General Practitioner - Rheumatology MCQs

An elderly lady presented with chronic knee pain bilaterally that increases with activity &
decreases with rest,

The most likely diagnosis is:

Osteoarthritis (Correct Answer)

Rheumatoid arthritis

Septic arthritis

An old woman complaining of hip pain that increases by walking and is peaks by the end of the
day and keeps

her awake at night, also morning stiffness:

Osteoporosis

Osteoarthritis (Correct Answer)

Rh. Arthritis

Old patient with bilateral knee swelling, pain, normal ESR:

Gout

Osteoarthritis (Correct Answer)

RA

What is the initial management for a middle age patient newly diagnosed knee osteoarthritis.

Intra-articular corticosteroid.
 Reduce weight (Correct Answer)

Exercise.

Strengthening of quadriceps muscle.

The useful exercise for osteoarthritis in old age to maintain muscle and bone:

Low resistance and high repetition weight training (Correct Answer)

Conditioning and low repetion weight training

Conditioning and low repetion weight training

Male patient present with swollen erythema, tender of left knee and right wrist, patient give
history of

international travel before 2 month, aspiration of joint ravel, gram negative diplococcic, what is
most likely

organism?

Neisseria gonorrhea (Correct Answer)

staphcoccus

streptococcus

Patient have urethritis now com with left knee, urethral swap positive puss cell but negative for
neisseria

meningitidis and chlymedia

RA

Reiter's disease (Correct Answer)

Gonococcal

Which of following favor diagnosis of SLE?

 Joint deformity

Lung cavitations

Sever raynaud phenomenon

Cystoid body in retina

Anti RNP+ (Correct Answer)

Patient with Rheumatoid arthritis on hand X-Ray there is swelling what you will do for him

NSAID (Correct Answer)

Injection steroid

positive pressure ventilation

True about dermatomyositis:

associated with inflammatory bowl disease

Indicate underlying malignancy (Correct Answer)

present as distal muscle weakness

Psuedogout:

Phosphate

Calcium

Florida

Calcium pyrophosphate (Correct Answer)

Patient complaints of abdominal pain and joint pains, the abdominal pain is colicky in character,
and
accompanied by nausea, vomiting and diarrhea. There is blood and mucus in the stools. The
pain in joints

involved in the ankles and knees, on examination there is purpura appear on the legs and
buttocks:

Meningococcal Infections

Rocky Mountain Spotted Fever

Systemic Lupus Erythematous

Henoch sconlein purpura (Correct Answer)

Long scenario, bone mineral density ,having T score - 3.5,, so diagnosis is

Osteopenia

Osteoporosis (Correct Answer)

Normal

Rickets disease

Old female patient with osteoporosis, what is exogenous cause?

Age

Decreased vitamin D (Correct Answer)

Patient with cervical spondylitis came with atrophy in Hypothenar muscle and decreased
sensation in ulnar

nerve distribution. Studies showed alertness in ulnar nerve function in elbow..to ur action is :

Physiotherapy
 Cubital tunel decompression (Correct Answer)

Patient is known case of cervical spondylolysis , presented by parasthesis of the little finger ,
with atrophy of

the hypothenar muscles, EMG showed Ulnar tunnel compression of the ulnar nerve, what is
your action now:

Steroid injection

CT scan of the spine

Ulnar nerve decompression (Correct Answer)

Polymyalgia Rheumatica case with elevated ESR , other feature :

Proximal muscle weakness

Proximal muscle tenderness (Correct Answer)

Patient came with osteoarthritis & swelling in distal interphalangeal joint, what is the name of
this swelling?

Bouchard nodes

Heberden's nodes (Correct Answer)

An 80 year old lady presented to your office with a 6 month history of stiffness in her hand,
bilaterally. This

stiffness gets worse in the morning and quickly subsides as the patient begins daily activities.
She has no other

significant medical problems. On examination the patient has bilateral bony swellings at the
margins of the distal

interphalangeal joints on the (2nd-5th) digits. No other abnormalities were found on the
physical examination.
These swellings represent :

Heberden’s nodes (Correct Answer)

Bouchar’s nodes

Synovial thickenings

Subcutaneous nodules

Sesamoids

Regarding Boutonniere deformity which one is true

Flexion of PIP & hyperextension of DIP. (Correct Answer)

Flexion of PIP & flexion of DIP

Extension of PIP & flexion of DIP.

Extension of PIP & extension of DIP

Patient has history of parotid and salivary gland enlargement complains of dry eye, mouth and
skin, lab results

HLA-B8 and DR3 ANA positive, rheumatoid factor positive, what is the course of treatment?

physostigmin

Eye drops with saliva replacement (Correct Answer)

NSAID

plenty of oral fluid

Young patient with red, tender, swollen big left toe 1st metatarsal, tender swollen foot and
tender whole left

leg. His temperature 38, what is the diagnosis?

 Cellulitis (Correct Answer)

Vasculitis

Vasculitis

Patient elderly with unilateral headache, chronic shoulder and limb pain, positive Rheumatoid
factor and

positive ANA, what is the treatment?

Aspirin

Indomethacin

Corticosteroid (Correct Answer)

Acute Gout management :

Allopurinol

NSAID (Correct Answer)

Paracetamol

Gold salt

Treatment of acute gouty arthritis

Allopurinol

Indomethacin (Correct Answer)

Pencillamin

Steroid

Patient with rheumatoid arthritis came to you and asking about the most effective way to
decrease joint
disability in the future, your advice will be:

Cold application over joint will reduce the morning stiffness symptoms

Disease modifying antirheumatic drugs are sufficient alone (Correct Answer)

Osteoporosis depend on

Age (Correct Answer)

Stage

Gender

30 years old male with hx of pain and swelling of the right knee, synovial fluid aspiration showed yellow
color

opaque appearance, variable viscosity. WBC = 150,000 , 80% neutrophil, poor mucin clot, Dx is :

Goutism Arthritis

Meniscal tear

RA

Septic arthritis (Correct Answer)

Pseudogout arthritis

Rheumatoid Arthritis:

Destruction in articular cartilage (Correct Answer)

M=F

No nodules

Any synovial joint

HLA DR4
Triad of heart block, Uveitis and sacroileitis, Dx:

Ankylosing Spondylitis (Correct Answer)

lumbar stenosis

multiple myeloma

Pseud-gout is

CACO3 (Correct Answer)

CACL3

Juvenile Idiopathic Arthritis treatment :

Aspirin (Correct Answer)

Steroid

Penicillamine

Hydrocloroquin

Paracetamol

Patient present with SLE, The least drug has side effect:

Methotrexate (Correct Answer)

name of other chemotherapy

Regarding Allopurinol:

is a uricouric agent

Decrease the development of uric acid stones (Correct Answer)

 useful in acute attack of gout

14 years girl with athralgia and photosensitivity and malar flush and protinurea , so diagnosis is :

RA

Lupus Nephritis (Correct Answer)

UTI

Which of the following is a disease improving drug for RA :

NSAID

Hydroxychloroquine (Correct Answer)

27 years old male has symmetric oligoarthritis, involving knee and elbow, painful oral ulcer for 10 years,
came

with form of arthritis and abdominal pain. Dx is:

Behjets disease (Correct Answer)

SLE

Reactive arthritis

UC

Wipple’s disease

Patient is 74 years female complaining of pain and stiffness in the hip and shoulder girdle muscles. She is
also

experiencing low grade fever and has depression. O/E: no muscle weakness detected. Investigation of
choice is

RF

Muscle CK

ESR (Correct Answer)

Female patient diagnosed as Polymyalgia Rheumatica, what you will find in clinical picture to support
this

diagnosis

osteophyte in joint radiograph

Tenderness of proximal muscle (Correct Answer)

weakness of proximal muscle

Very high ESR

Dermatomyositis came with the following symptoms:

Proximal muscle weakness (Correct Answer)

Proximal muscle tenderness

Most important point to predict a prognosis of SLE patient :

Degree of renal involvement (Correct Answer)

sex of the patient

leucocyte count

Most important point to predict a prognosis of SLE patient :

Degree of renal involvement (Correct Answer)

sex of the patient

leucocyte count

Which drug causes SLE like syndrome:

Hydralazine (Correct Answer)

Propranolol
 Amoxicillin

In patient with rheumatoid arthritis:

Cold app. over joint is good

Bed rest is the best

Exercise will decrease post inflammatory contractures (Correct Answer)

40 years old male come to you complaining of sudden joint swelling, no history of trauma, no history of

chronic disease, what is the investigation you will ask?

CBC for WBCs

ESR (Correct Answer)

MRI of knee joint

Rheumatoid factor

Female with sudden blindness of right eye, no pain in the eye, there is temporal tenderness when
combing

hair, what is the management?

eye drop steroid

oral steroid

IV steroids (Correct Answer)

Patient with oral ulcer, genital ulcer and arthritis, what is the diagnosis?

Behçet's disease (Correct Answer)

syphilis

herpes simplex

Patient with history of 5 years HTN on thiazide, came to ER midnight screaming holding his left foot, O/E
pt a

febrile, Lt foot tender erythema, swollen big toe most tender and painful, no other joint involvement

cellulitis

Gouty arthritis (Correct Answer)

septic arthritis

Child with back pain that wake patient from sleep , So diagnosis (incomplete Q)

lumber kyphosis (Correct Answer)

Osteoarthritis

Osteoarthritis

Scoliosis

Patient with pain in sacroiliac joint, with morning stiffness, X-ray of sacroiliac joint, all will be found
EXCEPT:

RF negative

Subcutaneous nodules (Correct Answer)

male > female

Allopurinol, one is true:

Effective in acute attack of gout.

decreases the chance of uric acid stone formation in kidneys (Correct Answer)

Salisylates antagonize its action

Mechanism of destruction of joint in RA :

Swelling of synovial fluid

Anti-inflammatory cytokines attacking the joint (Correct Answer)