IM 7.

Extraarticular manifestations may develop during the

October 19, 2018 clinical course of RA. Pts most likely to develop
extraarticular dse have the ff hx, except
1. Which of the ff drugs is known to slow down a. positive rheumatoid factor
structural progression damage in RA? b. early onset of significant physical disability
a. DMARDs c. smoking
b. NSAIDs d. none
c. steroids
d. TNFa inhibitors 8. Evaluation of dse activity improvement in RA by ACR
includes the ff measures except
2. Which of the ff is not included in the cardinal features a. swollen joint count
of the pathogenesis of systemic sclerosis? b. rheumatoid factor
a. cellular and humoral autoimmunity c. acute phase reactants
b. vasculopathy d. tender joint count
c. immune complex deposition
d. progressive visceral and vascular fibrosis in 9. A 24yo M complains of low back pain for 3-4mos
multiple organs associated with stiffness of the lumbar area, which
worsens with inactivity. He also has difficulty in getting
3. CASPAR criterial is used in the dx of which of the ff? out of bed in the morning. A lumbosacral spine is
a. RA requested, which of the ff is the most likely finding?
b. gout a. vertebral body destruction with wedge
c. psoriatic arthritis fractures
d. reactive arthritis b. degenerative joint dse with spur formation
c. osteonecrosis of the lumbar spine
4. A 55yo gardener complained of difficulty in using his L d. sacroilitis with increased sclerosis around the
elbow for a few days. He is unable to bend it easily, sacroiliac joint
warm to touch and is painful. On examination, the
elbow is red, swollen, and tender to light touch. He 10. Which of the ff patterns represent the most
denies fever, recent trauma, or previous hx of joint common presentation of early psoriatic arthritis?
problems. He states that his father and 2 brothers have a. arthritic mutilans
gout. Aspiration reveals thick tallow fluid. On b. psoriatic spondylitis
microscopic exam, wbcs, rbcs, and thin, needle-shaped c. asymmetric arthritis
crystals are noted. What is the next step in this pt’s d. symmetric polyarthritis
mgt?
a. start oral colchicine 11. Earliest manifestation of ankylosing spondylitis
b. inject steroids a. tenosynovitis
c. start allopurinol b. sacroilitis
d. start antibiotics c. pannus formation
d. tendinitis
5. Which of the ff is the initial radiographic finding in pts
with early RA
a. soft tissue swelling
b. symmetric joint space loss
c. periarticular osteopenia
d. subchondral bone erosion

6. In AL amyloidosis, which organ is primarily involved?

a. kidney
b. brain
c. bone marrow
d. heart
12. An 80yo M complained of difficulty holding the phone 18. A pt with a nonarticular type of joint pain will most
with his right hand. He has chronic morning stiffness that likely present with the ff except
lasts 1h, no recent episodes of acute swelling. a. no major limitation of movemt
Examination of the pt’s R hand reveals swelling and b. swelling
several hard nodules across the third digit. He has CKD c. focal tenderness
and lab tests showed a serum creatinine level of d. ..
2.0mg/dL (normal, 0.6-1.2), and a long hx of on and off
joint pains. Once a dx of gout is confirmed, goals of 19. The ff are true for enterohepatic arthritis, except
therapy should include which of the ff? a. equal male to female ratio
a. decrease the serum uric acid level to b. peripheral arthritis correlates well with GI sxs
<4.0mg/dL c. commonly presents with symmetrical
b. decrease the serum uric acid level to polyarthritis
<8.0mg/dL d. ..
c. decrease the serum uric acid level to
<6.0mg/dL 20. One approach to address a joint or muscular
d. normalize the ESR complaint is to differentiate whether the nature of the
sxs is articular or nonarticular. The ff refers to articular
13. Which of the ff is the drugs used for RA had a risk for structures, except
devt of bone erosions? a. synovium
a. cyclophosphamide b. joint capsule
b. infliximab c. tendon
c. glucocorticoids d. synovial fluid
d. methotrexate
21. Bony prominences on the fingers near the
14. The kidneys are the most common organ affected in fingernails were observed on PE of 55yo M. These are
which of the ff dses? most likely
a. sarcoidosis a. Heberden’s
b. amyloidosis b. Bouchard’s
c. sjogrens
d. ankylosing spondylitis 22. The ff are articular causes of joint pains, except
a. gout
15. Which of the ff is a char’c finding of pts with RA? b. trauma/fracture
a. back pain c. fibromyalgia
b. early morning stiffness lasting for >1h d.polymyalgia rheumatic
c. tenosynovitis e. none
d. fever and body malaise
23. Which of the ff clinical signs of AL amyloidosis is
16. The ff articular features distinguish psoriatic arthritis considered pathognomonic?
from other joint disorders a. circumoral ecchymoses
a. dactylitis b. unexplained nephropathy
b. rapid ankyloses of PIPs early in the course of c. macroglossia
dse d. fingernail dystrophy
c. tenosynovitis and enthesitis
d. …

17. A 30yo F is morbidly obese. Which joints are most

likely to have early degenerative changes?
a. knees
b. lumbar spine
c. hips
d. …
24. In the pathogenesis of SSc, which pathophysiologic 30. Bamboo spine is a manifestation of which of the ff
process is/are considered early mx of the dse? dse?
a. altered vascular reactivity and diffuse a. ankylosing spondylitis
microangiopathy b. ReA
b. altered vascular reactivity c. psoriatic arthritis
c. diffuse microangiopathy d. RA
d. inflammation and autoimmunity
e. inflammation and autoimmunity and altered 31. Which of the ff is least likely to be seen in pts with
vascular reactivity sjogrens synd?
a. renal tubular acidosis
25. A 55yo gardener complained of difficulty in using his b. lymphoma
L elbow for a few days. He is unable to bend it easily, c. cardiac fibrosis
warm to touch and is painful. On examination, the d. corneal ulceration
elbow is red, swollen, and tender to light touch. What is e. dental caries
the first step in the mgt of this pt?
a. start NSAIDs 32. Which of the joints is most frequently affected in
b. do radio studies CPPD arthropathy?
c. aspirate the olecranon bursa a. knee
d. start colchicine b. elbow
e. start antibiotics c. hand
d. wrist
26. Which of the ff autoantibodies is associated with
diffuse cutaneous SSc? 33. Which of the ff best differentiates hand Oa from RA?
a. anti-centromere a. involvement of the first CMC joints is seen
b. anti-RNP more in RA
c. anti-Jo-1 b. synovial inflammation is seen only in RA
d. anti-ScL-70 c. polyarticular involvement is note seen in RA
d. morning stiffness is present only in RA
27. Positive for HLA-B27 is often seen in
a. ReA 34. Which of the ff is the most common inflammatory
b. psoriatic arthritis arthritis in men?
c. ankylosing spondylitis a. gout
d. RA b. OA
c. gonococcal arthritis
28. Septic arthritis can present with any of the ff except d. pseudogout
a. synovitis
b. morning stiffness 35. Compressive myelopathy and resulting neurologic
c. systemic sxs dysfunction occur rarely in RA. If this occurs, which of
d. polyarthritis the ff section of the vertebra is most likely involved?
e. rash a. atlantoaxial of the cervical spine
b. apophyseal joint of the lumbar spine
29. Involvement of the DIP joint is often seen in? c. sacroiliac joint
a. OA d. facet joint of the thoracic spine
b. RA
c. both 36. The classification of whether a complaint referring
d. none to joint or musculoskeletal dse is acute or chronic is
based on whether the sxs have been present for >?
a. 5w
b. 4w
c. 6w
d. 10w
37. Positive RF test may be seen in all the ff except d. all
a. bacterial endocarditis
b. pTB 44. Leading cause of death from AL amyloidosis
c. syphilis a. cardiac involvement
d. ReA b. CNS
e. infectious mononucleosis c. lung
d. renal
38. Arthritis mutilans is often seen in which type of e. hepatic
arthritis?
a. psoriatic 45. Which of the ff conditions have the highest
b. ReA prevalence of infectious arthritis?
c. gout a. OA
d. RA b. RA
c. gout
39. Systemic sclerosis is an acquired sporadic dse with a d. pseudogout
worldwide distribution. The ff factors are impt in dse
susceptibility except 46. Which type of amyloidis is often associated a
a. gender chronic inflammatory state?
b. presence of co-morbid illness a. AA
c. age b. AL
d. ethnicity c. AF
d. all
40. A 20yo F presented with worsening cough
associated with SOB for about 6w. Antibiotic was given 47. In joint dses, the presence of intermittent stiffness is
with no improvement. Her serum Ca level is noted to be most likely observed in which of the ff conditions?
12.5mg/dL with cxr showing bilateral hilar a. noninflam
lymphadenopathy. Erythema nodosum was observed in b. inflam
the lower ex. Which of the ff is most likely the dx? c. both
a. RA
b. sarcoidosis 48. Type of anemia seen in RA
c. multiple myeloma a. normocytic hypochromic
d. sjogrens dse b. normocytic normochromic
e. systemic sclerosis c. microcytic hypochromic
d. macrocytic hypochromic
41. Cells that are more commonly seen in mild lesions of
sjogren dse 49. In the edematous phase of diffuse systemic
a. T lymphocytes sclerosis, a sign of early inflammation is
b. B lymphocytes a. digital necrosis
c. neutrophils b. muscle weakness
c. arthralgia
42. Which of the ff is the most potent risk factor for OA? d. intense pruritus
a. weight
b. age 50. Rectangular, rhomboid crystals are weakly positively
c. osteoporosis or non birefringent crystals
d. gender a. calcium oxalate deposition dse
b. gout
43. Which of the ff is an aggressive approach to mgt of c. pseudogout
autoimmune dse d. calcium apatite deposition dse
a. immune modulation
b. replacement
c. symptomatic tx
51. The ff arthritides are considered during acute
attacks except
a. gout
b. OA
c. infectious arthritis
d. ReA

52.

53.

54. A 70yo M was dxd with OA. Earliest changes can be

seen in the ___
a. cartilage
b. capsule
c. tendon
d. joint space

55. Which of the ff statements is false about diffuse

cutaneous systemic sclerosis?
a. presents with progressive skin induration
from fingers to extremities, to face and trunk
b. presents with long standing raynauds
phenomenon
c. higher risk for early pulmonary fibrosis
d. increased risk for acute renal involvement

56. Which of the ff statements about RF is true?

a. RFs are antibodies directed against the
variable region of IgG
b. only RF-positive pts have extraacrticular
complications
c. 40% of RA pts are RF positive
d.the newest generation of RF tests measures
all Ig classes
e. RFs are specific for RA