CUCMS

RHEUMATOLOGY QUESTIONS

Q1.
A 40 year old man presents with acute monoarthritis of the right knee. Gout is
confirmed following joint aspiration and examination of the fluid under
polarised light microscopy. He underwent endoscopy 3 weeks earlier because of
dyspepsia and this confirmed a duodenal ulcer. Which of the following would be
the best initial treatment for him?
a. Allopurinol
b. Indomethacin alone
c. Indomethacin and Lansoprazole
d. Indomethacin and Misoprostol
e. Intra-articular corticosteroid injection

Q2.
A 68-year-old woman complained of pain at the base of her right thumb. There
was tenderness and swelling of the right first carpo-metacarpal joint.
What is the most likely diagnosis?
a. Avascular necrosis of the scaphoid
b. De Quervain's tenosynovitis
c. Osteoarthritis
d. Psoriatic arthritis
e. Rheumatoid arthritis

Q3.
An 85 year old woman presented with bilateral osteoarthritis of the knees. She
had no history of previous gastrointestinal disease. Which of the following is the
most appropriate initial treatment for her?
a. Celecoxib
b. Naproxen
c. Dihydrocodeine
d. Paracetamol
e. Topical diclofenac.

Q4.
A 27 year old man presents with fever, urethritis and arthralgia. He is found to
have a swollen ankle with a pustular rash on the dorsal aspect of his foot. What is
the most likely diagnosis?
a. Gonococcal sepsis
b. Lyme disease
c. Reiter's syndrome
d. Staphylococcal arthritis
e. Tuberculous arthritis

Q5.
A man in his 20's begins to note persistent lower back pain and stiffness that
diminishes with activity. In his 30's he also develops hip and shoulder arthritis,
and in his 40's he is bothered by decreased lumbar spine mobility. He has no
other major medical problems.
 These findings are most typical for which of the following?
a. Ankylosing spondylitis
b. Calcium pyrophosphate dihydrate deposition disease
c. Lyme disease
d. Osteoarthritis
e. Rheumatoid arthritis

Q6.
A 49 year old lady with severe rheumatoid arthritis is currently taking
Methotrexate 20 mg weekly, Sulphasalazine 1g bd and Hydroxychloroquine 200
mg od. Her joints are still swollen and tender despite triple therapy for past 6
months. Which of the following is true regarding the next course of
management?
a. The current disease modifying anti-rheumatic drugs (DMARDs) needs
to be continued for another 3 months.
b. Her treatment should be switched to Methotrexate and Leflunomide.
c. A biologic DMARD for e.g. anti-tumour necrosis factor is indicated to
control her arthritis
d. She should be taken off her current DMARDs
e. She needs to be referred for joint replacement

Q7.
A 55-year-old woman on treatment for long-standing rheumatoid arthritis has
recently become dyspnoeic on mild exertion and developed a dry cough. The
oxygen saturation was found to be 87% on air. The chest x-ray showed a diffuse
bilateral interstitial infiltrate. An extensive infection screen was negative and her
symptoms were felt to be drug-induced.
Which drug is most likely to have caused this adverse effect?
a. azathioprine
b. cyclosporin
c. hydroxychloroquine
d. methotrexate
e. sulphasalazine

Q8.
Which one of the following drugs works by inhibiting the tumour necrosis
factor?
a. cyclosporin
b. infliximab
c. methotrexate
d. montelukast
e. sulphasalazine

Q9.
A 50 year old woman presents with dry eyes, a dry mouth, an erythematous rash
and polyarthralgia. Investigations: ANA strongly positive (1:1600), anti-Ro/SSA
antibodies strongly positive, rheumatoid factor positive, IgG markedly elevated
at 45 g/l (normal - <15 g/l), IgM and IgA levels are normal and the
kappa/lambda ratio is normal.
 What is the most likely diagnosis?
a. Hyperviscosity syndrome
b. Myeloma associated vasculitis
c. Primary Sjogren's Syndrome
d. Rheumatoid arthritis with secondary Sjogren's Syndrome
e. Systemic Lupus Erythematosus

Q10.
Which of the following statements regarding systemic lupus erythematosis (SLE)
is correct?
a. When disease is active the levels of complements C3 and C4 are raised.
b. When evidence of mild nephritis is present, a renal biopsy is
unnecessary.
c. There is a male preponderance of 8:1.
d. First manifestation of the disease may be idiopathic thrombocytopenia
purpura.
e. There is neurological involvement in about 10% of cases.

Q11.
A 25 year old lady with known SLE presents with the nephrotic syndrome. A
renal biopsy is performed and this confirms diffuse proliferative
glomeronephritis (WHO Class 1V).
Which of the following treatment regimes would you advise?
a. Azathioprine alone
b. Prednisolone alone
c. Azathioprine and Prednisolone
d. Prednisolone and intravenous Cyclophosphamide
e. Prednisolone and Methotrexate

Q12.
A 40 year-old woman presents with a year history of Raynaud’s phenomenon,
dyspepsia and arthralgias. On examination she has sclerodactyly and synovitis of
the small joints of the hands. Her ESR is 40 mm/hr (<10) but Rheumatoid factor
and Antinuclear Antibody are both negative. Which one of the following is most
likely to develop as a further complication of this disorder?
a. anterior uveitis
b. butterfly rash
c. erosive joint disease
d. erythema nodosum
malabsorption