10

Joint and Connective

Tissue Disorders
QUESTIONS

1. All of the following are common in idiopathic osteoarthritis (OA) of the knee except:
A) Age>50
B) Bony tenderness
C) Stiffness
D) Er)'.throcyte sedimentation rate (ESR) > 40

2. All of the following are common in idiopathic osteoarthritis (OA) of the knee except:
A) Palpa ble w armth
32•
B) Negative rheumatoid factor (or low titer)
C) Bony enlargement
D) Bony tenderness

3. Rheumatoid arthritis (RA):

A) Is primarily a noninflammatory disorder of weight-bearing joints
B) Primarily affects the distal interphalangeal (DIP) joints
C) Is more prevalent in females than in males
D) Is also known as "wear and tear" arthritis

ANSWERS TO THIS SECTION CAN BE FOUND ON PAGE 322 309

 JOINT AND CONNECTIVE TISSUE DISORDERS

4. A reasonable first line of treatment in osteoarthritis (OA) of the knee is:

A) Intra-articular injections
B) Oral steroids
C) Acetaminophen and/ or nonsteroidal an ti-inflammatory drugs (NSAIDs)
D) Colchicine

5. All of the following are true in systemic lupus erythematosus (SLE) except:
A) Avascular necrosis ty]jsally occurs in small joints
B) Low-dose steroids can be used to manage SLE
C) Arthritis is not necessary to diagnose SLE
D) Antimalarial drugs can be used for symptom control

6. Which of the following is true of gouty arthritis?

A) Calcium pyrophosphate dihydrate crystals are found in joint fluid
B) Female predominance
C) Allopurinol can be used during an attack
D) To£bj (de~ its of uric acid crystals) may be present

7. Which of the following is true about rheumatoid arthritis (RA)?

A) Asymmetric and nonerosive
B) Symmetric and erosive
C) Asymmetric and erosive
D) Symmetric and nonerosive

8. Which of the following are characteristic of rheumatoid arthritis (RA)?

A) Morning stiffness
B) Symmetric arthritis
C) Arthritis of the hand joints
D) All of the above 325

9. What causes a Boutonniere deformity?

A) Rupture of the extensor hood at the proximal interphalangeal joint (PIP), which causes
subluxation of the lateral bands of the extensor hood
B) Flexor synovitis
C) Ligamentous laxity
D) Rupture of the flexors with subluxation causing hyperextension at the PIP

10. What tendons are affected by de Quervain's synovitis?

A) Extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB)
B) Abductor r.ollicis longus (APL) and extensor r.ollicis brevis (EPB)
C) Extensor pollicis longus (EPL) and EPB
D) Extensor digiti minimi (EDM) and extensor carpi ulnaris (ECU)

11. Which of the following exercises is recommended for rheumatoid arthritis?

A) Isotonic
B) Concentric
C) Isokinetic
D) Isometric
 JOINT AND CONNECTIVE TISSUE DISORDERS: Questions

12. Which of the following are characteristics of osteoarthritis (OA)?

A) Dull, aching pain better with activity
B) Joint stiffness lasting< 30 minutes and .!!!!Proving as the d ay progresses
C) Typically involves the metacarpophalangeal (MCP) joints in the hands
D) Infrequently involves the spine

13. Which of the following is not a characteristic radiographic finding in osteoarthritis (OA)?
A) Asymmetric narrowing of the joint space
B) Erosive changes seen on x-ray
C) Subchondral bony sclerosis
D) Osteophytosis

14. Which of the following is not a characteristic radiographic finding in rheumatoid arthri-
tis (RA)?
A) Erosion of the ulnar styloid
B) Marginal bony erosions
C) Asymmetric joint involvement
D) Uniform joint space narrowing

15. What is the most common form of childhood arthritis?

A) Osteoarthritis
B) Juvenile rheumatoid arthritis
C) Rheumatic fever
D) Ankylosing spondylitis

16. Which of the following is a characteristic of gout?

A) Nega tive birefringence crystals noted on microscopy of joiqt aspiration
B) Positive birefringence crystals noted on microscopy of joint aspiration
C) Chondrocalcinosis
D) Affects hyaline cartilage

17. Which of the following is not associated with HLA-B27 (+) serology?
A) Reiter's syndrome (reactive arthritis)
B) Ankylosing spondylitis
C) Psoriatic arthritis
D) Osteoarthritis

18. Which joint/ area of the body is affected first in ankylosing spondylitis (AS)?
A) Lumbar spine
B) Sacroiliac joint
C) Cervical spine
D) Thoracic spine

19. Which of the following is not true about ankylosing spondylitis (AS)?
A) Onset is usually late adolescence or early adulthood
B) It is three times more common in men than in women
C) It can be associated with HLA-B27
D) The sacroili~ oint is usually not involved

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JOINT AND CONNECTIVE TISSUE DISORDERS

20. Which of the following is not a common disease complication of ankylosing spondylitis
(AS)?
A) Iritis/ uveitis
B) Inflammatory bowel disease
C) Osteoporosis
D) Dementia

21. What is the position of a swan-neck deformity of the finger typical in rheumatoid
arthritis?
A) Hyperextension of the proximal interphalangeal joint (PIP) with hyperextension of
the distal interphalangeal joint (DIP)
B) H)II>erextension of the PIP with flexion of the DIP
C) Flexion of the PIP with flexion of the DIP
D) Flexion of the PIP with hyperextension of the DIP

22. What is the earliest radiographic sign of rheumatoid arthritis?

A) Diffµse periarticular osteopenia
B) Ulnar deviation of the phalanges at the metacarpophalangeal joints (MCP)
C) Periarticular erosions
D) Pencil-in-cup deformity

23. What is the "gold standard" for diagnostic imaging in rheumatoid arthritis (RA)?
A) Ultrasound
B) Magnetic resonance imaging (MRI)
C) Plain radiogp eh
D) Bone scan

24. Which of the following is not a part of rehabilitation of the hand in a patient with rheu-
matoid arthritis?
A) Resting the involved joints
B) Heavy exercise of the involved joints
C) Joint protection instructions
D) Splinting regimens

25. What is a characteristic finding in polymyositis?

A) Skin abnormalities
B) Proximal muscle weakness
C) Distal muscle weakness
D) Ligamentous laxity

26. Which of the following is not a subtype of juvenile rheumatoid arthritis?

A) Chronic
B) Systemic
C) Pauciarticular
D) Polyarticular
JOINT AND CONNECTIVE TISSUE DISORDERS

34. What is the most serious complication of osteoarthritis (OA) of the cervical spine?
A) Radiculopathy
B) Myelopathy
C) Osteoporosis
D) Chronic pain

35. Aswan neck deformity is noted in your patient. Which condition is most likely, and which
area would have a hyperflexion deformity?
A) Osteoarthritis, proximal interphalangeal joint (PIP)
B) Rheumatoid arthritis, proximal interphalangeal joint (PIP)
C) Osteoarthritis, distal interphalangeal joint (DIP)
D) Rheumatoid arthritis, distal in~ halangetljoi nt (DIP)

36. A Boutonniere deformity is noted in your patient. Which condition is most likely, and
which area would have a hyperflexion deformity?
A) Osteoarthritis, proximal interphalangeal joint (PIP)
B) Rheumatoid arthritis, proximal interPEalangeilioi nt (PIP)
C) Osteoarthritis, distal interphalangeal joint (DIP)
D) Rheumatoid arthritis, distal interphalangeal joint (DIP)

37. How many tender points need to be present for the diagnosis of fibromyalgia?
A)7
B) 9
C) 11
D) 13

38. Pseudogout commonly involves which of the following areas?

A) Knee
B) Toe
C) Elbow
D) Fingers

39. Gout commonly involves which of the following areas?

A) Knee
B) Toe
C) Elbow
D) Fingers

40. Later stage of rheumatoid arthritis affects which type of joint?

A) Amphiarthrodial joint
B) Synarthrodial
C) Diarthrodial join t
D) None of the above
JOINT AND CONNECTIVE TISSUE DISORDERS

48. The Wright-Schober test is used in which of the following conditions?

A) Ankylosing~ ondylitis (AS)
B) Systemic lupus erythematosus
C) Reiter's syndrome
D) Dermatomyositis

49. Which of the following sports would be contraindicated in a patient with ankylosing
spondylitis?
A) Archery
B) Badminton
C) Bicycling
D) Table tennis

50. Which of the following radiographic features is not seen in patients with rheumatoid
arthritis?
A) Narrowing of the joint space
B) Increased bone density
C) Marginal erosion of bone
D) Joint fusion

51. Antihistone antibodies are present in which of the following conditions?

A) Rheumatoid arthritis
B) Sjogren's syndrome
C) Polymyositis
D) Drug-induced lupus

52. Massage, manipulation, and traction are all examples of which type of therapy?
A) Relaxation
B) Hydrotherapy
C) Mobilization
D) Immobilization

53. Which condition is associated with the following features: heliotrope rash, Gottron's pap-
ules, and shawl sign?
A) Dermatomyositis
B) Inclusion body myositis
C) Osteoarthritis
D) Fibromyalgia

54. All of the following are true regarding rheumatoid arthritis except:
A) 85% of cases are rheumatoid factor(+)
B) Rheumatoid nodules are present
C) More common in males
D) Inflammation of the synovial capsule

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 JOINT AND CONNECTIVE TISSUE DISORDERS: Questions

55. Which specific autoantibody is associated with systemic lupus erythematosus (SLE)?
A) Anti-Smith
B) Anti-sci-70
C) Anticentromere
D) Anti-Jo-1

56. What type of collagen deficiency is present in osteogenesis imperfecta?

A) Ty_ptlcollagen
B) Type 2 collagen
C) Type 3 collagen
D) Type 4 collagen

57. Which of the following conditions is associated with formation of abnormal fibrillin?
A) Osteogenesis imperfecta
B) Scleroderma
C) Ma rfan syndrome
D) Ehlers-Danlos syndrome

58. In Duchenne muscular dystrophy, which protein is absent?

A) Fibrillin
B) Dxstroehin
C) Huntington
D) Sarcoglycan

59. Which of the following is not a seronegative arthritis?

A) Psoriatic arthritis
B) Rheumatoid arthriti s
C) Reactive arthritis
D) Ankylosing spondylitis

60. Which of the following is elevated in Paget's disease?

A) Calcium
B) Phosphate
C) Aminotransferase
D) Alka line p hosphatase

61. Fibroblast growth factor receptor 3 mutation causes which of the following conditions?
A) Paget's disease
B) Achondroplasia
C) Osteogenesis imperfecta
D) Osteoporosis

62. Which contracture is caused by forearm injuries leading to lack of blood supply to the
region?
A) Dupuytren's contracture
B) Capsular contracture
C) Volkmann's contracture
D) None of the above

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JOINT AND CONNECTIVE TISSUE DISORDERS

63. Pain on ulnar deviation of the wrist with the thumb grasped in the fist is a positive sign
for which of the following conditions?
A) Carpal tunnel syndrome
B) Rheumatoid arthritis
C) Medial epicondylitis
D) De Quervain's tenosynovitis

64. Symmetric erosive destruction of multiple joints is more likely to be seen in which of the
following arthropathies?
A) Osteoarthritis
B) Reactive arthritis
C) Rheumatoid arthritis (RA)
D) Gout

65. A patient presenting with flexion contracture of the metacarpophalangeal (MCP), hyper-
extension of the proximal interphalangeal (PIP) joint, and the flexion of the distal inter-
phalangeal (DIP) joint is seen in which of the following diseases?
A) Osteoarthritis
B) Gout
C) Psoriatic arthritis
D) Rheumatoid arthritis

66. A painful joint is aspirated and is found to contain calcium pyrophosphate dihydrate
crystals. These joint crystals are pathognomonic of which of the following conditions?
A) Gout
B) Pseudogout
C) Psoriatic arthritis
D) Osteoarthritis

67. Which of the following disorders is caused by a fibrillin defect?

A) Osteogenesis imperfecta
B) Rheumatoid arthritis
C) Marfan syndrome
D) Scleroderma

68. Which of the following is the leading cause of morbidity and mortality in patients with
Marfan syndrome?
A) Arachnodactyly
B) Pneumothorax
C) Ectopia Lentis
D) Aortic disease

69. Which of the following antibodies is tested in patients suspected of having systemic lupus
erythematosus (SLE)?
A) Anticentromere
B) Antigliadin
C) P-ANCA
D) Anti-Smith

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 JOINT AND CONNECTIVE TISSUE DISORDERS: Questions

70. Which of the following pulmonary conditions is often seen in patients with systemic
sclerosis?
A) Interstitial lung disease
B) Pneumothorax
C) Aspiration pneumonia
D) Chronic obstructive pulmonary disease (COPD)

71. Which of the following is an acute phase protein seen in response to tissue injury?
A) Antinuclear antibody (ANA)
B) C-reactive erotein (CRP)
C) C-ANCA
D) Anticentromere

72. Which of the following organisms is commonly responsible for inflammatory

polyarthritis?
A) Parvovirus B-19
B) Haemophilus influenzae
C) Streptococcus pneumoniae
D) Neisseria gonorrhoeae

73. Which of the following is the most destructive element of rheumatoid arthritis?
A) Joint erosion
B) Pannus formation
C) Crystalline formation
D) Rheumatoid nodules

74. Which of the following pediatric conditions leads to fragile bones resulting in multiple
fractures?
A) Juvenile rheumatoid arthritis
B) Sickle cell disease
C) Osteogenesis ~ erfecta
D) Osteoarthritis

75. Which of the following is not part of the CREST syndrome?

A) Telangiectasia
B) Scleroderma
C) Raynaud's phenomenon
D) Calcinosis

76. In which of the following disorders would patients have a negative rheumatoid factor
(RF)?
A) Mixed connective tissue disease
B) Rheumatoid arthritis
C) Scleroderma
D) Sjogren's syndrome

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JOINT AND CONNECTIVE TISSUE DISORDERS

77. Which of the following vitamin deficiencies can cause scurvy?

A) Vitamin A
B) Vitamin B
C) Vitamin C
D) Vitamin D

78. Which of the following organisms has been identified as the cause of Lyme disease?
A) Borrelia burgdorfr ri
B) Streptococcus pyogenes
C) Neisseria meningitidis
D) Babesia microti

79. What is the most common cause of neuropathic arthropathy?

A) Osteoarthritis
B) Septic arthritis
C) Systemic lupus
D) Diabetes

80. Which of the following is not a feature of fibromyalgia?

A) Pain in all four quadrants
B) CREST synd rom e
C) Pain in 11 to 18 tender points
D) Symptoms for at least 3 months

81. Which of the following is the most common benign tumor composed of adipocytes?
A) Focal nodular hyperplasia
B) Neuroblastoma
C) Hemangioma
D) Lipoma

82. Which of the following is not a type of connective tissue fiber?

A) Epend ymal
B) Collagen
C) Elastic
D) Reticular

83. Which of the following conditions causes calcification of connective tissue?

A) Fibrodysplasia ossificans !)!£gressiva
B) Hajdu-Cheney syndrome
C) Fetal hydantoin syndrome
D) Hurler disease

84. What is the most common cause of acute nontraumatic monoarthritis in young adults?
A) Septic arthritis
B) Gonococcal arthritis
C) Gout
D) Rheumatoid arthritis

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 JOINT AND CONNECTIVE TISSUE DISORDERS: Questions

85. Pain relieved by activity is a feature of which of the following types of arthritis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Septic arthritis
D) Gouty arthritis

86. Ankylosing spondylitis is associated with which of the following HLA allele?
A) HLA-B47
B) H LA-B27
C) HLA-DR4
D) HLA-B72

87. Which of the following is not a feature of Scheuermann kyphosis?

A) Vertebral body wedging of at least 5 degrees
B) Flattening of cu rva ture with extension
C) Involvement of at least three vertebral bodies
D) Anterior wedging

88. Heberden's nodes are a common feature in which of the following disease processes?
A) Rheumatoid arthritis
B) Septic arthritis
C) Osteoa rthri tis
D) Gouty arthritis

89. What is the term given to the enlargement of the gastrocnernius-semimembranosus

bursa?
A) Baker's cyst
B) Septic arthritis
C) Gout
D) Pseudogout

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