Arab Board Rheumatology Questions 2004

ARAB BOARD RHEUMATOLOGY QUESTIONS 2004
HAMAD MEDICAL CORPORATION< DOHA, QATAR
:PART I QUESTIONS
DIRECTIONS: For each numbered word, phrase or statement, select the one lettered heading that is
.most closely associated with it
:For the management of rheumatoid arthritis -1
Nonsteroidal anti-inflammatory drugs .a
TNF inhibitors .b
Methotrexate .c
:Adverse drug reaction -2
Stomatitis .a
Renal insufficiency .b
Auto Antibodies .c
(True statements concerning cytotoxic and/or immunosuppressive drugs include: (Mark T or F -3
Prolonged therapy with cyclophosphamide has been associated with an increased incidence of -4
malignant neoplasms
Toxicity manifested by abnormal hepatic function might be expected to occur more frequently in -5
patients treated with cyclophosphamide than with methotrexate
Treatment of rheumatoid arthritis with methotrexate produces more frequent and longer-lasting -6
remissions than treatment with hydroxychloroquine
Prolonged therapy with methotrexate has been associated with rare cases of lymphoma -7
In a 32 year old patient with low back , ankle pain and stiffness that troubles him during the -8
night and who has eye symptoms, which test has the best prospect of establishing a definite
:rheumatologic diagnosis
ophthalmology slit lamp examination .a
B27test for the presence of HLA .b
ray of the pelvisX .c
ray of the anklesX .d
:The autoantibody characteristically found in MCTD is -9
SSA .a
Sm .b
U1 RNPAnti .c
s DNA .d
Anti-Jo .e
Each of the following is a criterion for the classification of systemic lupus erythematosus -10
EXCEPT
positive ANA .a
malar rash .b
Raynauds phenomenon .c
lymphopenia .d
pleuropericarditis .e
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:Which of the following laboratory tests will be abnormal in a patient with fibromyalgia -11
Erythrocyte sedimentation rate A.
Antinuclear antibody B.
Serum creatine kinase C.
Rheumatoid factor D.
.None of the above .E
:Pseudogout is seen in association with all of the following disease except -12
Hemochromatosis A.
Sarcoidosis B.
Hyperparathyroidism C.
Hypothyroidism D.
Degenerative Osteoarthritis .E
Match each clinical feature listed below with the disorder in which it most -13
characteristically appears. You can use the answers more than once
Keratodermia blenorrhagicum .a.i
Apical pulmonary fibrosis .a.ii
Basilar pulmonary fibrosis .a.iii
Distal interphalangeal involvement .a.iv
.Ankylosing spondylitis .a
.Reiter syndrome .b
.Psoriatic arthritis .c
Rheumatoid arthritis .d
:The major clinical feature of polymyositis at presentation is -14
Muscle pain .a
Dysphagia .b
Proximal muscle weakness .c
Arthritis or arthralgias .d
Raynaud phenomenon .e
PART II ARAB BOARD EXAM RHEUMATOLOGY QUESTIONS
A 25-year-old woman presents because of Raynaud's phenomenon of 4-years duration -1
precipitated by cold. She reports no rash, sicca, arthralgias, myalgias, weakness, or dysphagia. She
feels well. She smoke cigarettes. Her physical examination is normal, including nailfold
.capillaroscopy. You advise cessation of smoking
:The most appropriate next action is
Pulmonary function testing including diffusing lung capacity, for carbon monoxide A))
(DL.co) and arterial blood gases
Creatinine clearance B))
Barium swallow C))
Skin biopsy D))
Reassurance E))
A 42-year-old man presents because of 5 days of fever, shortness of breath, blood-streaked .2
mucoid sputum, and I week of "burning numbness" of his right sole. Today he noticed painless
purpura under the nose pieces of his eye glasses. Yesterday he developed very painful synovitis
of his right wrist and left ankle. He also notes dysesthesia of the lateral aspect of his left distal
lower extremity which began 2 weeks ago. Two weeks ago he also had the onset of mild pain and
diminished hearing in the left ear. he has not felt well for about 8 months, during which time he
has had chronic nasal congestion. For the past 2 months nasal discharge has been malodorous,
.sometimes blood-streaked, and unresponsive to multiple antibiotics
On physical examination, his pulse rate is 120/min, respiration rate is 20/min, and blood pressure
is 140/80 mm Hg. There are purpura on his nose. He has mucopurulent exudate in his nose and
marked turbinate swelling. The heart is normal except for regular tachycardia. The lungs are
clear. He has very tender synovitis of his right wrist and left ankle. Neurologic examination is
normal except for diminished sensation of the left lateral distal leg and right sole and weak left
.ankle extensors and right toe flexors
Laboratory studies show a leukocyte count of 12,000/FL and platelet count of 400,000/FL.
Urinalysis shows 2+ protein, 6 leukocytes, and 25 erythrocytes per high power field, which are
.dysmorphic. Chest radiograph shows multiple nodular densities from 1 to 3 cm in diameter
:The most likely diagnosis is

Churg-Strauss syndrome A.
Wegener's granulomatosis B.
Subacute bacterial endocarditis C.
Polyarteritis nodosa D.
Systemic lupus erythematosus E.
old woman with systemic lupus erythematosus and arthritis is treated withyearA 33 3
hydroxychloroquine and ibuprofen. She develops headache, neck pain, fever, and cerebrospinal
fluid pleocytosis; her condition improves after 2 days of bed rest, with acetaminophen as her
.only medication
The most likely cause of her condition is
a drug reaction to ibuprofen A.
a drug reaction to hydroxychloroquine B.
aseptic meningitis related to virus C.
central nervous system lupus D.
disseminated herpes virus infection E).
A 36-year-old female is diagnosed as having seropositive rheumatoid arthritis after 3 months of 4

symmetric polyarthritis and fatigue. Because of her joint pains and fatigue, she has had to leave work.
Physical examination shows symmetric swelling, warmth, and tenderness of the wrists,
metacarpophalangeal (MCP) joints, and proximal interphalangeal joints (PIP) of the hands, and similar
.joints in the feet. She also has bilateral knee, ankle, and elbow inflammation
:Laboratory studies
32% Hematocrit
9500/L Leukocyte count
560,000/L Platelet count
60 mm/h Erythrocyte sedimentation
(rate (Westergren
Anteroposterior and lateral radiographs of the right hand show juxta-articular osteoporosis about the
.MCP and PIP joints with radial marginal joint erosion of the second PIP joint
:The most appropriate treatment for this patient is
Nonsteroidal anti-inflammatory drugs (NSAIDS) and radiography of the hand in 3 months to look A))
for the development of more erosions
Prednisone, 40 mg/d orally, until joint inflammation is controlled and then taper to a maintenance B))
dose of 10 mg/d
NSAIDs; methotrexate, 7.5 mg per week orally; and physical therapy C))
NSAIDs and minocycline, 100 mg twice daily orally D))
Acetaminophen as needed, wrist splints, and short courses of prednisone E))
?Which of the following symptoms suggest spinal stenosis .5

chronic "back" pain localized to the gluteal muscles A.
chronic back and leg pain that is worse when the patient is standing erect but improves B.
when leaning forward
recurrent chronic back pain that occurs when walking long distances or riding in a car for C.
.2 hours but is relieved by a night's rest
.chronic back pain relieved by acetaminophen D.
A 28-year-old man with systemic lupus erythematosus (SLE) comes to the emergency .6
department at midnight because of headache and chills that began at 2200 h that evening and concern
that his lupus is flaring. The diagnosis of SLE was made 5 years ago when he presented with
polyarthritis, urticarial vasculitis, hypocomplementemia, and positive test results for antinuclear
antibody (1:640). He had been asymptomatic for months while taking predinisone, 10 mg/d orally, and
hydroxychloroquine, 200 mg/d orally. Laboratory studies done last month were unchanged from those
done a year ago. His leukocyte count was 3700/L, serum C3 was 38 mg/dL, serum C4 was 10 mg/dL
.(normal 15 to 22 mg/dL), and urinalysis showed 1+ protein
On physical examination the patient appears lethargic, but he is not in acute distress. He
has a temperature of 38.5 C (101.3 F), pulse rate of 100/min, respiration rate of 18/min, and
blood pressure of 126/78 mm Hg. Physical examination, including neurologic examination, is
.otherwise normal
:Laboratory studies
38.2% Hematocrit
6200/L with 20% Leukocyte count
band forms
Urinalysis
+1 Protein
Erythrocytes 5 to 10 per Microscopic
high power field, no
leukocytes
The chest radiograph shows atelectasis or an infiltrate at the left base. Cerebral spinal fluid
analysis shows no cells, with normal glucose and protein. Cultures of blood, cerebrospinal fluid,
.and sputum are sent to the laboratory
:The best initial management of this patient is
Prednisone, 20 mg/d A))
Hydroxychloroquine, 400 mg/d B))
C) Isoniazid)
Pulse methylprednisolone, 1 g/d D))
Intravenous broad-spectrum antibiotics (E)
A 43-year-old woman is evaluated because of a 1-month history of fatigue in the evening, .7

symmetrical polyarthritis involving most of the small joints, and morning stiffness lasting for 2
hours after awakening. Physical examination shows synovial proliferation of the proximal
interphalangeal joints of the hands, the metacarpophalangeal joints, the wrists, the elbows, the
:knees, and the metatarsophalangeal joints. Initial treatment may include
Naproxen, 500 mg twice a day A.
Prednisone, 7.5 mg every morning B.
Prednisone, 7.5 mg twice a day C.
Methotrexate 7.5 mg weekly D.
In a 40 year old woman with a 1 year history of peripheral joint polyarthralgias and swelling, .9
morning stiffness and soft tissue swelling of the MCP joints on physical exam, which test is
:most useful for establishing a definite diagnosis and guiding treatment
rays of both handsX A.
serum complement B.
sedimentation rate C.
FANA D.
Which of the following statements concerning nonsteroidal anti-inflammatory drugs (NSAID) 10

?and renal function is true
Azotemia resulting from the administration of an NSAID is an idiosyncratic adverse A.
effect that occurs rarely
Azotemia most commonly occurs in persons with rheumatoid arthritis B.
Persons with renal vascular disease are at increased risk for NSAID-related azotemia C.
Azotemia can be avoided by the use of diuretics D.
All of the adverse effects of NSAIDs on renal function are the result of inhibition of E.
.renal prostaglandin biosynthesis
A 72-year-old man presents with weakness, fatigue, and burning parasthesias over his feet. One -11
week ago he underwent outpatient cardiac catheterization for recurrent chest pain: he had multiple
.lesions in two vessels and medical therapy was initiated
Examination reveals a mottled lacelike rash over the legs, especially when dependent. There are
.scattered petechiae over the feet, and the tips of several toes are cyanotic
:Laboratory studies
37% Hematocrit
,8400/l Leukocyte count
Differential
58% Segmented neutrophils
20% Lymphocytes
8% Monocytes
14% Eosinophils
4 mg/dL Serum creatinine
68/mg/dL Serum complement (C3)
?Which of the following should be done in order to establish a diagnosis

Cryoglobulin test A.
Antiphospholipid antibody test B.
Abdominal aortography C.
Skin test with contrast dye D
Skin biopsy of the foot E
:Rhumatology I Answers
PART 1
:Answer A
C-1
A-2
B-3
.answer T F T T
Answrer C -8
Answer C -9
Answrr c -10
Answer E -11
Answer : B -12
A 13
D 14
C 15
Answer C
Rhumatology 1 Answers
PART II
Answer E -1
ANSWRER B -2
Answer : A -3
Answer c -4
Answer b -5
E -6
A -7
A -9
C -10
E -11
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ARAB BOARD RHEUMATOLOGY QUESTIONS 2004

HAMAD MEDICAL CORPORATION< DOHA, QATAR

:The most likely diagnosis is

A 36-year-old female is diagnosed as having seropositive rheumatoid arthritis after 3 months of 4

?Which of the following symptoms suggest spinal stenosis .5

A 43-year-old woman is evaluated because of a 1-month history of fatigue in the evening, .7

Which of the following statements concerning nonsteroidal anti-inflammatory drugs (NSAID) 10

?Which of the following should be done in order to establish a diagnosis

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