Mount Kenya University · School of Medicine · Internal Medicine
Paper details
- Paper: "Rheumatology CAT", time 2 hours. The scan has no printed date or unit code, so it is filed as undated.
- Questions: 30 multiple choice questions and 5 short answer questions (5 marks each).
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme. The pen marks on the scan were ignored.
- Topics tested: rheumatoid arthritis, systemic lupus erythematosus, CREST and systemic sclerosis, myositis, vasculitis, gout and pseudogout, osteoporosis and fibromyalgia.
- Questions that need care: Q2, Q10, Q15 and Q22 are loosely worded. The explanation says which option is best and why.
Section A: Multiple choice questions
1. Which of the following is the most common area affected by rheumatoid arthritis?
- A. Temporomandibular joint
- B. Metatarsophalangeal joint
- C. Metacarpophalangeal and proximal interphalangeal joints
- D. Wrist joint
2. Which of the following is NOT associated with a poor prognosis in rheumatoid arthritis?
- A. Large number of involved joints
- B. HLA-DRB102 / HLA-DRB103 alleles
- C. Extra-articular manifestations
- D. High serum titre of autoantibodies (rheumatoid factor, anti-CCP)
3. Regarding extra-articular disease, which organ system is more likely to be affected by rheumatoid arthritis?
- A. Urinary system
- B. Digestive system
- C. Cardiovascular system
- D. Lymphatic system
4. Which is the first choice for imaging in rheumatoid arthritis?
- A. CT scan
- B. MRI
- C. Ultrasonography
- D. Radiography
5. Which drug is the recommended first-line therapy for rheumatoid arthritis?
- A. Abatacept
- B. Etanercept
- C. Sarilumab
- D. Methotrexate
6. What are the early signs and symptoms of rheumatoid arthritis?
- A. Joint pain, tenderness, redness and swelling
- B. Loss of joint range of movement
- C. Limping
- D. All of the above
7. Rheumatoid arthritis differs from some other forms of arthritis because it:
- A. Is more painful than other forms
- B. Occurs below the waist
- C. Is symmetrical, affecting the right and left side of the body
- D. Generally occurs above the waist
8. Rheumatology is the branch of medicine that involves the study of:
- A. The immune system
- B. The musculoskeletal system (muscle and bone)
- C. Rheumatic disease
- D. All of the above
9. The sudden appearance or worsening of RA symptoms is called a:
- A. Outbreak
- B. Flare
- C. Burst
- D. Eruption
10. The term arthritis refers to:
- A. Stiffness in a joint
- B. Inflammation of the joints
- C. Both (a) and (b)
- D. None of the above
11. Rheumatoid arthritis is more severe in:
- A. Men
- B. Women
- C. Both (a) and (b)
- D. None of the above
12. People with rheumatoid arthritis experience the most stiffness at night.
- A. True
- B. False
13. Rheumatoid arthritis can be treated by:
- A. Medication
- B. Exercise
- C. Surgery
- D. All of the above
14. Which test cannot be used to aid diagnosis or monitor progression of rheumatoid arthritis?
- A. ESR
- B. RF test
- C. Anti-CCP
- D. Heterophile antibody
15. The cause of rheumatoid arthritis is:
- A. Heterophile antibodies
- B. Epstein-Barr virus (EBV)
- C. IgM
- D. IgG
16. Which is NOT a criterion for remission in RA by the ACR/EULAR 2011 criteria?
- A. C-reactive protein of 1 mg/dL or less
- B. Swollen joint count of 1 or less
- C. Tender joint count of 1 or less
- D. Physician global assessment of 1 or less
17. A 45-year-old woman has widespread joint pains worse after a stressful day, puffy hands and feet, a painful neck and poor concentration. Rheumatoid factor is mildly positive. BMI is raised and movement is restricted by pain, with no synovitis. Which investigation is most useful?
- A. Anti-cyclic citrullinated peptide antibody
- B. Ultrasound of hands and feet
- C. Anti-Jo-1 antibody
- D. ESR and C-reactive protein
- E. Anti-mitochondrial antibody
18. Which drug is most likely to cause a systemic lupus-like syndrome?
- A. Baclofen
- B. Isoniazid
- C. Methotrexate
- D. Procainamide
- E. Sulfasalazine
19. A 25-year-old woman has a baby with complete heart block that needs a pacemaker. Which maternal antibody is most likely?
- A. Anti-double-stranded DNA
- B. Anti-endomysial
- C. Anti-Ro/SSA
- D. Anti-Scl-70
- E. Rheumatoid factor
20. Which of the following is a pro-inflammatory cytokine?
- A. CRP
- B. Interleukin 4
- C. IL-10
- D. Serum amyloid precursor protein
- E. Tumour necrosis factor-alpha
21. A 72-year-old man has an acutely painful hot right knee, temperature 37°C, WBC 12.6 × 10⁹/L, an X-ray showing reduced joint space and calcification of the articular cartilage, and aspirate culture with no growth. Most likely diagnosis?
- A. Gout
- B. Psoriatic monoarthropathy
- C. Pseudogout
- D. Rheumatoid arthritis
- E. Septic arthritis
22. Which statement about infliximab is most true?
- A. It is a monoclonal antibody to the glycoprotein IIb-IIIa receptor
- B. It is authorised for severe ulcerative colitis
- C. It is licensed for the treatment of RA
- D. It prevents relapse of Crohn's disease in patients in remission
- E. It must not be used with methotrexate because of toxicity
23. A 25-year-old woman with SLE has nephrotic syndrome. Biopsy shows diffuse proliferative glomerulonephritis (WHO class IV). Which regimen would you advise?
- A. Azathioprine alone
- B. Prednisolone alone
- C. Azathioprine and prednisolone
- D. Prednisolone and intravenous cyclophosphamide
- E. Prednisolone and methotrexate
24. Which autoantibody may have a role in monitoring disease activity?
- A. Rheumatoid factor in RA
- B. Antinuclear antibody in SLE
- C. Anti-Sm in SLE
- D. Anti-dsDNA in SLE
- E. Anti-Ro in Sjögren's syndrome
25. A 69-year-old woman on hydralazine for hypertension has joint pain and chest pain with a pericardial rub. Diagnosis?
- A. Dermatomyositis
- B. Systemic lupus erythematosus (drug-induced)
- C. Polymyalgia rheumatica
- D. Felty syndrome
26. Which drug class has been shown to halt or reverse the progression of RA in most patients?
- A. Aspirin
- B. Azathioprine
- C. Everolimus
- D. Methotrexate
- E. Prednisone
27. Which statement about allopurinol is correct?
- A. It increases glomerular filtration of uric acid
- B. It reduces tubular reabsorption of uric acid
- C. It inhibits the conversion of xanthine to uric acid
- D. It is indicated in a 37-year-old with uric acid 0.42 mmol/L and one attack of gout
- E. It is associated with aplastic anaemia in 1% of cases
28. Alendronate has been proven effective in randomised trials in which condition?
- A. Osteomalacia
- B. Bony metastases
- C. Algodystrophy
- D. Postmenopausal osteoporosis
- E. Hypercalciuria
29. A 33-year-old woman has a malar rash worse with sun, myalgia, pleural effusion, pericarditis and arthralgia without deformity over 7 years, with haematuria and no drug history. Best screening test?
- A. Antinuclear antibody
- B. Anti-dsDNA
- C. Anti-RNP antibody
- D. Anti-histone antibody
30. A 40-year-old woman with asthma for 4 years has a 2-month history of asymmetric neuropathy in the right arm and both legs, palpable purpura on the legs and eosinophilia. Likely diagnosis?
- A. Systemic lupus erythematosus
- B. Polyarteritis nodosa
- C. Giant cell arteritis
- D. Churg-Strauss syndrome