Rheumatology 1a 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.
1-3. For the management of rheumatoid arthritis:

(A) Nonsteroidal anti-inflammatory drugs
(B) TNF inhibitors
(C) Methotrexate
Adverse drug reaction:

1- Stomatitis
2- Renal insufficiency
3- Auto Antibodies
Answer: 1-C
2-A
3-B
4-7 True statements concerning cytotoxic and/or immunosuppressive drugs include: (Mark T
or F)
.4- Prolonged therapy with cyclophosphamide has been associated with an increased
incidence of malignant neoplasms
5-. Toxicity manifested by abnormal hepatic function might be expected to occur more
frequently in patients treated with cyclophosphamide than with methotrexate
6-. Treatment of rheumatoid arthritis with methotrexate produces more frequent and longer-
lasting remissions than treatment with hydroxychloroquine
7-. Prolonged therapy with methotrexate has been associated with rare cases of lymphoma
answer T F T T.
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8- In a 32 year old patient with low back , ankle pain and stiffness that troubles him
during the night and who has eye symptoms, which test has the best prospect of
establishing a definite rheumatologic diagnosis:
A. ophthalmology slit lamp examination
B. test for the presence of HLA-B27
C. X-ray of the pelvis
D. X-ray of the ankles
Answrer C
9 The autoantibody characteristically found in MCTD is:

A. SSA
B. Sm
C. Anti-U1 RNP
D. ds DNA
E. Anti-Jo
Answer C
10 Each of the following is a criterion for the classification of systemic lupus erythematosus
EXCEPT
A. positive ANA
B malar rash
C. Raynauds phenomenon
D. lymphopenia
F. pleuropericarditis
Answrr c
11. Which of the following laboratory tests will be abnormal in a patient with fibromyalgia:
A. Erythrocyte sedimentation rate
B. Antinuclear antibody
C. Serum creatine kinase
D. Rheumatoid factor
E. None of the above.
Answer E
11 Pseudogout is seen in association with all of the following disease except:
A. Hemochromatosis
B. Sarcoidosis
C. Hyperparathyroidism
D. Hypothyroidism
E. Degenerative Osteoarthritis
Answer : B
Match each clinical feature listed below with the disorder in which it most
characteristically appears. You can use the answers more than once
A. Keratodermia blenorrhagicum
B. Apical pulmonary fibrosis
C. Basilar pulmonary fibrosis
D. Distal interphalangeal involvement
12. Ankylosing spondylitis.
13. Reiter syndrome.
14. Psoriatic arthritis.
15. Rheumatoid arthritis
Answer 12 B
13 A
14 D
15 C
16 The major clinical feature of polymyositis at presentation is:
A. Muscle pain
B. Dysphagia
C. Proximal muscle weakness
D. Arthritis or arthralgias
E. Raynaud phenomenon
Answer C
PART II ARAB BOARD EXAM RHEUMATOLOGY QUESTIONS
1- A 25-year-old woman presents because of Raynaud's phenomenon of 4-years duration
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:
(A) Pulmonary function testing including diffusing lung capacity, for carbon
monoxide (DL.co) and arterial blood gases
(B) Creatinine clearance
(C) Barium swallow
(D) Skin biopsy
(E) Reassurance
Answer E
2. A 42-year-old man presents because of 5 days of fever, shortness of breath, blood-streaked
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:

A. Churg-Strauss syndrome
B. Wegener's granulomatosis
C. Subacute bacterial endocarditis
D. Polyarteritis nodosa
E. Systemic lupus erythematosus
ANSWRER B
3 A 33-year-old woman with systemic lupus erythematosus and arthritis is treated with
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. a drug reaction to ibuprofen
B. a drug reaction to hydroxychloroquine
C. aseptic meningitis related to virus
D. central nervous system lupus
E). disseminated herpes virus infection
Answer : A
4 A 36-year-old female is diagnosed as having seropositive rheumatoid arthritis after 3

months of 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:
Hematocrit 32%
Leukocyte count 9500/L
Platelet count 560,000/L
Erythrocyte sedimentation 60 mm/h
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:
(A) Nonsteroidal anti-inflammatory drugs (NSAIDS) and radiography of the hand in 3 months
to look for the development of more erosions
(B) Prednisone, 40 mg/d orally, until joint inflammation is controlled and then taper to a
maintenance dose of 10 mg/d
(C) NSAIDs; methotrexate, 7.5 mg per week orally; and physical therapy
(D) NSAIDs and minocycline, 100 mg twice daily orally
(E) Acetaminophen as needed, wrist splints, and short courses of prednisone
Answer c
5. Which of the following symptoms suggest spinal stenosis?
A. chronic "back" pain localized to the gluteal muscles
B. chronic back and leg pain that is worse when the patient is standing erect but
improves when leaning forward
C. recurrent chronic back pain that occurs when walking long distances or riding in a
car for 2 hours but is relieved by a night's rest.
D. chronic back pain relieved by acetaminophen.
Answer b
6. A 28-year-old man with systemic lupus erythematosus (SLE) comes to the

emergency 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:
Hematocrit 38.2%
Leukocyte count 6200/L with 20%
band forms
Urinalysis
Protein 1+
Microscopic Erythrocytes 5 to 10 per
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:
(A) Prednisone, 20 mg/d
(B) Hydroxychloroquine, 400 mg/d
(C) Isoniazid
(D) Pulse methylprednisolone, 1 g/d
(E) Intravenous broad-spectrum antibiotics
ANSWER E
7. A 43-year-old woman is evaluated because of a 1-month history of fatigue in the evening,
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:
A. Naproxen, 500 mg twice a day
B. Prednisone, 7.5 mg every morning
C. Prednisone, 7.5 mg twice a day
D. Methotrexate 7.5 mg weekly
Answere A
9. In a 40 year old woman with a 1 year history of peripheral joint polyarthralgias and
swelling, 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:
A. X-rays of both hands
B. serum complement
C. sedimentation rate
D. FANA
ANSWER A
10 Which of the following statements concerning nonsteroidal anti-inflammatory drugs

(NSAID) and renal function is true?
A. Azotemia resulting from the administration of an NSAID is an idiosyncratic
adverse effect that occurs rarely
B. Azotemia most commonly occurs in persons with rheumatoid arthritis
C. Persons with renal vascular disease are at increased risk for NSAID-related
azotemia
D. Azotemia can be avoided by the use of diuretics
E. All of the adverse effects of NSAIDs on renal function are the result of inhibition
of renal prostaglandin biosynthesis.
Answer C
A 72-year-old man presents with weakness, fatigue, and burning parasthesias over his feet. One
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:
Hematocrit 37%
Leukocyte count 8400/l,
Differential
Segmented neutrophils 58%
Lymphocytes 20%
Monocytes 8%
Eosinophils 14%
Serum creatinine 4 mg/dL
Serum complement (C3) 68/mg/dL
Which of the following should be done in order to establish a diagnosis?

A. Cryoglobulin test
B. Antiphospholipid antibody test
C. Abdominal aortography
D Skin test with contrast dye
E Skin biopsy of the foot
Answer E
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ARAB BOARD RHEUMATOLOGY QUESTIONS 2004

HAMAD MEDICAL CORPORATION< DOHA, QATAR

1-3. For the management of rheumatoid arthritis:

Adverse drug reaction:

9 The autoantibody characteristically found in MCTD is:

The most likely diagnosis is:

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

6. A 28-year-old man with systemic lupus erythematosus (SLE) comes to the

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

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

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