Rheumatic Conditions

  1. Human leukocyte antigen associated with rheumatoid arthritis
    HLA-DR 4
  2. Presence of this substance indicates that rheumatoid arthritis manifests with more extra-articular symptoms and poorer prognosis




    B) Rheumatoid factor (RF)
  3. Serves as a better marker than rheumatoid factor for diagnosing rheumatoid arthritis




    C) Anti-citrullinated protein antibody (ACPA)

    ACPA level is included in the revised 2010 criteria for rheumatoid arthritis.
  4. Proliferation of vascular granulomatous tissue in rheumatoid arthritis eventually leading to fibrosis and ankylosis
    Pannus formation
  5. Stage of rheumatoid arthritis with possible osteoporosis




    B) Stage 1 (early)
  6. Stage of rheumatoid arthritis with osteoporosis, limitation of joint mobility, adjacent muscle atrophy, rheumatoid nodules, and slight cartilage destruction




    A) Stage 2 (moderate)
  7. Stage of rheumatoid arthritis with osteoporosis, subchondral destruction, joint deformity, extensive muscle atrophy, rheumatoid nodules, but without ankylosis




    C) Stage 3 (severe)
  8. Stage of rheumatoid arthritis with fibrous/bony ankylosis




    D) Stage 4 (terminal)
  9. In the 1987 ACR Criteria for rheumatoid arthritis, what signs and symptoms must be present for at least six weeks?
    MASH
    • 1. Morning stiffness (at least one hour before improvement)
    • 2. Arthritis of three or more joints simultaneously (14 possible areas: PIP, MCP, wrist, elbow, knee, ankle, and MTP joints)
    • 3. Symmetrical arthritis
    • 4. Hand arthritis (at least one swollen area in wrist, MCP, or PIP joint)
  10. How many in the 1987 ACR Criteria must be fulfilled in order to make a diagnosis of rheumatoid arthritis?




    D) 4 out of 7
  11. What score in the 2010 ACR criteria would you give a patient who has arthritis affecting 5 large joints, decreased RF and ACPA, abnormal ESR and CRP, and symptoms lasting for 3 weeks? Can you diagnose this patient with rheumatoid arthritis?
    • 2010 ACR Criteria
    • Joint involvement = 1
    • 0 = 1 large joint
    • 1 = 2-10 large joints
    • 2 = 1-3 small joints
    • 3 = 4-10 small joints
    • 4 = >10 joints regardless of size
    • Serology = 1
    • 0 = (-) RF and ACPA
    • 2 = decreased RF and ACPA
    • 3 = increased RF and ACPA
    • Acute phase reactants = 1
    • 0 = normal ESR and CRP
    • 1 = abnormal ESR and CRP
    • Duration = 0
    • 0 = <6 weeks="" br=""> 1 = >= 6 weeks
    • Total score = 3 out of 10 (Patient cannot be diagnosed with rheumatoid arthritis because minimum score required is 6.)
  12. How many test result/s are needed for serology and acute phase reactants in accordance to 2010 ACR Criteria?




    A) One
  13. Steinbrocker functional classification: carry usual duties without handicaps




    D) Class I
  14. Steinbrocker functional classification: conduct normal activities despite handicap of discomfort or limited mobility of one or more joints




    A) Class II
  15. Steinbrocker functional classification: perform only a few or none of the duties of usual occupation or self-care




    A) Class III
  16. Steinbrocker functional classification: largely or wholly incapacitated with patient being bedridden or confined to wheelchair, permitting little or no self-care




    D) Class IV
  17. Functional classification: independent in self-care, vocational, and avocation activities




    A) Class I
  18. Functional classification: independent in self-care and vocational activities, but limited or dependent in avocational activities




    B) Class II
  19. Functional classification: independent in self-care activities, but limited or dependent in vocational and avocational activities




    A) Class III
  20. Functional classification: limited or dependent in self-care, vocational, and avocational activities




    C) Class IV
  21. Joints commonly affected in rheumatoid arthritis, except:




    C) Knee
  22. Floating of ulna on the wrist due to the destruction of ulnar collateral ligament




    D) Piano key sign
  23. MC UE nerve entrapment associated with rheumatoid arthritis




    D) Carpal tunnel syndrome
  24. Rupture of extensor tendons which progresses from the ulnar to the radial side of the hand, resembling a benediction sign




    D) Vaughan-Jackson deformity
  25. Rupture of flexor pollicis longus, resulting to weak pinch




    A) Mannerfelt syndrome
  26. Nalebuff classification: boutonniere deformity




    D) Type 1
  27. Nalebuff classification: boutonniere deformity and CMC subluxation




    B) Type 2
  28. Nalebuff classification: swan neck deformity




    C) Type 3
  29. Nalebuff classification: gamekeeper's thumb (CMC adduction and radial deviation due to rupture of ulnar collateral ligament)




    B) Type 4
  30. Nalebuff classification: swan neck deformity and MCP disease




    B) Type 5
  31. Nalebuff classification: arthritis mutilans (opera glass hand and telescoping sign)




    A) Type 6
  32. Cervical segments most commonly affected in rheumatoid arthritis




    B) C1-C2
  33. Cervical segments most commonly affected in osteoarthritis




    A) C5-C6
  34. Results from collapse of transverse arch




    A) Splay foot
  35. MC LE nerve entrapment in rheumatoid arthritis
    Tarsal tunnel syndrome
  36. One of the joints to be affected last in rheumatoid arthritis




    D) Temporomandibular joint
  37. MC cause of death in rheumatoid arthritis




    A) Ischemic heart disease
  38. Manifestations of Felty's syndrome
    SLLAANT
    • 1. Splenomegaly
    • 2. Lymphadenopathy
    • 3. Leukopenia
    • 4. Anemia (hypochromic, microcytic)
    • 5. Arthritis
    • 6. Neutropenia
    • 7. Thrombocytopenia
  39. Intrapulmonary nodules associated with rheumatoid arthritis




    D) Caplan syndrome
  40. Sjogren's syndrome triad
    DAD
    • 1. Dry eyes (sicca, xerophthalmia)
    • 2. Dry mouth (xerostomia)
    • 3. Arthralgia

    • Other manifestations:
    • 1. Bilateral parotiditis
    • 2. Skin lesions
    • 3. Raynaud's phenomenon
  41. Sjogren syndrome can be associated with the following rheumatic conditions, except:




    C) Psoriatic arthritis
  42. True or False: Primary Sjogren's syndrome presents with dry eyes, dry mouth, and (+) RF and ANA.
    True

    Whereas, secondary Sjogren's syndrome is associated with RA, SLE, PM/DM, or PSS.
  43. Test for dry eyes wherein a strip of paper is placed on lower eyelid and after five minutes, the length of the wetted area is measured




    B) Schirmer's test
  44. Test for dry eyes which involves staining of eye to assess epithelial cell damage




    D) Rose Bengal Test
  45. Test for dry mouth which involves chewing of a sterile sponge for two minutes, then the weight of the sponge before and after chewing is measured




    A) Saxon test
  46. True or False: Juvenile idiopathic arthritis is the most common form of childhood arthritis.
    True

    Juvenile idiopathic arthritis is also known as juvenile rheumatoid arthritis.
  47. Type of JIA in which five or more joints are involved




    A) Polyarticular JIA
  48. Type of JIA in which one to four joints are affected




    D) Pauciarticular JIA
  49. Multisystemic manifestation in Still's disease
    OPPAH
    • 1. Osteoporosis/osteopenia
    • 2. Pericarditis
    • 3. Pleuritis
    • 4. Anemia
    • 5. Hepatosplenomegaly
  50. JIA which is more common in women and has poorer prognosis, especially if it is unremitting




    B) Polyarticular JIA (RF positive)
  51. JIA associated with uveitis




    B) Polyarticular JIA (RF negative)
  52. Commonly affected joints in pauciarticular JIA (most to least)
    KAWE
    • 1. Knee
    • 2. Ankle
    • 3. Wrist
    • 4. Elbow
  53. Eye impairment associated with pauciarticular JIA which presents with cataract, glaucoma, and eventually blindness
    Chronic iridocyclitis
  54. True or False: Late-onset pauciarticular JIA is more common in females.
    False

    Early-onset pauciarticular JIA is more common in females younger than 5 years old.
  55. True or False: Late-onset pauciarticular JIA is less common in males.
    False

    Late-onset pauciarticular JIA is more common in males.
  56. ACR Criteria for Systemic Lupus Erythematosus
    DOPAMIN RASH
    • Discoid rash
    • Oral ulcers
    • Photosensitivity
    • Antinuclear antibody
    • Malar rash
    • Immunologic disease
    • Neurologic disease (seizures, psychosis)
    • Renal disease (proteinuria, lupus nephritis)
    • Arthritis (Jaccoud's: non-erosive, reversible but deforming arthritis on two or more joints)
    • Serologic disease (pericarditis, pleuritis)
    • Hematologic disease (Felty's syndrome)
  57. How many should be fulfilled in the ACR Criteria to be diagnosed with Systemic Lupus Erythematosus?




    B) 4 out of 11
  58. MC cardiac event in systemic lupus erythematosus




    C) Pericarditis
  59. MC cause of death in systemic lupus erythematosus




    B) Cardiovascular disease
  60. Type of scleroderma with rapid onset of skin thickening after Raynaud's phenomenon




    D) Diffused cutaneous scleroderma
  61. Type of scleroderma with poorer prognosis and variable course




    C) Diffuse cutaneous scleroderma
  62. Type of scleroderma associated with anti-centromere antibody




    A) Limited cutaneous scleroderma
  63. The following organs are affected in diffused cutaneous scleroderma, except:




    D) None of these

    • The following organs are affected in diffused cutaneous scleroderma:
    •    1. Heart (pericarditis)
    •    2. Gastrointestinal tract (dysphagia, xerostomia)
    •    3. Kidneys (hypertension)
    •    4. Lungs (restrictive lung disease)
  64. Type of scleroderma with better prognosis and predictable course




    D) Limited cutaneous scleroderma
  65. Manifestations of limited cutaneous scleroderma
    CREST
    • 1. Calcinosis
    • 2. Raynaud's phenomenon
    • 3. Esophageal dysmotility
    • 4. Sclerodactyly
    • 5. Telangiectasia
  66. Form of localized scleroderma with discolored patches of skin due to uneven collagen deposition




    C) Morphea
  67. Type of linear scleroderma found in frontoparietal region, often with loss of hair on the involved side and loss of facial symmetry
    En coup de sabre
  68. All of the following are manifestations of edematous stage of scleroderma, except:




    B) Raynaud's disease

    The edematous stage of scleroderma manifests with pitting or non-pitting edema and Raynaud's phenomenon. Raynaud's disease (primary Raynaud's) occur without an underlying condition.
  69. The sclerotic stage of scleroderma manifests with all of the following signs, except: skin thickening, sclerodactyly, tobacco pouch sign, salt and pepper skin, and flexion contracture




    B) Adduction contracture

    It should be flexion, not adduction contracture.
  70. True or False: Sclerotic stage of scleroderma which manifests with thinning of skin, making it prone to tearing and ulceration.
    False

    It should be atrophic, not sclerotic stage.
  71. Life threatening complication of systemic JIA with persistent fever, lymphadenopathy, splenomegaly, and profound depression in one or more blood cell lines (often initially platelets) with raised liver function enzymes and clotting abnormalities




    D) Macrophage Activation Syndrome
  72. Persistent pauciarticular JIA affects not more than four joints throughout the disease course. Meanwhile, extended pauciarticular JIA affectS more than four joints after the first six months of disease.




    C) Both statements are true.

    Pauciarticular JIA is also known as oligoarticular JIA.
  73. Marker which is a risk factor for iridocyclitis seen in pauciarticular/oligoarticular JIA




    B) Antinuclear antibody (ANA)
  74. Diagnostic criteria for psoriatic arthritis
    • 1. Simultaneous presence of arthritis and typical psoriatic rash
    • 2. If the rash is absent, arthritis plus two of the following:
    •      a. Family history of psoriasis in a first-degree relative
    •      b. Dactylitis
    •      c. Nail pitting
  75. Most common infection preceding the development of reactive arthritis




    D) Chlamydia

    Chlamydia trachomatis is sexually transmitted.
  76. Usually monoarticular in children, but may involve multiple joints; presents with fever, joint pain, and decreased mobility




    D) Septic arthritis
  77. True or False: Most cases of septic arthritis are caused by gram-positive aerobes.
    True

    • Gram-positive aerobes:
    •  1. Staphylococcus aureus (60%)
    •  2. Beta-hemolytic streptococci (15%)
    •  3. Streptococcus pneumoniae (5%)
  78. True or False: Majority of septic arthritis in neonates and infants younger than six months are caused by gram-positive aerobes.
    False

    Septic arthritis in neonates and in infants younger than six months are caused by gram-negative aerobes.
  79. Spirochete responsible for Lyme Disease
    Borrelia burgdorferi
  80. Borrelia burgdorferi, the spirochete responsible for Lyme Disease, is transmitted to humans via deer tick called
    Ixodes dammini
  81. Most common tickborne disease in North American and Europe
    Lyme Disease
  82. Characteristic finding in Lyme Disease which looks like a reverse target skin lesion, as it is a large, red lesion with a central clearing area
    Erythema migrans
  83. Following a tick bite, how many days would it take before erythema migrans develop in Lyme Disease?




    C) 1-30 days
  84. MC involved joint in Lyme Disease
    Knee

    Others: hip, shoulder, elbow, wrist, and ankle
  85. Multisystem autoimmune disease with widespread immune complex deposition that results in episodic inflammation, vasculitis, and serositis




    C) Systemic Lupus Erythematosus
  86. Synovial fluid analysis findings: 
     1. Color: pale yellow
     2. Clarity: transparent
     3. Viscosity: high
     4. Mucin clot: good
     5. Cells/mm3: <25%
     6. WBC pecentage that are polymorphonuclear leukocytes: <10%




    D) Normal
  87. Synovial fluid analysis findings:
     1. Color: yellow or straw
     2. Clarity: transparent
     3. Viscosity: high
     4. Mucin clot: good
     5. Cells/mm3: <2,000
     6. WBC pecentage that are polymorphonuclear leukocytes: <25%




    C) Group I (non-inflammatory)
  88. Synovial fluid analysis findings:
     1. Color: yellow or straw
     2. Clarity: transparent to opaque, slightly cloudy
     3. Viscosity: variably decreased
     4. Mucin clot: fair to poor
     5. Cells/mm3: 3,000-50,000
     6. WBC pecentage that are polymorphonuclear leukocytes: >70%




    D) Group II (moderately inflammatory)
  89. Synovial fluid analysis findings:
     1. Color: yellow-gray, purulent
     2. Clarity: opaque, cloudy
     3. Viscosity: low
     4. Mucin clot: poor
     5. Cells/mm3: 50,000-100,000
     6. WBC pecentage that are polymorphonuclear leukocytes: >75% (usually close to 100%)




    A) Group III (highly inflammatory, septic)
  90. Synovial fluid analysis findings:
     1. Color: red
     2. Clarity: opaque
     3. Viscosity: high
     4. Mucin clot: good
     5. Cells/mm3: up to normal count in blood
     6. WBC pecentage that are polymorphonuclear leukocytes: may be the same as normal blood




    A) Group IV (hemorrhagic)
  91. All of the following are classified as inflammatory connective tissue disease, except:




    A) Osteoarthritis

    It should be rheumatoid arthritis, not osteoarthritis. Osteoarthritis is non-inflammatory.
  92. True or False: Gout and pseudogout are both classified under inflammatory crystal-induced disease.
    True
  93. Inflammatory arthritis classified under seronegative spondyloarthropathies
    APIR
    • 1. Ankylosing spondylitis
    • 2. Psoriatic arthritis
    • 3. Inflammatory bowel disease 
    • 4. Reiter's syndrome
  94. All of the following infectious agents can cause inflammatory arthritis, except:




    B) Protozoas

    Infectious agents which can cause inflammatory arthritis include bacteria, viruses, spirochetes, and fungi.
  95. True or false: Non-inflammatory arthritis which are classified under degenerative, posttraumatic, or overuse include osteoarthritis and post-traumatic avascular necrosis.
    False

    It should be post-traumatic aseptic, not avascular necrosis.
  96. Non-inflammatory arthritis classified under hereditary or metabolic
    • 1. Lipid storage disease
    • 2. Hemochromatosis
    • 3. Ochronosis
    • 4. Hypogammaglobulinemia
    • 5. Hemoglobinopathies
  97. Rheumatic condition which manifests with juxta-articular osteoporosis, fusiform soft-tissue swelling, marginal erosions, and bony cysts




    B) Rheumatoid arthritis
  98. Seronegative spondyloarthropathies which manifest with soft tissue swelling, sausage fingers, new bone formation, fluffy periosteal bone, syndesmophytes, enthesopathic ossification and/or erosion, bony ankylosis, and in severe cases arthritis mutilans
    • 1. Ankylosing spondylitis
    • 2. Reiter's syndrome
    • 3. Psoriatic arthritis
  99. Arthritis which manifests with periarticular soft tissue swelling, joint space enlargement, periosteal elevation, and in late stages bony destruction




    A) Septic arthritis
  100. Crystal-induced inflammatory disease which manifests with chondrocalcinosis and subchondral cysts
    Pseudogout
  101. Arthritis which manifests with epiphyseal enlargement, flattening and abnormal diaphyseal growth, periostitis, and apophyseal narrowing




    D) Juvenile idiopathic arthritis
  102. Crystal-induced inflammatory disease which manifests with soft-tissue speckled calcification and tophi deposits
    Gout
  103. Rheumatic conditions with symmetric joint involvement
    • 1. Rheumatoid arthritis
    • 2. Pseudogout
    • 3. Systemic lupus erythematosus
    • 4. Progressive systemic sclerosis
  104. Rheumatic conditions with asymmetric joint involvement
    • 1. Spondyloarthropathies (ankylosing spondylitis, Reiter's syndome, and psoriatic arthritis)
    • 2. Septic arthritis
    • 3. Gout
  105. Most frequently involves the MCP, MTP, PIP, and wrist joints




    C) Rheumatoid arthritis
  106. Areas most frequently involved in spondyloarthropathies
    • 1. Sacroiliac joint
    • 2. Heel
    • 3. Vertebral column
  107. Rheumatic condition which manifests with acroosteolysis, soft tissue calcification, sausage digits, and joint space loss in late stages




    A) Progressive systemic sclerosis
  108. All of the following rheumatic conditions have eye involvement, except:




    A) Psoriatic arthritis
  109. All of the following rheumatic conditions have gastrointestinal tract involvement, except:




    A) Rheumatoid arthritis
  110. Rheumatic conditions associated with skin involvement
    • 1. Psoriatic arthritis (e.g. psoriatic plaques)
    • 2. Juvenile idiopathic arthritis (e.g. Still's rash)
    • 3. Reiter's syndrome (e.g. keratoderma blennorrhagica, balanitis circinata)
    • 4. Colitic arthritis
    • 5. Sarcoid arthritis
    • 6. Systemic lupus erythematosus (e.g. discoid rash, malar rash)
    • 7. Amyloidosis
    • 8. Dermatomyositis
  111. Rheumatic conditions which also manifest with neurologic and hematologic symptoms
    • 1. Rheumatoid arthritis (e.g. entrapment neuropathies, mononeuritis multiplex, spinal cord compression)
    • 2. Systemic lupus erythematosus (e.g. psychosis, seizures)
  112. Rheumatic conditions associated with renal system involvement
    • 1. Gout
    • 2. Amyloidosis
    • 3. Systemic lupus erythematosus (e.g. proteinuria, glomerulonephritis)
    • 4. Progressive systemic sclerosis
  113. Rheumatic conditions also affecting the respiratory system
    • 1. Rheumatoid arthritis
    • 2. Sarcoidosis
    • 3. Polymyositis
  114. Rheumatic conditions also affect the heart and circulation
    • 1. Amyloidosis
    • 2. Polymyositis
    • 3. Juvenile idiopathic arthritis
    • 4. Reiter's syndrome
    • 5. Ankylosing spondylitis
  115. Inflammatory arthritis which is more common in whites and Native Americans (Pima Indians)




    B) Rheumatoid arthritis
  116. Inflammatory arthritis which has a lower prevalence among African Americans, Asian, and Japanese




    B) Juvenile idiopathic arthritis
  117. Inflammatory arthritis which is three times higher in blacks and Chinese and has increased prevalence in Haida, North American Indian




    B) Systemic lupus erythematosus
  118. Inflammatory arthritis which is higher in Central European




    B) Ankylosing spondylitis
  119. Inflammatory arthritis which is three times higher in black females




    D) Polymyositis
  120. Inflammatory arthritis which has increase prevalence in Southern US and is higher among African Americans




    B) Progressive systemic sclerosis
  121. Inflammatory arthritis common among African Americans and Asian-Pacific Islanders




    B) Gout
  122. Inflammatory arthritis more common in men
    • 1. Gout
    • 2. Ankylosing spondylitis
  123. MC inflammatory arthropathy
    Rheumatoid arthritis
  124. True or False: Women taking estrogen-based oral contraceptives are at higher risk for having systemic lupus erythematosus than those taking progesterone-based oral contraceptives.
    False

    Women taking progesterone-based oral contraceptives are at higher risk for having systemic lupus erythematosus than those taking estrogen-based oral contraceptives.
  125. Hallmark of this inflammatory arthritis is induration of the skin




    A) Progressive systemic sclerosis
  126. Primary idiopathic polymyositis




    D) Group 1
  127. Primary idiopathic dermatomyositis




    D) Group 2
  128. Dermatomyositis-polymyositis associated with neoplasia




    C) Group 3
  129. Juvenile dermatomyositis-polymyositis associated with vasculitis




    A) Group 4
  130. Dermatomyositis-polymyositis associated with collagen vascular disease




    B) Group 5
  131. Inclusion body myositis




    B) Group 6
  132. Familial rheumatic disorder which is associated with deficiency of hypoxanthine-guanine phosphotransferase, resulting in overproduction of uric acid
    Gout
  133. Onset before age 16 with arthritis affecting one joint or more for more than six weeks with no other known etiology
    Juvenile idiopathic arthritis
  134. Arthritis in one or more joints with or preceded by fever of at least two-week duration with at least three days of daily documented temperatures greater than 39°C, evanescent rash, generalized lymphadenopathy, hepatosplenomegaly, and serositis
    Systemic juvenile idiopathic arthritis
  135. Subgroup of polyarticular juvenile idiopathic arthritis which is usually more aggressive, symmetrically affecting small joints of the hands, wrists, and some larger joints similar to the adult form of the disease




    C) RF positive
  136. JIA associated with dactylitis, nail pitting, and onycholysis




    D) Psoriatic JIA
  137. Juvenile idiopathic arthritis with sacroiliac joint tenderness and/or inflammatory lumbosacral pain, positive HLA-B27 antigen, and acute asymptomatic uveitis




    D) Enthesopathic JIA
  138. The following muscles are commonly affected in polymyositis and dermatomyositis, except:




    A) Forearm supinators
  139. True or False: Childhood dermatomyositis can be treated with corticosteroids only which can be stopped over time.
    True
  140. True or False: Adult polymyositis or dermatomyositis can be treated with corticosteroids supplemented with immunosuppressive medications, both of which can be discontinued.
    False

    Corticosteroids and immunosuppressants cannot be discontinued.
  141. Myositis which is not responsive to corticosteroids and immunosuppressive agents




    D) Group 6
  142. Myositis which involves distal muscle weakness and may be associated with polyneuropathy




    A) Inclusion body myositis
  143. Myositis associated with occult carcinoma in adult males aged 40 years and older




    A) Dermatomyositis
  144. Characteristic finding in dermatomyositis described as cracking and fissuring on fingertips




    A) Mechanic's hand
  145. Characteristic finding in dermatomyositis described as purple rash on the upper eyelid




    B) Heliotrope rash
  146. Characteristic finding in dermatomyositis described as scaly dermatitis over joints or bony prominences of the hand




    B) Gottron papules
  147. Vasculitis affecting large arteries
    • 1. Giant cell arteritis
    • 2. Takayasu arteritis
  148. Vasculitis affecting small to medium arteries
    Polyarteritis nodosa
  149. Vasculitis affecting small arteries
    • 1. Wegener's granulomatosis
    • 2. Behcet's disease
  150. Expression of giant cell arteritis which manifests with pain and stiffness of proximal muscles
    Polymyalgia rheumatica
  151. ACR Criteria for polymyalgia rheumatica
    • 1. Hip pain or limitation of motion = 1 point
    • 2. Absence of other joint pain = 1 point
    • 3. Morning stiffness >45 minutes = 2 points
    • 4. Ultrasound findings
    •      a. One abnormal finding (e.g. subdeltoid bursitis, glenohumeral synovitis, biceps tenosynovitis) in the shoulder AND one abnormal finding (e.g. hip synovitis, trochanteric bursitis) in the hip = 1 point
    •      b. Two abnormal findings in the shoulder (e.g. subdeltoid bursitis, glenohumeral synovitis, biceps tenosynovitis) = 1 point
    • 5. Normal RF and ACPA (but abnormal ESR and CRP)

    A score of at least 5 out of 7 is needed to diagnose polymyalgia rheumatica.
  152. Vasculitis which commonly affects large, elastic arteries such as aorta
    Takayasu arteritis
  153. Manifestations of Takayasu arteritis
    • 1. Erythema nodosum
    • 2. Pulselessness
    • 3. Arm claudication
    • 4. Chest pain
    • 5. Difference in blood pressures between two arms
  154. Takayasu arteritis classification which only affects the branches of aortic arch




    C) I
  155. All of the following segments of aorta are affected in Takayasu arteritis class IIa, except:




    C) Thoracic descending aorta
  156. What segments of aorta are affected in Takayasu arteritis classified as IIb?
    • 1. Ascending aorta
    • 2. Aortic arch
    • 3. Branches of aortic arch
    • 4. Thoracic descending aorta
  157. Takayasu arteritis classification which involves the thoracic descending aorta, abdominal aorta, and renal arteries




    D) III
  158. What segments of aorta affected in Takayasu arteritis classified as IV?




    A) Abdominal aorta and renal arteries
  159. Takayasu arteritis classification which involves the ascending aorta, aortic arch and its branches, thoracic descending aorta, abdominal aorta, and renal arteries




    B) V
  160. MC cause of death in patients with polyarteritis nodosa
    Glomerulonephritis
  161. Vasculitis with characteristic saddle nose deformity




    A) Wegener's granulomatosis
  162. Triad of Behcet's Disease
    • 1. Oral aphthous ulcers 
    • 2. Genital ulcers
    • 3. Uveitis
  163. Autoimmune disease in which the antibodies attack the lungs and kidneys, leading to organ failure




    A) Good pasture syndrome
  164. Other names of ankylosing spondylitis
    • 1. Rheumatoid spondylitis
    • 2. von Bechterew's disease
    • 3. Marie-Strumpell disease
  165. How long does the morning lumbar stiffness in ankylosing spondylitis typically last prior to improving?




    D) 3 hours
  166. How long should symptoms persist to be diagnosed as ankylosing spondylitis?




    B) 3 months
  167. Progression of vertebral joint involvement in ankylosing spondylitis (first to last)
    • 1. Sacroiliac joint
    • 2. Lumbar vertebra
    • 3. Thoracic vertebra
    • 4. Cervical vertebra
  168. Other manifestations of ankylosing spondylitis
    • 1. C1-C2 subluxation
    • 2. Cauda equina syndrome
    • 3. Pulmonary fibrosis
    • 4. Uveitis
  169. Reiter's syndrome is also known as
    Reactive arthritis
  170. Infections which could lead to Reiter's syndrome
    • 1. Chlamydia
    • 2. Campylobacter
    • 3. Shigella
    • 4. Salmonella
    • 5. Yersinia
  171. Triad of Reiter's syndrome
    • 1. Conjunctivitis
    • 2. Arthritis (oligoarticular or polyarticular commonly involving sacroiliac, knee, and ankle joints)
    • 3. Non-gonococcal urethritis
  172. Small, painless ulcers in glans penis seen in Reiter's syndrome




    B) Balanitis circinata
  173. Hypertrophic lesions on palms and soles of individuals with Reiter's syndrome




    A) Keratoderma blennorrhagica
  174. How many percent of individuals with psoriasis develop psoriatic arthritis?




    C) 5-7%
  175. Epidemiology of psoriatic arthritis




    A) Female = Male; 30-50 years old
  176. MC affected joint in psoriatic arthritis




    B) DIP joint
  177. Pinpoint bleeding that occurs when the surface of a psoriatic plaque has been removed and capillaries just beneath the skin's surface rupture




    A) Auspitz's sign
  178. Appearance of new skin lesions on previously unaffected skin secondary to trauma




    C) Koebner phenomenon
  179. Manifestations of psoriatic arthritis
    • 1. DIP joint involvement
    • 2. Auspitz's sign
    • 3. Koebner phenomenon
    • 4. Onycolysis
    • 5. Telescoping sign (arthritis mutilans)
    • 6. Asymmetric joint involvement
    • 7. Pencil in cup deformity
  180. Remission of enteric arthropathy occurs when the underlying inflammatory bowel disease subsides.
    True
  181. MC affected joint in gouty arthritis
    First metatarsophalangeal (podagra)
  182. Four stages of gouty arthritis
    • 1. Asymptomatic hyperuricemia
    • 2. Acute gouty arthritis (presence of non-specific symptoms such as fever, chills, and malaise; inflammation of joint/s)
    • 3. Intercritical gout (asymptomatic but uric acid continues to accumulate in the body)
    • 4. Chronic tophaceous gout (presence of sodium urate crystal deposits in joint/s)
  183. Medication used in acute gout attacks




    A) Colchicine
  184. Medication used to decrease uric acid formation and is effective in long-term management of gouty arthritis




    C) Allopurinol
  185. The following are characteristics of crystals seen in pseudogout, except:




    C) Needle-shaped
  186. The following are characteristics of crystals seen in gout, except:




    D) Commonly found in the knee
  187. Calcium deposition on alar and cruciform ligaments of dens seen in pseudogout
    Crowned dens syndrome
  188. MC affected joint in pseudogout
    Knee
  189. Other names of osteoarthritis
    • 1. Degenerative joint disease
    • 2. Kellgren's disease
  190. Non-inflammatory, but progressive rheumatic condition which is associated with degeneration of the articular cartilage due to the weakening of collagen network
    Osteoarthritis
  191. True or Fals: In osteoarthritis, weakening of the collagen network of articular cartilages results from decreased water and increased proteoglycan content.
    False

    Weakening of collagen network of articular cartilages results from increased water and decreased proteoglycan content.
  192. Epidemiology of osteoarthritis
    • <50 years old (Males > Females)
    • >50 years old (Females > Males)
  193. Inflammatory variant of hand osteoarthritis which commonly affects the PIP and DIP joints of women aged 50-55 years
    Erosive osteoarthritis
  194. Deformities seen in erosive osteoarthritis of the IP joints in the hand
    • 1. Gull wing deformity
    • 2. Saw tooth deformity
  195. Condition commonly mistaken for ankylosing spondylitis as it involves calcification of ALL and PLL in three or more consecutive IV discs
    Diffused idiopathic skeletal hyperostosis (DISH)
  196. DISH is also known as
    Forestier's disease
  197. Hallmark of osteoarthritis




    B) Asymmetric joint space narrowing
  198. MC clinical finding in osteoarthritis




    A) Crepitus
  199. How long does joint stiffness in osteoarthritis last prior to improvement?




    A) 30 minutes
  200. MC affected joint in osteoarthritis




    D) Knee
  201. Disabling form of hip osteoarthritis which causes limitation in hip internal rotation and referred pain to the buttocks, knee, groin, and greater trochanter
    Manum coxae senilis
  202. Criteria for knee osteoarthritis
    • 1. Persistent knee pain
    • 2. Limited morning stiffness ≤30 minutes
    • 3. Reduced function
    • 4. Crepitus
    • 5. Bony enlargement
    • 6. Restricted movement
  203. Criteria for hip osteoarthritis
    • Pain present in combination with either:
    •     a. hip IR ≥15°. morning stiffness ≤60 minutes, age >50 years, and pain upon hip IR
    •     b. hip IR <15° and hip flexion <115°
  204. Criteria for hand osteoarthritis
    • 1. Presence of Heberden's nodes
    • 2. Age >40 years
    • 3. Family history of nodes
    • 4. Joint space narrowing in any finger joint
  205. Kellgren-Lawrence Radiographic Grading Scale for osteoarthritis: no radiographic findings of OA




    A) Grade 0
  206. Kellgren-Lawrence Radiographic Grading Scale for osteoarthritis: doubtful joint space narrowing and possible osteophytic lipping




    D) Grade 1
  207. Kellgren-Lawrence Radiographic Grading Scale for osteoarthritis: definite osteophytes with possible/questionable joint space narrowing




    D) Grade 2
  208. Kellgren-Lawrence Radiographic Grading Scale for osteoarthritis: definite osteophytes with moderate joint space narrowing and some sclerosis




    C) Grade 3
  209. Kellgren-Lawrence Radiographic Grading Scale for osteoarthritis: definite osteophytes with severe joint space narrowing, subchondral sclerosis, and definite deformity of bony contour




    A) Grade 4
  210. First line agent for mild osteoarthritis because of its benign safety profile




    B) Acetaminophen
  211. Strongest risk factor for prevalence and incidence of osteoarthritis




    A) Advanced age
  212. Primary modifiable risk factor of osteoarthritis that has the greatest potential for having an impact on treating the disease
    Obesity
  213. Segments of the spine MC involved in osteoarthritis
    • 1. C5-C6
    • 2. L4-L5
    • 3. L5-S1
  214. Among the hand joints, which is rarely involved in rheumatoid arthritis because it has less synovium




    C) Distal interphalangeal joint
  215. Deformity seen in rheumatoid arthritis characterized by extension of IP joint, as well as flexion and subluxation of MCP joint of the thumb




    A) Z deformity
  216. Most commonly used DMARD in management of rheumatoid arthritis




    A) Methotrexate
  217. Chronic inflammatory arthritis involving the axial structures, manifested by chronic back pain and progressive stiffness of the spine; but may also involves large peripheral joints
    Ankylosing spondylitis
  218. Ankylosing spondylitis may involve arthritis outside the spine and the most commonly affected joints, in order of frequency, are:
    • 1. Shoulders
    • 2. Hips
    • 3. Knees
  219. Most common location of enthesitis in ankylosing spondylitis
    • Calcaneal attachments of Achilles tendon
    • Others: calcaneal attachments of plantar fascia, shoulders, costochondral junctions, sternoclavicular and manubriosternal joints, and superior iliac crest
  220. Radiographic grading of sacroilitis: normal




    C) Grade 0
  221. Radiographic grading of sacroilitis: suspicious changes




    D) Grade 1
  222. Radiographic grading of sacroilitis: minimal abnormality - small localized areas with erosions or sclerosis, without alteration in the joint width




    B) Grade 2
  223. Radiographic grading of sacroilitis: unequivocal abnormality - moderate or advanced sacroilitis with erosions, sclerosis, widening, narrowing, or partial ankylosis




    A) Grade 3
  224. Radiographic grading of sacroilitis: total ankylosis




    D) Grade 4
  225. 1984 Modified New York Criteria for ankylosing spondylitis
    • Clinical variables:
    •  1. Inflammatory back pain >3 months
    •  2. Limitation of motion of the lumbar spine in both sagittal and frontal planes
    •  3. Limitation of chest expansion relative to normal values

    • Radiologic Variables (plain radiographs):
    •  1. Sacroiliitis grade ≥2 bilaterally
    •  2. Sacroiliitis grade 3-4 unilaterally

    Definite Diagnosis: at least one clinical variable plus at least one radiologic variable
  226. Disorder characterized by widespread musculoskeletal pain is usually associated with constitutional symptoms such as fatigue, malaise, sleep disturbances, headaches, mood disturbances, memory loss, and irritable bowel symptoms
    Fibromyalgia
  227. Joints MC affected in systemic lupus erythematosus
    Smaller peripheral joints such as fingers, wrists, elbows, toes, and ankles
  228. Calcium phyrophosphate deposition disease
    Pseudogout
  229. The onset of pseudogout is sudden with symptoms reaching maximum intensity within 8-12 hours. Meanwhile, the course of gout is more insidious, gradually intensifying over several days.




    C) Both statements are false.

    The onset of gout is sudden with symptoms reaching maximum intensity within 8-12 hours. The course of pseudogout is more insidious gradually intensifying over several days.
  230. Hyperechoic, irregular line of monosodium urate crystals on the surface of articular cartilage seen in ultrasound




    D) Double contour sign
  231. Non-pharmacologic management of gouty arthritis includes:
    • 1. Abundant hydration
    • 2. Avoiding high purine foods (meats and seafood)
    • 3. Avoiding high-fructose corn syrup (soft drinks and artificial fruit drinks)
    • 4. Decreasing alcohol intake (especially beer)
    • 5. Weight reduction (if obesity is an issue)
  232. True or False: Psoriatic arthritis affects females more than males.
    False

    Psoriatic arthritis affects males and females equally.
  233. MC clinical pattern of psoriatic arthritis




    A) Polyarthritis
  234. Medication which has been shown to reduce radiographic progression of psoriatic arthritis and its effect is superior to methotrexate
    TNF inhibitors (e.g. etanercept, adalimumab, or infliximab)
  235. Classification Criteria for psoriatic arthritis
    • 1. Inflammatory musculoskeletal disease (peripheral arthritis, spondylitis, or enthesitis) AND
    • 2. At least three points from the following:
    •     a. Current psoriasis (2 points), a personal history of psoriasis (1 point), or a family history of psoriasis (1 point)
    •     b. Typical nail lesions (1 point): onycolysis, pitting
    •     c. Dactylitis (1 point): present or past, documented by a rheumatologist
    •     d. Negative rheumatoid factor (1 point)
    •     e. Juxtaarticular bone formation (1 point): on hand or foot radiographs
  236. Common feature of dermatomyositis and polymyositis
    Painless muscle weakness
  237. ACR Criteria for fibromyalgia
    • 1. Widespread pain on both sides of the body
    • 2. 11 out of 18 tender points

    NOTE: To be diagnosed as fibromyalgia, both criteria must be fulfilled.
  238. Tender point sites in fibromyalgia
    There are 18 tender point sites, 9 on each side of the body.
    • 1. Occiput
    • 2. Lower cervical
    • 3. Trapezius
    • 4. Supraspinatus
    • 5. Second rib
    • 6. Lateral epicondyle
    • 7. Buttock
    • 8. Greater trochanter
    • 9. Knee
  239. Antihistone antibodies are present in which of the following conditions?




    D) Drug-induced lupus
Author
carminaorlino
ID
355338
Card Set
Rheumatic Conditions
Description
Updated