41.) A 28-year-old female patient with a six-year history of Raynaud’s syndrome has recently
developed pain in the small joints of hands, difficult movement of food down the esophagus.
What kind of disease can you think of in this case?
A. Systemic scleroderma
B. Periarteritis nodosa
C. Rheumatoid arthritis
D. Systemic lupus erythematosus
E. Pseudotrichiniasis
EXPLANATION:-Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia) is associated with limited scleroderma.There are two forms of scleroderma: localized and systemic. The localized (limited) form affects the skin of only the face, hands, and feet. The systemic (diffuse) form involves those and, in addition, may progress to visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract.
42.) A 60-year-old patient complains of recurrent pain in the proximal interphalangeal and wrist
joints, their periodic swelling and reddening that have been observed for 4 years. X-ray picture
represents changes in form of osteoporosis, joint space narrowing and single usuras. What is the
most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout
E. Multiple myeloma
EXPLANATION;-Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
43.) A 36-year-old female patient complains of intense pain in the knee joints and neck. In the
morning she experiences pain in the interscapular region and leg joints; pain subsides after
warm-up gymnastics. The patient is overnourished, there is a clicking sound in the knees when
squatting, the knees are somewhat disfigured, painful on palpation. Blood test results: ESR- 18
mm/h, WBC- 8, 0·109/l. Radiography reveals subchondral sclerosis in the left knee. What is the
basis of this pathology?
A. Degenerative processes in cartilage
B. Autoimmune process in the synovium
C. Deposition of urates (tophi) in the articular tissues
D. Beta-haemolytic streptococcus
E. Hemarthrosis
EXPLANATION;-Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
44.) After a holiday in the Crimea, a 36-yearold female patient presents with severe pain in the elbow
joints, dyspnea and weakness. The body temperature is of 37, 6oC, the skin is pale, there is
erythema of cheeks and nose, lower lip ulceration. Visual inspection reveals no changes in the
joints, the right elbow movement is limited. There is murmur and pleural friction in the lungs
below the right angle of the scapula. Cardiac sounds are muffled, there is tachycardia, gallop
rhythm, Ps- 114/min. AP- 100/60. What is the most likely diagnosis?
A. SLE
B. Rheumatic heart disease
C. Rheumatoid arthritis
D. Infectious allergic myocarditis
E. Dry pleurisy
EXPLANATION:-is an autoimmune systemic disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.
American College of Rheumatology (ACR) established .A person has SLE if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.
• Malar rash (rash on cheeks- BUTTERFLY RASH)
• Discoid rash (red, scaly patches on skin that cause scarring).
• Serositis: Pleurisy (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart).
• Oral ulcers (includes oral or nasopharyngeal ulcers).
• Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion.
• Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups).
• Blood—hematologic disorder—hemolytic anemia (low red blood cell count), leukopenia (white blood cell count<4000/µl), lymphopenia (<1500/µl), or low platelet count (<100000/µl) in the absence of offending drug. Hypocomplementemia is also seen, due to either consumption of C3 and C4 by immune complex-induced inflammation or to congenitally complement deficiency, which may predispose to SLE.
• Renal disorder: More than 0.5 g per day protein in urine or cellular casts seen in urine under a microscope.
• Antinuclear antibody test positive.
• Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody . Presence of anti-ss DNA in 70% of cases(most common in SLE).
• Neurologic disorder: Seizures or psychosis.
Note: Libman–Sacks endocarditis associated with SLE
45.)A 60-year-old female patient complains of recurrent pain in the proximal interphalangeal and
wrist joints, their periodic swelling and reddening that have been observed for 4 years. X-ray
picture represents changes in form of osteoporosis, joint space narrowing and single usuras.
What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gout
D. Pseudogout
E. Multiple myeloma
EXPLANATION;-Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
46.) A 39-year-old male patient complains of moderate pain and weakness in the shoulder, back and
pelvic girdle muscles, that has been progressing for the last 3 weeks; great difficulty in getting
out of bed, going up and down the stairs, shaving. Dermatomyositis has been suspected. Blood
test results: Hb- 114 g/l, WBC- 10, 8 · 109/l, eosinophils - 9%, ESR -22 mm/h, C-reactive
protein - (++). The alteration in the following laboratory value wil be of decisive diagnostic
significance:
A. Creatine phosphokinase
B. Ceruloplasmin
C. Sialic acids
D. dsDNA antibodies
E. Gamma-globulins
Explanation :read more dermatomyositis
47.) A 26-year-old male patient complains of pain in the right knee, which is getting worse in the
morning. Two weeks before, he consulted an urologist about prostatitis. Objectively:
conjunctivitis is present. There is also periarticular edema of the knee joint, redness of the
overlying skin. Rheumatoid factor was not detected. Until further diagnosis is specified, it would
be reasonable to start treatment with the following antibiotic:
A. Tetracyclines
B. Cephalosporins
C. Penicillins
D. Aminoglycosides
E. Lincosamides
EXPLANATION: Also known as reactive arthritis, autoimmune condition that develop to an infection in another part of body usually genitourinary and gastrointestinal infection. Mostly caused by chlamydia, e coli, campylobacter etc
Traid - Conjunctivitis, Arthritis, Non gonococcal urethritis
Treatment - tetracycline (chlamydia)
48.) Examination of a 35-year-old patient with rheumatism revealed that the right heart border was 1
cm displaced outwards from the right parasternal line, the upper border was on the level with
inferior margin of the 1st rib, the left border was 1 cm in from the left midclavicular line.
Auscultation revealed atrial fibrillation, loud apical first sound, diastolic shock above the
pulmonary artery. Echocardiocopy revealed abnormal pattern of the mitral valve motion. What
heart disease is characterized by these symptoms?
A. Mitral stenosis
B. Mitral valve prolapse
C. Mitral valve insufficiency
D. Aortic stenosis
E. Tricuspid valve insufficiency
EXPLANATION: patient has history of rheumatism and must common complication of rheumatism is mitral stenosis > arotic stenosis> tricuspic vulve> pulmonary vulve (rare)
49.) A 36-year-old female patient complains of intense pain in the knee joints and neck. In the
morning she experiences pain in the interscapular region and leg joints; pain subsides after
warm-up gymnastics. The patient is overnourished, there is a clicking sound in the knees when
squatting, the knees are somewhat disfigured, painful on palpation. Blood test results: ESR- 18
mm/h, WBC-8,0·109/l. Radiography reveals subchondral sclerosis in the left knee. What is the
basis of this pathology?
A. Degenerative processes in cartilage
B. Autoimmune process in the synovium
C. Deposition of urates (tophi) in the articular tissues
D. Beta-haemolytic streptococcus
E. Hemarthrosis
EXPLANATION;- Patients has features of Rheumatoid arthritis(RA) a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.Female affected more than male. MCPs and PIPs involved but not DIPs. Characterized by morning stiffness more than 1hr, pain gradually reliefs after exercis , ulnar deviation, Boutonierre deformity ,Swan neck deformity ,rheumatoid nodules backers cysts also present.
Factors that may increase your risk of rheumatoid arthritis include:
- Your sex. Women are more likely than men to develop rheumatoid arthritis.
- Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
- Family history. If a member of your family has rheumatoid arthritis, you may have an increased risk of the disease.
- Smoking. Cigarette smoking increases your risk of developing rheumatoid arthritis, particularly if you have a genetic predisposition for developing the disease. Smoking also appears to be associated with greater disease severity.
- Environmental exposures. Although uncertain and poorly understood, some exposures such as asbestos or silica may increase the risk for developing rheumatoid arthritis. Emergency workers exposed to dust from the collapse of the World Trade Center are at higher risk of autoimmune diseases such as rheumatoid arthritis.
- Obesity. People who are overweight or obese appear to be at somewhat higher risk of developing rheumatoid arthritis, especially in women diagnosed with the disease when they were 55 or younger.
The following are the revised criteria of American Rheumatology Association (ARA), for diagnosing RA:
"MORNING Always Helps to See Nature Fresh and RADIANT"
- MORNING - Morning stiffness of >1 hour duration
- Always - Arthritis of atleast three areas ( PIP, MCP, MTP, WRIST etc.)
- Helps - Hand arthritis
- See* - Symmetrical arthritis
- Nature - Nodules as observed by physician
- Fresh - rheumatoid Factor &
- RADIANT - Radiological changes
50.) After a holiday in the Crimea, a 36-year old female patient presents with severe pain in the
elbow joints, dyspnea and weakness. The body temperature is of 37,6oC, the skin is pale, there is
erythema of cheeks and nose, lower lip ulceration. Visual inspection reveals no changes in the
joints, the right elbow movement is limited. There is murmur and pleural friction in the lungs
below the right angle of the scapula. Cardiac sounds are muffled, there is tachycardia, gallop
rhythm, Ps- 114/min. AP- 100/60. What is the most likely diagnosis?
A. SLE
B. Rheumatic heart disease
C. Rheumatoid arthritis
D. Infectious allergic myocarditis
E. Dry pleurisy
EXPLANATION:-is an autoimmune systemic disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body.
American College of Rheumatology (ACR) established .A person has SLE if any 4 out of 11 symptoms are present simultaneously or serially on two separate occasions.
• Malar rash (rash on cheeks- BUTTERFLY RASH)
• Discoid rash (red, scaly patches on skin that cause scarring).
• Serositis: Pleurisy (inflammation of the membrane around the lungs) or pericarditis (inflammation of the membrane around the heart).
• Oral ulcers (includes oral or nasopharyngeal ulcers).
• Arthritis: nonerosive arthritis of two or more peripheral joints, with tenderness, swelling, or effusion.
• Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups).
• Blood—hematologic disorder—hemolytic anemia (low red blood cell count), leukopenia (white blood cell count<4000/µl), lymphopenia (<1500/µl), or low platelet count (<100000/µl) in the absence of offending drug. Hypocomplementemia is also seen, due to either consumption of C3 and C4 by immune complex-induced inflammation or to congenitally complement deficiency, which may predispose to SLE.
• Renal disorder: More than 0.5 g per day protein in urine or cellular casts seen in urine under a microscope.
• Antinuclear antibody test positive.
• Immunologic disorder: Positive anti-Smith, anti-ds DNA, antiphospholipid antibody . Presence of anti-ss DNA in 70% of cases(most common in SLE).
• Neurologic disorder: Seizures or psychosis.
