M1 2022
18. 25-years-old-female with history of unexplained fetal deaths referred to rheumatology
clinic for the workup of antiphospholipid syndrome Which of the following antibodies has NOT
a proven association with the diagnosis of antiphospholipid syndrome
A.Anti-beta 2 glycoprotein antibody
B.Anticardiolipin antibody
C.Anti-Smith antibody
D.Lupus anticoagulant
17. A 68 year female presented with pain and swelling of left knee joint for the past 2 days.
Arthrocentesis revealed rhomboid-shaped crystals that stained deeply blue with H&E stain and
show weak positive refringence on light microscopy. X-ray reveal chondrocalcinosis. Which of
the following crystals are most likely to be present in synovial fluid?
A.Calcium apatite crystals
B Calcium oxalate crystals
C.Calcium pyrophosphate crystals
D.Monosodium urate crystals
16. A19-year-old male presents to ER with dyspnea on exertion and red painful eyes. He
complains of chronic dull pain in the gluteal region for the last 5 years and stiffness in the lower
back that wakes him up in the morning. X-ray spine reveals squaring of vertebrae with bone
spur formation On MRI sacroiliayis is seen. Which of the following is the most likely diagnosis?
A.Ankylosing spondylitis
B.Reactive arthritis
C.Reiters syndrome
D.Rheumatoid arthritis
15. A 40-year-old female comes to OPD with inability to take dry food and a gritty sensation
in the eyes. She also complains of cough and fatigue with joint pains. On examination, her
parotid gland is enlarged. Which of the following tests is recommended to this patient?
A.C-reactive protein
B.P.ANCA antibodies
C.Rheumatoid factor
D.Schirmer test
M2 2022 CONV
M2 2021
M2 2020
M2 2019
M2 2018
M2 2017
EMQ-8
Theme: Rheumatological conditions
Polymyositis
Bahçet's Disease
Syphilis
Relapsing Polychondritis
Polymyalgia Rheumatica
Primary Raynaud's Disease
Ankylosing Spondylitis
Systemic Sclerosis
Stevens-Johnson's Syndrome
Sjogren's Syndrome
36) A 45-year-old woman complained of cold numb fingers and difficulty in swallowing On
examination she had tight skin thickening of the fingers and telangiectasia,
37) A 51-year-old woman complained of weakness in her shoulders and thighs. She had a
significantly raised creatine kinase (CK) level,
38) A 25-year-old man had been referred to rheumatology clinic with multiple painful stiff
joints and uveitis. He also complained of oral and genital ulcers
39) A 45-year-old woman presented with dryness of the eyes and mouth. Her Schimmer's test
was positive.
40)A patient presented to rheumatology clinic with recurrent attacks of pain and swelling in
the nose and
external ear
EMQ-7
Theme: Regarding Joint Pain
Psoriatic Arthritis
Rheumatoid arthritis
Polymyalgia Rheumatica
Systemic lupus erythematosus
Cervical Spondylosis
Reiter's Syndrome
Sjogren’s syndrome
Ankylosing Spondylosis
Osteoporosis
Osteoarthritis
31) A 64-year-old woman presented to GP with swollen painful hands and feet, which were
stiffer in the mornings. On examination there were signs of ulnar deviation and sub-luxation at
me metacarpophalangeal (MCP) joints
32) A 65-year-old woman complained of pain in her fingers on movement which was worst at
the end of the day. On examination there was joint tenderness and bony lumps at the distal
interphalangeal joints A radiograph showed loss of joint space
33) A30-year-old woman complained of joint pain in her hands and feet. She also gave history
of 02 abortions in last couple of years. Her chest radiograph showed reduced lung volumes
34)A 22-year-old man presented with acute arthritis of the left knee, dysuria and bilateral
conjunctivitis He bas recently suffered from gastroenteritis
35)A 45-year-old woman presented with bilateral painful deformed distal Interphalangeal
(DIP) joints Examination revealed discoloration and onycholysis of the nails
22) Following lab investigations favors osteomalacia:
Normal calcium, raised parathyroid hormone and elevated alkaline phosphatase
Low calcium and normal alkaline phosphatase
Hypocalcemia with hyperphosphatemia
Normal parathyroid hormone with normal vitamin D level and low parthyroid hormone
21) A 50 years old lady presented with sudden severe headache, vomiting and vertigo for 2
hours On examination she has coarse nystagmus and gait imbalance. Most likely clinical
diagnosis would be:
Transient ischemic attack
Posterior circulation stroke
Total anterior circulation stroke
Partial anterior circulation stroke
20)What is the reliable investigation for CREST syndrome
Anti SCL-70
Anti ds DNA
Anti Ro antibody
Anti centromere antibody
19) A 30 year old female of asian origin presented with fatigue and symptoms of intermittent
claudication in her jaw, hands and feet She was found hypertensive however there was a 15
mm Hg difference in the blood pressure in the arms. Her pulses on right upper and lower limb
were absent. There was evidence of a bruit over the right subclavian and artery. What would be
the most likely diagnosis?
Takayasu's arteritis
Coarcation of the aorta
Thoracic outlet syndrome
SLE (Systemic Lupus Erythematosus
18)Typical radiological feature of Ankylosing spondylitis:
Erosions
Syndesmophytes
Collapse of thoracic vertebral body
Presence of tophi around distal phalanges
17)A 45 year old female has noticed arm weakness and found it increasingly difficult to
brush her hair, lift objects and climb stairs. On examination there was evidence of reduced
power and wasting in her proximal muscles. On investigation CK (creatinine kinase) was
raised What would be the most likely diagnosis:
Polymyositis
Fibromyalgia
Dermatomyositis
Polymyalgia rheumatic
16)A28 year old woman presented to her GP with generalized aches and pains. She was
generally fatigued. On examination there was nothing specific to find however there were
certain points when pushed which elicited pain. Her all bloods test were normal. Which of
the following is the mostly diagnosis?
Depression
Polymyositis
Fibromyalgia
SLE (Systemic Lupus Erythematosus)
15)A 73 year old female had a long history of rheumatoid arthritis on methotrexate and
hydroxychloroquine. However recently he had notice peripheral oedema and swelling around
his eyes Urinalysis revealed proteinuria in nephrotic range. What would be the most likely
complication:
Amyloidosis
IgA nephropathy
Acute Tubular Necrosis
Drug-induced nephropathy
14)A 24 year old male has recently had unprotected sex. He presented with arthritis, red
watery eyes and dysuria. He also noticed plaques on his hands. What is the most likely
diagnosis?
UTI
Still's Disease
Reiter's syndrome
Seronegative arthritis
13)Sacroiliitis is a feature of
Systemic Sclerosis
Psoriatic arthritis
Rheumatoid arthritis
Systemic lupus Erythematosus
12)A 10 year old male was presented with back pain. He had stiffness in morning and the
pain and stiffness eases with exercise. What would be the finding in clinical examination?
Positive Kernig's sign
Positive Straight Leg Raising
Tenderness over the thoracic spine
Tenderness over the sacroiliac joint
11)Which of the following is a feature on X-ray of Rheumatoid Arthritis?
Osteophytes
Lytic lesions
Widened joint space
Periarticular osteopenia
10) 69-year-old woman taking hydralazine for hypertension presented with joint pain and
chest painOn cardiac examination, the patient had a pericardial rubWhat would be the likely
diagnosis?
Felty syndrome
Dermatomyositis
Polymyalgia rheumatica
SLE (Systemic Lupus Erythematosus)
9) Osteoarthritis is characterized by
Heberden's nodes
Cardiac complication
Increased prevalence in young age
Involvement of proximal interphalangeal joints
8) A 25-year-old female gave birth to a baby with complete heart block who subsequently
requires pacemaker insertion. Which of the following antibodies is most likely to be
detected in the maternal serum?
Rheumatoid factor
Ant-SCL70 antibodies
Ant-Ro/SSA antibodies
Ant-double-stranded deoxyribonucleic acid (dsDNA) antibodies
7)Which of the following drugs is most likely to cause Systemic lupus-like syndrome?
Ethambutol
Sulfasalazine
Methotrexate
Procainamido
6) Which skin manifestation is characteristic of systemic lupus erythematosus?
Erythema nodosum
Butterfly rash on the face
Heiotrope discoloration of eyelids
Skin tightening leading to spindle like fingers
5)A 20-year-old mare presented with the complaints of low backache and stiffness for 2
years. He also complained of painful red eyes for the last 2 weeks Spine examination
revealed positive Schober's test and costochondral joints were tenderWhat is the
diagnosis?
Osteoarthritis
Reter's disease
Rheumatoid arthritis
4)The clinical feature of progressive Systemic Sclerosis include
Bronchiectasis
Reflux esophagitis and dysphagia
Rarely presented with Raynaud's phenomenon
Anti-DNA Antibodies and decreased serum complement level
3)A 21-year-old female presented with the complaints of pain, swelling and morning stiffness
of interphalangeal Joints for 1 hour. She was febrile and anaemic There was a hand nodule
palpable on extensor surface of right forearm. What investigation should be done to predict the
prognosis of her disease?
ANA
X-ray of hands
Joint fluid analysis
Rheumatoid factor
2)The following suggest a mechanical rather than inflammatory cause of back pain
An elevated C reactive protein (CRP)
Gradual mode of onset in elderly patient
Back pain and stiffness exacerbated by rest
Radiation of pain down the back of one leg to the ankle
M2 2016
EMQ
For the following scenarios pick the most appropriate diagnostic test from the listed
options
a) ANA
b) Anti-ds DNA
c) Anti-Scl 70
d) Anti-phospholipids antibodies
e) ESR
f) CRP
g) Anti jo
h) Anti- centromere antibodies
i) Anti-CCO
j) RA factor
36. A young female with joint pain, oral ulcers and butterfly rash.
37. A 24 years old female with bilateral, symmetrical joint pain mainly of hands and feet. On
examination there is ulnar deviation of hands.
38. A 50 years old female complaining of difficulty in swallowing, bluish discoloration of
hands after exposure to cold water and shortness of the breath.
39. A 29 years old female with history of recurrent miscarriages now admitted with right
sided weakness
40. A 24 years old female complaining of difficulty in climbing stairs and pain in the
shoulder while combing. She also had rash over upper eye lids and over cheeks.
EMQ
For the following scenarios pick the most appropriate treatment from the listed options:
a) Gout
b) Rheumatoid arthritis
c) Osteoarthritis
d) Pseudogout
e) Septic arthritis
f) Ankylosing spondylitis
g) Polymyalgia
h) Psoraitic arthritis
21. A 27 years old female presented with pain and swelling in the joints particularly in the
small joints of the hands associated with morning stiffness for one hour
22. A 47 years old male complaining of pain in his right foot. On examination there is
redness, swelling in the right hallux.
23.A 63 years old female complaining of pain in the joints of the hands and some loss of
function. On examination the ring finger on her right hands become shortened and some
degree of ulnar deviation. She had some chronic skin disease.
24. A 23 year old man present to his GP with an increasing pain in his lower back and
stiffness that is worse in the morningsHe has noticed some intermittent pain in his knees
and increasing pain in the soles of his feet towards the end of the day. Spine X-ray reveals
squaring of the vertebrae
25. A 65 years old female, obese, complaining of bilateral knee joint pain mostly in the
evening and night and it is not associated with redness and swelling.
10. Which of the following is contra indication to the use of bisphosphonate?
a) Age 21
b) BMI 19
c) GFR>30
d) Corrected calcium of 2.5
9. Which of the following is deficient in SLE?
a) C 7
b) C 5
c) C 1q
d) C 3
8. A 18 year old male presented with painful right knee joint for 2 days with TLC of 26000
What is likely
a) Septic arthritis
b) Still's disease
c) Rheumatoid arthritis
d) Systemic lupus erythematosus
11. A 30 years old male presented with back pain radiated to the buttocks and posterior
thigh, his symptoms exacerbated by inactivity and relieved by movementOn examination he
has a reduce range of lumbar spine movements in all directions. X ray of sacroiliac joint
show irregularity, widening of the joint spaces and sclerosisWhat is the most likely
diagnosis?
a) Mechanical back pain
b) Osteoarthritis
c) Spondylosis
d) Ankylosing spondylitis
7. Which of the following is the most specific test of rheumatoid arthritis?
a) ESR
b) CRP
c) Anti-CCP
d) ANA
6. Ankylosing Spondylitis is associated with
a) HLA DR 3
b) HLA B27
c) HLA DR 4
d) HLA DR6
5. A young female with history of fever, joint pain, photosensitivity now complaining of
shortness of breath on mild exertion, most likely diagnosis is?
a) Tuberculosis
b) Systemic lupus erythematosus
c) Sarcoidosis
d) Septicemia
4. Morning stiffness is the characteristic features of which of the following disease?
a) Osteoarthritis
b) Septic arthritis
c) Rheumatoid arthritis
d) Gout
A 66 years old male presented with bilateral knee joint pain. What is the likely diagnosis?
a) SLE
b) Ankylosing spondylitis
c) Osteoarthritis
d) Rheumatoid arthritis
Most specific test for systemic lupus erythematosus:
a) ANA
b) Anti-ds DNA
c) CRP
d) RA Factor.
A 24 years old male presents with arthritis, red watery eyes and dysuria. What is the most
likely diagnosis?
a) Urinary tract infection
b) Still's disease
c) Seronegative arthritis
d) Reiter's disease
M2 2012
an acute inflammatory oligoarthritis during exacerbation of UC is called:
A.septic arthritis
B.enteropathic arthritis
C.reactive arthritis
D.spondylolisthesis
Anticentromere antibodies are most commonly associated with:
A.Diffuse Cutaneous systemic sclerosis
B.PAN
C.CREST syndrome
D.Polymyositis
Systemic sclerosis is associated with:
A.normal complement
B.anti DNA antibody
C.Anti Scl 70
D.Anti RNA
A 25 years old female comes to your clinic with 2 months h/o double vision and drooping of
eyelids worsening in the evening. On examination, you find ptosis and fatigable proximal
muscle weakness bilaterally.
What is the diagnosis?
How will you investigate?
What is the treatment?
a 29 years male has low back pain and stiffness for the last 4-5 years. Stiffness is worse in
the morning and relieved with exercise. On examination he has limited movements at
lower back and also has anterior uveitis. ESR 100 mm. X-ray chest shows upper lobe
pulmonary fibrosis.
What is the diagnosis?
How will you investigate?
How will you treat the patient?
M2 2015
RHUEMATOLOGICAL DISEASE
A. POLYMYOSITIS
B. BEHCET'S DISEASE
C. SYPHILIS
D RELAPSING POLYCHONDRITIS
F. POLYMYALGIA RHUEMATICA PRIMARY RAYNAUD DISEASE
G. ANKYLOSING SPONDYLITIS
H. SYSTEMIC SCLEROSIS
SJOGREN'S SYNDROME
J. REITER SYNDROME
K RHUEMATOID ARTHRITIS
21. 45 year old woman complain of cold numb fingers and difficulty in swallowing. On
examination she has tight akig, thickening of fingers and telangiectasia.
22. 51 year old woman with complaining of weakness in her shoulders and thighs. She has a
significantly raised creatinine kinase(CPK) level. A
23. 26 years old man has been referred to rhuematological clinic with multiple painful stiff
joints and uveitis. B23. He also complain of ulcer on his penis and mouth. J.
24. A 55 year old woman with dryness in his eyes and mouth. Her schirmer's test is positive.
I.
25. A patient presents to rhuematological clinic with recurrent attacks of pain and swelling
in nose and
external ear.
93. Migratory arthritis is a feature of:
Rheumatoid arthritis
b. Gonococcal arthritie
c. Systemic lupus erythematosle
d. Ankylosing arthritis
Complication of rheumatoid arthritis is:
Heberden nodes
b. Bouchard nodes
a Swan neck deformity
d. Osler nodes
Gold standard test for diagnosis of gouty arthritis :
a. Serum uric acid level
b. Urinary uric acid level
Synovial fluld aspiration
d. X-ray of joint
All are the causes of monoarthritis, except
Septic arthritis
b. Gout
c. Haemophilla
Rheumatic fever
89. Hebeden Node arthritis typically more often effects:
Metacarpophalangeal joints
Distal Interphalangeal joints
C. Proximal Interphalangeal joints
d. Elbow and shoulder joints
Recognized radiological feature of osteomalacia is:
Psuedo fracture
b. Spurs
c. Syndesmophytes
d Osteophytes
A 34 year old male known case of psoriatic arthritis present with some eye complaints. Eye
examination revealed anterior uveitis. The commonest genetic association for this disease:
&HLA-B8
b. HLA-DR5
c. HLA-DRA3
HLA-B27
Typical radiological feature of rheumatoid arthritis le
Presance of tophi around distal joints
Erosions
c. Collapse of thoracic vertebral bodies
d. Syndesmophytes
54. The best test for predictor of rheumatoid arthritis is
Rheumatoid factor
b. X-ray of hands
John fliud analysis
d. ANA-
48 year old female presented with history of painful left ankle joint for lest one week. On
examination it is hot, tender and swollen. She hes bilateral conjunctivitis. She also had
history of dysentery few weeks back. The most likely diagnosis ls
rheumatoid arthritis
Reactive arthritis
d. Acute gout
48 year old female presented with history of painful left ankle joint for lest one week. On
examination it is hot, tender and swollen. She hes bilateral conjunctivitis. She also had
history of dysentery few weeks back. The most likely diagnosis ls
rheumatoid arthritis
Reactive arthritis
d. Acute gout
20 year old male presented with low back pain and stiffness for 2 years. He also complains
of painful red eyes for last two weeks, Spine examination reveal positive schoebar test and
costochondral joints are tender. The most likely diagnosis:
a. Rheumatoid arthritis.
Ankylosing spondylitis
c. Osteoarthritis
d. Reiter's disease
Following is not a feature of rheumatoid arthritis:
a. Scleritis
b. Lymphadenopathy
Photosensitivity
d. Pulmonary fibrosis
Drug associated with Systemic lupus erythematosus is:
a. Methotrexate
Isoniazid
C. Beta blocker
d. Rifampicin
All of Following recognized neurological complications of rhyamatoid arthritis is except:
Autonomous neuropathy
b. Carpal tunnel syndrome
c. Peripheral neuropathy
d. Mononuerttis multiplex
50 years old female came with insidious onset of difficulty in walking and climbing stairs.
She also finds difficulty to put her clothes, On examination there is a purplish rash around
her eyes with scaly rash over knuckles. Proximal muscles are wasted and tender. CPK 2000
IU/L The most likely diagnosis:
Systemic lupus erythematosus
b. Systemic sclerosis
Dermatomyositis
Sjogren syndrome
M1 2012
Most common organism causing septic arthritis Is:
a) Streptococcus pneumonia
b) Salmonella species
c) Staphylococcus aureus.
d) Neisseria gonorrhoeae
