipid antibodies Correct answer.
  2. Anti-centromere antibody
  3. Anti-histone antibody
  4. Anti-Jo-1 antibody

Explanation

Recurrent pregnancy loss plus venous thrombosis in a patient with lupus suggests secondary antiphospholipid syndrome, diagnosed by persistent anticardiolipin antibodies, anti-beta-2-glycoprotein I antibodies, or a lupus anticoagulant. Confirmation requires repeat testing at least twelve weeks apart. Anticoagulation then reduces thrombotic recurrence.

Question 33Rheumatology (general)

A 60-year-old man has sudden severe pain and swelling of the first metatarsophalangeal joint. Joint aspiration shows needle-shaped negatively birefringent crystals. Which finding on history most strongly increases the likelihood of this disease?

  1. Long-standing hypothyroidism
  2. Chronic hepatitis C infection
  3. Recent treatment with a loop diuretic Correct answer.
  4. Prior splenectomy

Explanation

The crystals described are monosodium urate, confirming gout. Loop and thiazide diuretics reduce renal urate excretion and raise serum urate, precipitating flares. Other risk factors include chronic kidney disease, alcohol use, and purine-rich diets.

Question 34Rheumatology (general)

A 32-year-old woman has a malar rash, oral ulcers, and arthritis. Urinalysis shows red cell casts and proteinuria. Which additional finding best predicts active proliferative lupus nephritis?

  1. Positive rheumatoid factor
  2. Positive anti-centromere antibody
  3. Elevated creatine kinase
  4. Rising anti-double-stranded DNA titer with falling complement Correct answer.

Explanation

Active proliferative lupus nephritis is typically accompanied by a rising anti-double-stranded DNA titer and falling C3 and C4 levels as immune complexes consume complement. These serologic trends support the urinalysis findings and prompt renal biopsy for classification. Creatine kinase and anti-centromere antibodies reflect muscle and scleroderma disease, respectively.

Question 35Rheumatology (general)

Which biologic mechanism of action is shared by etanercept and adalimumab?

  1. Blockade of tumor necrosis factor Correct answer.
  2. Blockade of the interleukin-1 receptor
  3. Inhibition of interleukin-6 receptor
  4. Depletion of B lymphocytes

Explanation

Both etanercept and adalimumab neutralize tumor necrosis factor, though etanercept is a soluble receptor fusion protein and adalimumab is a monoclonal antibody. This class is effective in rheumatoid arthritis, spondyloarthritis, and psoriasis. All tumor necrosis factor blockers carry an increased risk of reactivation of latent tuberculosis, so screening is mandatory before starting therapy.

Question 36Rheumatology (general)

A 45-year-old woman has Raynaud phenomenon, puffy fingers, and positive anti-topoisomerase I antibodies. Which internal organ complication is she at highest risk of developing?

  1. Cerebellar ataxia
  2. Hepatic cirrhosis
  3. Isolated diastolic hypertension
  4. Interstitial lung disease Correct answer.

Explanation

Anti-topoisomerase I, also called anti-Scl-70, marks diffuse cutaneous systemic sclerosis and strongly predicts interstitial lung disease and scleroderma renal crisis. These patients need baseline pulmonary function tests and high-resolution computed tomography with periodic monitoring. Early detection allows immunosuppressive treatment of the lung disease.

Question 37Rheumatology (general)

A 24-year-old woman has fever, a new heart murmur, and painful erythematous nodules on the shins. Which diagnosis should be considered first?

  1. Erythema nodosum from streptococcal infection or sarcoidosis Correct answer.
  2. Erythema migrans from Borrelia burgdorferi
  3. Cellulitis from Staphylococcus aureus
  4. Erythema multiforme from herpes simplex virus

Explanation

Tender nodules on the anterior shins represent erythema nodosum, a septal panniculitis that occurs with streptococcal infection, sarcoidosis, inflammatory bowel disease, and certain drugs. The accompanying fever and murmur warrant evaluation for infection and sarcoidosis-related cardiac disease. Erythema nodosum itself is a reactive finding, not an infection of the skin.

Question 38Rheumatology (general)

A 58-year-old man with long-standing rheumatoid arthritis is found to have a low absolute neutrophil count and splenomegaly. Which diagnosis best explains this combination?

  1. Acute myeloid leukemia
  2. Drug-induced aplastic anemia
  3. Hemophagocytic lymphohistiocytosis
  4. Felty syndrome Correct answer.

Explanation

Felty syndrome is the triad of seropositive erosive rheumatoid arthritis, splenomegaly, and neutropenia, and it predisposes to recurrent bacterial infections. It typically occurs in patients with long-standing, nodular disease and high rheumatoid factor titers. Treatment centers on controlling the arthritis and managing infection risk.

Question 39Rheumatology (general)

A 35-year-old man has recurrent anterior uveitis, oral ulcers, and a positive pathergy test. Which treatment is most appropriate for severe ocular and mucocutaneous disease?

  1. High-dose glucocorticoids with a tumor necrosis factor inhibitor Correct answer.
  2. Hydroxychloroquine alone
  3. Oral acyclovir
  4. Colchicine alone

Explanation

This presentation is Behçet disease, and severe eye or mucocutaneous involvement requires systemic glucocorticoids combined with a tumor necrosis factor inhibitor such as infliximab or adalimumab. Biologic therapy reduces relapse and preserves vision. Colchicine helps milder mucocutaneous and joint disease but is insufficient for severe ocular inflammation.

Question 40Rheumatology (general)

A 70-year-old woman has proximal muscle weakness, a normal creatine kinase, and markedly elevated erythrocyte sedimentation rate with shoulder and hip girdle pain. Which feature most strongly supports polymyalgia rheumatica over late-onset rheumatoid arthritis?

  1. Erosive changes on hand radiographs
  2. Rapid dramatic response to low-dose prednisone Correct answer.
  3. Positive anti-cyclic citrullinated peptide antibody
  4. Symmetrical small-joint synovitis of the wrists

Explanation

Polymyalgia rheumatica characteristically responds within days to low-dose prednisone, in contrast to the slower and less complete response of rheumatoid arthritis. It affects the shoulder and hip girdles with stiffness and a high sedimentation rate while creatine kinase remains normal. Anti-cyclic citrullinated peptide antibodies and erosions indicate rheumatoid arthritis.

Question 41Inflammatory joint diseases

Which set of criteria is used to classify a patient as having fibromyalgia in current clinical practice?

  1. The Jones criteria for acute rheumatic fever
  2. The Ottawa ankle rules adapted for polyarthralgia
  3. The 2010/2016 ACR diagnostic criteria based on widespread pain index and symptom severity Correct answer.
  4. The 1987 ACR classification criteria based on tender point count

Explanation

Fibromyalgia is classified using the ACR 2010 criteria, later modified in 2016, which combine a widespread pain index with a symptom severity score and no longer require tender point examination. These criteria were designed to make diagnosis feasible in routine clinical settings.

Question 42Inflammatory joint diseases

A 34-year-old woman reports morning stiffness lasting about 90 minutes, symmetric swelling of the wrists and metacarpophalangeal joints, and fatigue. Which diagnosis is most likely?

  1. Gout
  2. Rheumatoid arthritis Correct answer.
  3. Fibromyalgia
  4. Osteoarthritis

Explanation

Prolonged morning stiffness exceeding one hour, symmetric small-joint synovitis of the wrists and MCP joints, and systemic fatigue are classic for rheumatoid arthritis. Osteoarthritis stiffness is usually brief and related to activity, while fibromyalgia causes pain without synovitis.

Question 43Inflammatory joint diseases

What is the most characteristic radiographic finding in established rheumatoid arthritis?

  1. Chondrocalcinosis of the menisci
  2. Osteophytes with subchondral sclerosis
  3. Punched-out lesions with overhanging edges
  4. Marginal erosions with periarticular osteopenia Correct answer.

Explanation

Rheumatoid arthritis causes marginal erosions at the bare areas of the joint along with periarticular osteopenia and symmetric joint space narrowing. These features reflect inflammatory pannus eroding bone.

Question 44Inflammatory joint diseases

Which autoantibody is most specific for rheumatoid arthritis and associated with more erosive disease?

  1. Antinuclear antibody
  2. Anti-cyclic citrullinated peptide antibody Correct answer.
  3. Rheumatoid factor
  4. Anti-histone antibody

Explanation

Anti-cyclic citrullinated peptide antibodies are highly specific for rheumatoid arthritis and predict a more aggressive, erosive course. Rheumatoid factor is sensitive but far less specific.

Question 45Inflammatory joint diseases

Which pattern of joint involvement is most typical of gout?

  1. Chronic axial involvement with sacroiliitis
  2. Painful hypermobility of the fingers
  3. Acute monoarthritis of the first metatarsophalangeal joint Correct answer.
  4. Symmetric polyarthritis of the hands and wrists

Explanation

Gout classically presents as sudden severe monoarthritis, most often at the first metatarsophalangeal joint, with rapid onset over hours. The joint is red, hot, and exquisitely tender.

Question 46Inflammatory joint diseases

Which finding in synovial fluid confirms the diagnosis of gout?

  1. Abundant lipid droplets
  2. Needle-shaped negatively birefringent crystals Correct answer.
  3. Gram-positive cocci in clusters
  4. Rhomboid-shaped positively birefringent crystals

Explanation

Monosodium urate crystals are needle-shaped and show negative birefringence under polarized light microscopy, which is diagnostic of gout. Calcium pyrophosphate crystals, by contrast, are rhomboid and positively birefringent.

Question 47Inflammatory joint diseases

What is the typical pattern of joint involvement in ankylosing spondylitis?

  1. Shoulder and hip involvement only
  2. Asymmetric oligoarthritis of the lower limbs with axial involvement Correct answer.
  3. Symmetric small-joint polyarthritis of the hands
  4. Distal interphalangeal joint predominance

Explanation

Ankylosing spondylitis is a seronegative spondyloarthritis characterized by inflammatory back pain and sacroiliitis, often with asymmetric oligoarthritis of the lower limbs. Peripheral involvement tends to be pauciarticular.

Question 48Inflammatory joint diseases

Which laboratory marker is most useful for monitoring disease activity in rheumatoid arthritis?

  1. Serum uric acid
  2. Antinuclear antibody titer
  3. C-reactive protein Correct answer.
  4. Serum creatinine

Explanation

C-reactive protein and erythrocyte sedimentation rate reflect systemic inflammation and are used to monitor rheumatoid arthritis activity alongside clinical assessment. Uric acid and autoantibody titers do not track inflammatory activity.

Question 49Inflammatory joint diseases

A 28-year-old man has inflammatory back pain, morning stiffness, and bilateral sacroiliitis on imaging. He is HLA-B27 positive. Which diagnosis fits best?

  1. Polymyalgia rheumatica
  2. Ankylosing spondylitis Correct answer.
  3. Rheumatoid arthritis
  4. Systemic lupus erythematosus

Explanation

Inflammatory back pain in a young adult with bilateral sacroiliitis and HLA-B27 positivity strongly supports axial spondyloarthritis, classically ankylosing spondylitis. The typical age of onset and axial pattern distinguish it from other inflammatory arthritides.

Question 50Inflammatory joint diseases

Which crystal is responsible for pseudogout?

  1. Calcium pyrophosphate dihydrate Correct answer.
  2. Calcium oxalate
  3. Monosodium urate
  4. Hydroxyapatite

Explanation

Pseudogout, or calcium pyrophosphate deposition disease, is caused by calcium pyrophosphate dihydrate crystals, which are rhomboid and positively birefringent. It often affects the knee and wrist in older adults.