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Multiple choice questions on Rheumatology

1. Which of the following is not a criterion for
remission in rheumatoid arthritis (RA) according
to the ACR/EULAR 2011 criteria?
a. C-reactive protein (CRP) 1 mg/dL
b. Swollen joint count 1
c. Tender joint count 1
d. Physician global assessment 1
2. A 45-year-old female complaints of increasing
widespread joint pains which are worse in the
evening after a stressful day at work. She describes
puffy hands and feet and a painful neck. Her
concentration is very poor and she has recently
suffered from marital problems. Rheumatoid factor
is mildly positive. Examination reveals an increased
body mass index and global restriction of movement
due to pain, but no synovitis. Which of the following
investigations would be useful in this case?
a. Anti-cyclic citrullinated peptide antibody
b. Ultrasound scan hands and feet
c. Anti-JO-I antibody
Erythrocyte sedimentation rate and C reactive
e. Anti-mitochondrial antibody
3. Which of the following drugs is most likely to
cause systemic lupus-like syndrome?
a. Baclofen
b. Isoniazid
c. Methotrexate
d. Procainamide
e. Sulfasalazine
4. A 25-year-old female gives 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?
Anti-double-stranded deoxyribonucleic acid
(dsDNA) antibodies
b. Anti-endomysial antibodies
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Journal of Mahatma Gandhi Institute of Medical Sciences


c. Anti-Ro/SSA antibodies
d. Anti-SCL70 antibodies
e. Rheumatoid factor
Which of the following is a pro-inflammatory
a. CRP
b. Interleukin 4 (IL-4)
c. IL-10
d. Serum amyloid precursor protein
e. Tumour necrosis factor-alpha
6. A 72-year-old man presents with an acutely painful
right knee. On examination, he had a temperature
of 37C with a hot, swollen right knee. Of relevance
amongst his investigations, was his white cell count
which was 12.6 109/l and a knee X-ray revealed
reduced joint space and calcification of the articular
cartilage. Culture of aspirated fluid revealed no growth.
What is the most likely diagnosis?
a. Gout
b. Psoriatic monoarthropathy
c. Pseudogout
d. Rheumatoid arthiritis
e. Septic arthritis
7. Which of the following regarding Infliximab is
most true?
a. Is a monoclonal antibody to the glycoprotein
IIb-IIIa receptor
Is authorized for the treatment of severe
ulcerative colitis
c. Is licensed for the treatment of RA
d. It prevents relapse of Crohns disease in patients
who are in remission
Must not be used in combination with
methotrexate due to increased toxicity
8. A 25-year-old lady with known systemic lupus
erythematosus (SLE) presents with the nephrotic
syndrome. A renal biopsy is performed and this
confirms diffuse proliferative glomeronephritis (WHO
Class IV). Which of the following treatment regimens
would you advise?
a. Azathioprine alone
b. Prednisolone alone
c. Azathioprine and prednisolone
d. Prednisolone and intravenous cyclophosphamide
e. Prednisolone and methotrexate
March 2014 | Vol 19 | Issue 1

Jain: MCQ in Rheumatology


9. Which of the following auto-antibodies may have a

role in monitoring disease activity?
a. Rheumatoid factor in RA
b. Antinuclear antibodies in SLE
c. Anti-Sm antibodies in SLE
d. Anti-dsDNA antibodies in SLE
Anti-Ro (SSA) antibodies in Sjogrens

10. A 69-year-old woman taking hydralazine for

hypertension presents with joint pain and chest
pain. On cardiac examination, the patient has a
pericardial rub. What is the diagnosis?
a. Dermatomyositis
b. SLE
c. Polymyalgia rheumatic
d. Felty syndrome


5. Tumor necrosis factor-alpha

6. Pseudogout
7. Is licensed for the treatment of RA
8. Prednisolone and intravenous cyclophosphamide
9. Anti-dsDNA antibodies in SLE
10. SLE

1. Physician global assessment <1

2. a, b and d
3. Procainamide
4. Anti-Ro/SSA antibodies
March 2014 | Vol 19 | Issue 1

Journal of Mahatma Gandhi Institute of Medical Sciences