Internal Medicine/ Rheumatology

                                                                                 I.            Immunology & Investigations.

1.    Immunology.

***) One of the following is true regarding 40 years old man with history of shortness of breath after exposure to penicillin 15 years ago:

A.    Amoxicillin can be given safely to this patient since it has been more 10 years after reaction

B.     It is contraindicated to give this patient further dose of penicillin

C.     You can give penicillin safely if combined with NSAIDs

D.    Small doses of penicillin should be safe

E.     Cephalosporin antibiotics are safe in this patient

Answer: B* It is contraindicated to give this patient further dose of penicillin

***) In a patient with anaphylactic shock, all are correct treatments, except: Q2012

A.    Epinephrine

B.     Hydralazine

C.     Adrenaline

D.    IV fluids

E.     Steroids

Answer: B* Hydralazine

***) IgE mediated hypersensitivity reaction like bronchial asthma is: Q2012

A.    Type I hypersensitivity reaction

B.     Type II hypersensitivity reaction

C.     Type III hypersensitivity reaction

D.    Type IV hypersensitivity reaction

E.     Type V hypersensitivity reaction

Answer: A* Type I hypersensitivity reaction

***) All of the following are type 1 (immediate) hypersensitivity, except:

A.    Extrinsic asthma

B.     Atopic asthma

C.     Urticaria

D.    Pulmonary TB

E.     Allergic rhinitis

Answer: D* Pulmonary TB

                                          II.            Rheumatological Diseases and Conditions.

1.    Osteoarthritis (OA).

***) Osteoarthritis:

A.    Is commoner in males than females

B.     Usually secondary to overweight only

C.     Usually treated by arthroplasty

D.    Chondrocytes imbalance is the main pathology

E.     Physical therapy is not useful in moderate cases

Answer: D* Chondrocytes imbalance is the main pathology

***) A 50 years old woman complains of redness, swelling and stiffness of the distal interphalangeal joints of the hands without other joint complaints, the most likely diagnosis is:

A.    Rheumatoid arthritis

B.     Erosive osteoarthritis

C.     Systemic lupus erythematosus

D.    Ankylosing spondylitis

E.     Systemic sclerosis

Answer: B* Erosive osteoarthritis

2.    Septic Arthritis.

***) The most common cause of acute pyogenic arthritis in adults is:

A.    Streptococcal infection

B.     Haemophilus influenza

C.     Escherichia coli

D.    Neisseria gonorrhea

E.     Proteus mirabilis

Answer: D* Neisseria gonorrhea

***) The most common cause of septic arthritis is:

A.    Staphylococcus

B.     Pneumococcal infection

C.     Gram-negative bacilli

D.    Trauma

E.     Intra-articular injection

Answer: A* Staphylococcus

***) The most frequent etiological agent in septic arthritis in children 2 months to 4 years of age is:

A.    Pneumococci

B.     Streptococci

C.     Candida albicans

D.    Staphylococcus epidermidis

E.     Staphylococcus aureus

Answer: E* Staphylococcus aureus

***) All of the following can cause arthritis, except:

A.    Staphylococcus

B.     Hepatitis A

C.     Tuberculosis

D.    Gonococcal infection

E.     Lyme disease

Answer: B* Hepatitis A

3.    Rheumatoid Arthritis.

***) All of the following about rheumatoid arthritis are true, except:

A.    More common in females

B.     Splenomegaly is a feature

C.     Colchicine is used in the treatment

D.    Pericardial effusion may occur

E.     Amyloidosis is a recognized complication

Answer: C* Colchicine is used in the treatment

***) All of the following are true about rheumatoid arthritis, except:

A.    Episcleritis may occur

B.     Amyloidosis is a recognized complication

C.     Causes carpal tunnel syndrome

D.    Pericarditis may occur

E.     Retinitis pigmentosa is a feature

Answer: E* Retinitis pigmentosa is a feature

***) All of the following are manifestations of rheumatoid arthritis except:

A.    Pleural effusion

B.     Firm, non tender nodules

C.     Pitting of nails

D.    Scleritis

E.     Pericarditis

Answer: C* Pitting of nails

***) All of the following joints may be involved in rheumatoid arthritis, except:

A.    Proximal interphalangeal joints

B.     Knee joints

C.     Distal interphalangeal joints

D.    Wrist joints

E.     Ankle joints

Answer: C* Distal interphalangeal joints

***) All of the following are extra-articular manifestations of rheumatoid arthritis, except:

A.    Pericarditis

B.     Mononeuritis multiplex

C.     Fibrosing alveolitis

D.    Pneumoconiosis

E.     Scleritis

Answer: D* Pneumoconiosis

***) All of the following are extra-articular manifestations of rheumatoid arthritis, except:

A.    Pleural effusion

B.     Episcleritis

C.     Keratoderma blenorrhagica

D.    Anemia

E.     Keratoconjunctivitis sicca

Answer: C* Keratoderma blenorrhagica

***) All of the following are seronegative arthritis, except:

A.    Ankylosing spondylitis

B.     Psoriatic arthritis

C.     Reiter's syndrome

D.    Rheumatoid arthritis

E.     Reactive arthritis

Answer: D* Rheumatoid arthritis

***) Rheumatoid arthritis may cause all of the following in the hand, except:

A.    Joint ankylosis

B.     Rupture of extensor tendons

C.     Intrinsic contractures

D.    Rupture of flexor tendons

E.     Heberden's nodes

Answer: E* Heberden's nodes

***) Which of the following is not a feature of Felty's syndrome:

A.    Lymphadenopathy

B.     Splenomegaly

C.     Polycythemia

D.    Rheumatoid arthritis

E.     Leucopenia

Answer: C* Polycythemia

                                                                                             III.            Crystal Arthropathies.

1.    Gout.

***) Acute attacks of gout rarely affect the:

A.    First metatarsophalangeal joint

B.     Shoulder

C.     Ankle

D.    Wrist

E.     Elbow

Answer: B* Shoulder

***) A 50 years old male awoke in the midnight with severe pain in his left big toe. He was taking some diuretics for hypertension. His toe was swollen, hot and severely tender, and patient was unable to stand on it. The most probable diagnosis is:

A.    Reiter's syndrome

B.     Acute pyogenic arthritis

C.     Rheumatoid arthritis

D.    Osteoarthritis

E.     Acute gouty arthritis

Answer: E* Acute gouty arthritis

***) Acute gouty arthritis can be precipitated by all of the following, except:

A.    Initiation of all purina therapy

B.     Alcohol

C.     Severe dieting

D.    Steroid therapy

E.     Surgery

Answer: D* Steroid therapy

***) In gouty arthritis which of the following is the most specific diagnostic finding:

A.    Family history of gout

B.     Presence of sodium urate crystals in synovial fluid

C.     Prompt response to colchicine therapy

D.    Presence of hyperuricemia

E.     Involvement of the big toe

Answer: B* Presence of sodium urate crystals in synovial fluid

***) Each of the following is acceptable for treatment of acute gouty arthritis, except:

A.    Indomethacin

B.     Oral colchicine

C.     Azapropazone

D.    Allopurinol

E.     ACTH IM

Answer: D* Allopurinol

***) Which drug inhibits uric acid synthesis by inhibiting xanthine oxidase:

A.    Probenecid

B.     Phenylbutazone

C.     Colchicine

D.    Allopurinol

E.     Indomethacin

Answer: D* Allopurinol

2.    Pseudogout.

***) In crystal synovitis all are true except:

A.    Pseudo gout is caused by Na urate

B.     Pseudo gout is caused by Ca urate

C.     Arthroscopy is useful

D.    Septic arthritis is a differential diagnosis

E.     First metatarsophalangeal joint is the commonest site

Answer: A* Pseudo gout is caused by Na urate

                                                                                           IV.            Spondyloarthropathies.

1.    Ankylosing Spondylitis.

***) Ankylosing spondylitis is associated with: Q2012

A.    HLA B27

B.     HLA B8

C.     HLA DR4

D.    HLA A3

E.     HLA A56

Answer: A* HLA B27

***) The radiological findings of obliteration of the sacroiliac joints with ossification in the spinal ligaments (bamboo spine) are characteristics of:

A.    TB arthritis

B.     Gouty arthritis

C.     Rheumatoid arthritis

D.    Ankylosing spondylitis

E.     Osteoarthritis

Answer: D* Ankylosing spondylitis

***) HLA B27 is associated with all of the following, except:

A.    Ulcerative colitis

B.     Crohn's disease

C.     Gouty

D.    Ankylosing spondylitis

E.     Reiter's syndrome

Answer: C* Gouty

2.    Psoriatic Arthritis (PsA).

***) Rheumatoid factor is not present in:

A.    Rheumatoid Arthritis

B.     SLE

C.     Systemic Sclerosis

D.    Psoriatic arthritis

E.     Old age

Answer: D* Psoriatic arthritis

                                             V.            Autoimmune Connective Tissue Diseases.

1.    Systemic Sclerosis.

***) Diffuse scleroderma patients at increased risk for all the following, except: Q2012

A.    Acute renal crisis

B.     Pulmonary hypertension

C.     Repeated abortions

D.    Secondary Sjogren's

E.     Lung fibrosis

Answer: C* Repeated abortions

***) Systemic sclerosis may result in all of the following, except:

A.    Dysphagia

B.     Pulmonary fibrosis

C.     Renal failure

D.    Pre-senile dementia

E.     Malabsorption

Answer: D* Pre-senile dementia

2.    Polymyositis.

***) All of the following about polymyositis is true, except:

A.    Proximal weakness

B.     Normal muscle biopsy

C.     Dysphagia can occur

D.    Raised ESR

E.     Raised serum creatine phosphokinase

Answer: B* Normal muscle biopsy

3.    Plasma Autoantibodies.

***) Positive tests for rheumatoid factor commonly occur in which the following:

A.    Ankylosing spondylitis

B.     Reiter's syndrome

C.     Down's syndrome

D.    Sjogren's syndrome

E.     Chronic gout

Answer: D* Sjogren's syndrome

4.    Systemic Lupus Erythematosus (SLE).

***) All of the following about systemic lupus erythematosus are true, except:

A.    It is usually present in middle-aged men

B.     Butterfly rash can occur

C.     Raynaud's phenomenon is present

D.    Pancytopenia usually occur

E.     Arthritis is common clinical feature

Answer: A* It is usually present in middle-aged men

***) In systemic lupus erythematosus (SLE) all of the following are true, except:

A.    Involve the proximal interphalangeal joints

B.     Pneumonitis may occur

C.     Raised anti DNA support the diagnosis

D.    Chloroquine is used in management

E.     Elevated complement indicates activity

Answer: E* Elevated complement indicates activity

***) All of the following are features of systemic lupus erythematosus, except:

A.    Alopecia

B.     Pleurisy

C.     Depression

D.    Raised level of C reactive protein

E.     Neutropenia

Answer: D* Raised level of C reactive protein

***) All of the following are features of systemic lupus erythematosus, except:

A.    Fever

B.     Abdominal pain

C.     Myopathy

D.    Glomerulonephritis

E.     Keratoderma blenorrhagica

Answer: E* Keratoderma blenorrhagica

***) Raynaud's phenomenon is seen in all the following, except: Q2012

A.    Reiter’s disease

B.     SLE

C.     Scleroderma

D.    Rheumatoid arthritis

E.     CREST

Answer: A* Reiter’s disease

***) Raynaud's phenomenon is described in all the following, except:

A.    Rheumatoid arthritis

B.     Hyperthyroidism

C.     Thoracic outlet syndrome

D.    Cold agglutinin disease

E.     Systemic sclerosis

Answer: B* Hyperthyroidism

***) Raynaud’s phenomenon may be associated with all of the following, except:

A.    Cervical rib

B.     Obesity

C.     Scleroderma

D.    Systemic lupus erythematosus

E.     Rheumatoid arthritis

Answer: B* Obesity

                                                                                                                          VI.            Vasculitides.

1.    Polyarteritis Nodosa.

***) All of the following are features of polyarteritis nodosa, except:

A.    Commoner in males

B.     Hypertension may occur

C.     Mononeuritis multiplex

D.    Death usually from anemia

E.     Myocardial infarction can occur

Answer: D* Death usually from anemia

2.    Behçet's Disease.

***) All of the following about Behchet's disease are true, except:

A.    It causes orogenital ulceration

B.     It spares the CNS

C.     Arthritis is a feature

D.    Colchicine is used in the management

E.     Superior vena cava obstruction may occur

Answer: B* It spares the CNS

***) All of the following about Behchet's disease are true, except:

A.    Iritis may occur

B.     Thrombophlebitis may occur

C.     It is a viral infection

D.    Steroids can be used in the treatment

E.     Neurological complications may occur

Answer: C* It is a viral infection

***) All of the following are features of Behchet’s disease except:

A.    Genital ulceration

B.     Iritis

C.     Thrombophlebitis

D.    Erythema nodosum

E.     Osteomyelitis

Answer: E* Osteomyelitis

                                                                                                     VII.            Systemic Diseases.

1.    Dermatological Manifestations.

***) In erythema nodosum associated findings include all of the following, except:

A.    Arthralgia

B.     Conjunctivitis

C.     Residual bruised appearance

D.    Ulceration

E.     Tenderness of lesions

Answer: B* Conjunctivitis

***) All of the following can cause erythema nodosum, except:

A.    Streptococcal infections

B.     Tuberculosis

C.     Leprosy

D.    Sarcoidosis

E.     Amyloidosis

Answer: E* Amyloidosis

***) Erythema nodosum may be associated with all of the following, except:

A.    Sarcoidosis

B.     Tuberculosis

C.     Streptococcal pharyngitis

D.    Crohn's disease

E.     Rheumatoid arthritis

Answer: E* Rheumatoid arthritis

***) All of the following are causes of erythema nodosum, except:

A.    Sarcoidosis

B.     Streptococcal infection

C.     Tuberculosis

D.    Indomethacin

E.     Oral contraceptives pills

Answer: D* Indomethacin

***) Erythema nodosum may be seen in all of the following, except:

A.    Ulcerative colitis

B.     Dermatomyositis

C.     Sarcoidosis

D.    Post streptococcal infection

E.     Crohn's disease

Answer: B* Dermatomyositis

***) Iris skin lesion is a major diagnostic feature of one of the following skin disorders:

A.    Atopic dermatitis

B.     Scarlet fever

C.     Measles

D.    Erythema multiform

E.     Erythema marginatum

Answer: D* Erythema multiform

***) Vitiligo is associated with all of the following, except:

A.    Addison's disease

B.     Rheumatoid arthritis

C.     Pernicious anemia

D.    Diabetes mellitus

E.     Thyrotoxicosis

Answer: B* Rheumatoid arthritis