1. Which of following favor diagnosis of SLE?

a) Joint deformity
b) Lung cavitations
c) Sever raynaud phenomenon
d) Cystoid body in retina
e) Anti RNP+

2. Patient with Rheumatoid arthritis on hand X-Ray there is swelling what you will do for him
a) NSAID
b) Injection steroid
c) positive pressure ventilation
 If there is DMARD choose it

3. Psuedogout:
a) Phosphate
b) Calcium
c) Florida
d) Calcium pyrophosphate

4. Patient complaints of abdominal pain and joint pains, the abdominal pain is colicky in character, and
accompanied by nausea, vomiting and diarrhea. There is blood and mucus in the stools. The pain in
joints involved in the ankles and knees, on examination there is purpura appear on the legs and
buttocks:
a) Meningococcal Infections
b) Rocky Mountain Spotted Fever
c) Systemic Lupus Erythematous
d) Henoch sconlein purpura

5. Long scenario, bone mineral density ,having T score - 3.5,, so diagnosis is

a) Osteopenia
b) Osteoporosis
c) Normal
d) Rickets disease
 Normal bone mineral density (T score > -1)
 Osteopenia (T score between -1 and –2.5)
 Osteoporosis (less than -2.5)

6. Patient with HTN and use medication for that, come complain of pain and swelling of big toe (MTJ) on
light of recent complain which of following drug must be change?
a) Thiazide
 side effect of Thiazide is gout

7. Elderly came with sudden loss of vision in right eye with headache, investigation show high CRP and high
ESR, what is the diagnosis?
a) Temporal arteritis

8. Case of temporal arteritis, what's the treatment:

a) Corticosteroids

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9. Old female patient with osteoporosis, what is exogenous cause?
a) Age
b) Decreased vitamin D

10. Patient with cervical spondylitis came with atrophy in Hypothenar muscle and decreased sensation in
ulnar nerve distribution. Studies showed alertness in ulnar nerve function in elbow..to ur action is :
a) Physiotherapy
b) Cubital tunnel decompression

11. Patient is known case of cervical spondylolysis , presented by parasthesis of the little finger , with atrophy
of the hypothenar muscles, EMG showed Ulnar tunnel compression of the ulnar nerve, what is your
action now:
a) Steroid injection
b) CT scan of the spine
c) Ulnar nerve decompression

12. Polymyalgia Rheumatica case with elevated ESR , other feature :

a) Proximal muscle weakness
b) Proximal muscle tenderness
 In polymyalgia Rhematica pain occurs on movement with normal strengths of the muscles.

13. Patient came with osteoarthritis & swelling in distal interphalangeal joint, what is the name of this
swelling?
a) Bouchard nodes
b) Heberden's nodes

14. An 80 year old lady presented to your office with a 6 month history of stiffness in her hand, bilaterally. This
stiffness gets worse in the morning and quickly subsides as the patient begins daily activities. She has no
other significant medical problems. On examination the patient has bilateral bony swellings at the margins
of the distal interphalangeal joints on the (2nd-5th) digits. No other abnormalities were found on the
physical examination. These swellings represent :
a) Heberden’s nodes
b) Bouchar’s nodes
c) Synovial thickenings
d) Subcutaneous nodules

 Explanation: the history suggests osteoarthritis which has both heberden’s nodes and
bouchard’s; depending on the location the names of the nodes differ heberden’s nodes
are at the DIPJ while
bouchard’s nodes are at the PIPJ. Reference: Saunders’pocket essentials of Clinical medicine
(parveen KUMAR)
15. Regarding Boutonniere deformity which one is true
a) Flexion of PIP &hyperextension of DIP.
b) Flexion of PIP & flexion of DIP
c) Extension of PIP & flexion of DIP.
d) Extension of PIP & extension of DIP

16. Young patient with red, tender, swollen big left toe 1st metatarsal, tender swollen foot and tender whole
left leg. His temperature 38, what is the diagnosis?
a) Cellulitis
b) Vasculitis
c) Gout Arthritis
17. Patient has history of parotid and salivary gland enlargement complains of dry eye, mouth and skin,
lab results HLA-B8 and DR3 ANA positive, rheumatoid factor positive, what is the course of treatment?
a) physostigmin
b) Eye drops with saliva replacement
c) NSAID
d) plenty of oral fluid

18. Patient elderly with unilateral headache, chronic shoulder and limb pain, positive Rheumatoid factor
and positive ANA, what is the treatment?
a) Aspirin
b) Indomethacin
c) Corticosteroid

19. Patient with recurrent inflammatory arthritis (migratory) and in past she had mouth ulcers now
complaining of abdominal pain what is the diagnosis

 Read about causes of migratory arthritis

20. Acute Gout management :

a) Allopurinol
b) NSAID
c) Paracetamol
d) Gold salt

21. Treatment of acute gouty arthritis

a) Allopurinol
b) Indomethacin
c) Penicillamine
d) Steroid

22. All can be used for the treatment of acute gout EXCEPT:
a) Allopurinol.
b) Penicillamine.
c) Gold salt.
d) Paracetamol.
e) Indomethacin.

23. Best investigation for Giant Cell Arteritis

a) Biopsy from temporal arteritis

24. Patient with rheumatoid arthritis came to you and asking about the most effective way to decrease joint
disability in the future, your advice will be:
a) Cold application over joint will reduce the morning stiffness symptoms
b) Disease modifying antirheumatic drugs are sufficient alone

25. Osteoporosis depend on

a) Age
b) Stage
c) Gender

26. Patient present with SLE, The least drug has side effect:
a) Methotrexate
b) name of other chemotherapy
27. 30 years old male with history of pain and swelling of the right knee, synovial fluid aspiration showed
yellow color opaque appearance, variable viscosity. WBC = 150,000 , 80% neutrophil, poor mucin clot, Dx is :
a) Goutism Arthritis
b) Meniscal tear
c) RA
d) Septic arthritis
e) Pseudogout arthritis
 Explanation: WBC>50,000 with poly predominance>75% is suspicious for bacterial infection

29. Juvenile Idiopathic Arthritis treatment :

a) Aspirin
b) Steroid
c) Penicillamine
d) Hydrocloroquin
e) Paracetamol

30. Man with pain and swelling of first metatarso-phalyngeal joint. Dx:
a) Gout “also called Podagra”

31. Rheumatoid Arthritis:

a) Destruction in articular cartilage
b) M=F
c) No nodules
d) Any synovial joint
e) HLA DR4
 Explanation:
a is true plus destruction of bones
b is false the M:F is 1:3
c is false Nodules are present in elbows & lungs
d is false because it doesn't affect the dorsal & lumbar spines
e is true but it also affects HLA DR1

32. Pseud-gout is
a) CACO3
b) CACL3
 Gout : Deposition of Monosodium Urate Monohydrate, –ve of birefringent, needle shape
 Psudogout : Deposition of Calcium Pyrophosphates Dehydrate crystal, +ve birefringent,
rhomboid shape, (CACO3)

33. Female patient diagnosed as Polymyalgia Rheumatica, what you will find in clinical picture to support
this diagnosis
a) osteophyte in joint radiograph
b) Tenderness of proximal muscle
c) weakness of proximal muscle
d) Very high ESR
 Polymyalgia Rheumatica is a syndrome with pain or stiffness, usually in the neck, shoulders, and hips,
caused by an inflammatory condition of blood vessels. Predisposes to temporal arteritis
 Usually treated with oral Prednisone
34. 14years girl with arthralgia and photosensitivity and malar flush and proteinuria , so diagnosis is :
a) RA
b) Lupus Nephritis
c) UTI

35. Which of the following is a disease improving drug for RA :

a) NSAID
b) Hydroxychloroquine

 Disease Modifying Anti-Rheumatic Drugs (DMARDs) :

 Chloroquine & Hydroxychloroquine
 Cyclosporin A
 D-penicillamine
 Gold salts
 Infliximab
 Methotrexate (MTX)
 Sulfasalazine (SSZ)

36. Which drug causes SLE like syndrome:

a) Hydralazine
b) Propranolol
c) Amoxicillin

 High risk:
1) Procainamide (antiarrhythmic)
2) Hydralazine (antihypertensive)
 Moderate to low risk:
1. Infliximab (anti-TNF-α)
2. Isoniazid (antibiotic)
3. Minocycline (antibiotic)
4. Pyrazinamide (antibiotic)
5. Quinidine (antiarrhythmic)
6. D-Penicillamine (anti-inflammatory)
7. Carbamazepine (anticonvulsant)
8. Oxcarbazepine (anticonvulsant)
9. Phenytoin (anticonvulsant)
10. Propafenone (antiarrhythmic)

37. Most important point to predict a prognosis of SLE patient :

a) Degree of renal involvement
b) sex of the patient
c) leucocyte count

38. Patient was presented by back pain relieved by ambulation, what is the best initial treatment:
a) Steroid injection in the back.
b) Back bracing.
c) Physical therapy “initial treatment”

39. Diet supplement for osteoarthritis

a) Ginger
40. Mechanism of destruction of joint in RA :
a) Swelling of synovial fluid
b) Anti-inflammatory cytokines attacking the joint

41. 27 years old male has symmetric oligoarthritis, involving knee and elbow, painful oral ulcer for 10
years, came with form of arthritis and abdominal pain. Dx is:
a) Behjets disease
b) SLE
c) Reactive arthritis
d) UC
e) Wipple’s disease

 Explanation: The diagnosis of Behçet disease was clarified by an international study group (ISG) .This group
developed ISG criteria, which currently are used to define the illness. At least 3 episodes of oral ulceration
must occur in a 12-month period. They must be observed by a physician or the patient and may be
herpetiform or aphthous in nature.
 At least 2 of the following must occur:
1) recurrent, painful genital ulcers that heal with scarring;
2) ophthalmic lesions, including anterior or posterior uveitis, hypopyon, or retinal vasculitis;
3) skin lesions, including erythema nodosum, pseudofolliculitis, or papulopustular lesions
4) pathergy, which is defined as a sterile erythematous papule larger than 2 mm in size appearing 48 hours
after skin pricks with a sharp, sterile needle (a dull needle may be used as a control).
5) Neurologic manifestations: The mortality rate is up to 41% in patients with CNS disease. This tends to be an
unusual late manifestation 1-7 years after disease onset: Headache - 50% , Meningoencephalitis - 28% ,
Seizures - 13% , Cranial nerve abnormalities - 16% , Cerebellar ataxia , Extrapyramidal signs, Pseudobulbar
palsy , Hemiplegia or paralysi , Personality changes ,Incontinence ,Dementia (no more than 10% of patients,
in which progression is not unusual)
6) Vasculopathy: Behçet disease is a cause of aneurysms of the pulmonary tree that may be fatal. DVT has
been described in about 10% of patients, and superficial thrombophlebitis occurred in 24% of patients in
the same study. Noninflammatory vascular lesions include arterial and venous occlusions, varices, and
aneurysms.
7) Arthritis: Arthritis and arthralgias occur in any pattern in as many as 60% of patients. A predilection exists
for the lower extremities, especially the knee. Ankles, wrist, and elbows can also be primarily involved. The
arthritis usually is not deforming or chronic and may be the presenting symptom and rarely involves
erosions. The arthritis is inflammatory, with warmth, redness, and swelling around the affected joint.Back
pain due to sacroiliitis may occur.
8) Gastrointestinal manifestations: Symptoms suggestive of IBD, Diarrhea or gastrointestinal bleeding,
ulcerative lesions (described in almost any part of the gastrointestinal tract) , Flatulence ,Abdominal pain,
Vomiting and Dysphagia.
9) Other manifestations : Cardiac lesions include arrhythmias, pericarditis, vasculitis of the coronary arteries,
endomyocardial fibrosis, and granulomas in the endocardium, Epididymitis , Glomerulonephritis
Lymphadenopathy , Myositis, Polychondritis

42. Patient is 74 years female complaining of pain and stiffness in the hip and shoulder girdle muscles. She
is also experiencing low grade fever and has depression. O/E: no muscle weakness detected.
Investigation of choice is
a) RF
b) Muscle CK
c) ESR

 Typical presentation of Polymyalgia rheumatic

43. In patient with rheumatoid arthritis:
a) Cold app. over joint is good
b) Bed rest is the best
c) Exercise will decrease post inflammatory contractures

 Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and
organs, but mainly joints. It involves an inflammation of the capsule around the joints (synovium)
 Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for
more than an hour. Gentle movements may relieve symptoms in early stages of the disease

44. Gouty arthritis negative pirfringes crystal what is the mechanism :

a) Deposition of uric acid crystal in synovial fluid due to over saturation

 Gout (also known as Podagra when it involves the big toe) is a medical condition characterized by
recurrent attacks of acute inflammatory arthritis — a red, tender, hot, swollen joint. The metatarsal-
phalangeal joint at the base of the big toe is the most commonly affected (50% of cases). However, it may
also present as tophi, kidney stones or urate nephropathy
 Mechanism: disorder of purine metabolism, and occurs when its final metabolite, uric acid, crystallizes
in the form of monosodium urate, precipitating in joints, on tendons, and in the surrounding tissues

45. Old patient with history of bilateral pain and crepitations of both knee for years now come with acute
RT knee swelling, on examination you find that there is edema over dorsum and tibia of RT leg, what is
the best investigation for this condition?
a) Right limb venogram

 To R/O DVT we have to do D-Dimer level first; if it is less than 500ng/ml DVT excluded.

46. 40 years old male come to you complaining of sudden joint swelling, no history of trauma, no history
of chronic disease, what is the investigation you will ask?
a) CBC for WBCs
b) ESR
c) MRI of knee joint
d) Rheumatoid factor

47. Female with sudden blindness of right eye, no pain in the eye, there is temporal tenderness
when combing hair, what is the management?
a) eye drop steroid
b) oral steroid
c) IV steroids
 Giant-cell arteritis (temporal arteritis): inflammatory disease of blood vessels most commonly involving
large and medium arteries of the head, predominately the branches of the external carotid artery. It is
a form of vasculitis.
 Treatment: Corticosteroids, typically high-dose prednisone (40–60 mg), must be started as soon as the
diagnosis is suspected (even before the diagnosis is confirmed by biopsy) to prevent irreversible blindness
secondary to ophthalmic artery occlusion. Steroids do not prevent the diagnosis from later being confirmed
by biopsy, although certain changes in the histology may be observed towards the end of the first week of
treatment and are more difficult to identify after a couple of months. The dose of prednisone is lowered
after 2–4 weeks, and slowly tapered over 9–12 months. Oral steroids are at least as effective as intravenous
steroids, except in the treatment of acute visual loss where intravenous steroids appear to be better
48. Patient with oral ulcer, genital ulcer and arthritis, what is the diagnosis?
a) Behçet's disease
b) syphilis
c) herpes simplex
 Behçet's disease: rare immune-mediated systemic vasculitis, described as triple-symptom complex of
recurrent oral aphthous ulcers, genital ulcers, and uveitis. As a systemic disease, it can also involve
visceral organs and joints

49. Patient with history of 5 years HTN on thiazide, came to ER midnight screaming holding his left foot, O/E
pt a febrile, Lt foot tender erythema, swollen big toe most tender and painful, no other joint
involvement
a) cellulitis
b) Gouty arthritis
c) septic arthritis
 one of the Thiazide side effect is Hyperuricemia which predisposes to Gout

50. Joint aspirate, Gram stain reveal gram negative diplococcic (N. gonorrhea), what is the treatment?
a) Ceftriaxone IM or cefepime PO one dose

51. Patient with pain in sacroiliac joint, with morning stiffness, X-ray of sacroiliac joint, all will be found
EXCEPT:
a) RF negative
b) Subcutaneous nodules
c) male > female
 Explanation: This inflammatory joint disease characterized by persistently –ve test for RF
 It develops in men before age of 40 with HLA B27.It causes synovial and extra synovial inflammation
involving the capsule, periarticularperiosteum, cartilage and subchondral bone.
 Large central joints are particularly involved such as (sacroiliac, symphysis pubis & intervertebral joints)
 Resolution of inflammation leads to extensive fibrosis and joint fusion, but no subcutaneous nodules
since it's not a seropositive disease

52. Allopurinol, one is true:

a) Effective in acute attack of gout.
b) decreases the chance of uric acid stone formation in kidneys
c) Salisylates antagonize its action

 Explanation: Indication of Allopurinol: Prevention of attacks of gouty arthritis uric acid nephropathy.
[but not in acute attack
 Allopurinol is used to treat Hyperuricemia along with its complications “chronic gout & kidney
stones”

53. A painful knee with swelling and positive ballotman test. What’s the next best step in
investigation?
a) CBC
b) MRI
c) CT
d) Arthrocentesis

54. Commonest organisms in Septic arthritis:

a) Staphylococcus aureus
181
b) Streptococci
c) N. gonorrhea

181
55. 28 years old woman came to your clinic with 2 months history of flitting arthralgia. Past medical history:
Unremarkable. On examination: she is a febrile. Right knee joint: mild swelling with some tenderness,
otherwise no other physical findings. CBC: HB 124 g/L = 12.4 g\dl) WBC: 9.2 x 109/L ESR: 80 mm/h
Rheumatoid factor: Negative, VDRL: Positive, Urine: RBC 15-20/h PF Protein 2+, The MOST appropriate
investigation at this time is:
a) Blood culture.
b) A.S.O titer.
c) C-reactive protein.
d) Double stranded DNA.
e) Ultrasound kidney.
 Explanation: young female, with a joint problem, high ESR, Proteinuria and a positive VDRL (which
is false positive in SLE). Blood culture is not needed (patient is a febrile, inflammatory features in
the joint aren’t so intense), A.S.O. titer is also not top in your list although post strept.
glomerulonephritis is possible but not top in the list since its more common in pediatric age group.
So the answer would be double stranded DNA which is one of the serology criteria in SLE

56. ulnar nerve entrapment what is your action :

a) cubital fossa release

57. 74 years old female patient of Cushing’s syndrome, had hip fracture falling off stool, what will
you screen for while also treating her fracture:
a) Hyperparathyroidism
b) Osteomyelitis
c) Osteoporosis
d) Osteomalacia

58. 30 age women with sharp pain in the index finger increase with using scissors or nail cut which
cause sharp pain at the base of the finger in matacarpophlyngeal joint and the finger become
directed downward in (mean flexed DIP) and cause pain when try to extend the finger..
a) trigger finger
b) tendon nodule
c) dupetren contracure
d) mallet finger

 loss of extensor tendon continuity at the DIPJ causes the joint to rest on an abnormaly flexed
positionthe classic mechanism of injury is a finger held rigidly in extension or nearly full
extension.

59. 65 years old female patient who has a 10 years history of symmetrical polyarthritis is admitted to the
hospital, examination reveals splenomegally, ulceration over lateral malleoli and synovitis of the
wrists, shoulders and knees, investigation shows WBC 2500 ,the most likely diagnosis is:
a) Felty's syndrome
 Felty’s syndrome: triad of RA, neutropenia, and splenomegaly.

60. typical scenario of giant cell arteritis wtas th rx

a) steroid

61. What is the best way for bone and muscle to prevent aging process.
a) Low resistence excercises with conditioning
62. Adult male during exercise he suddenly felt pain in the middle of his rt. Thigh posteriorly. On exam.
He has discoloration in the same site and mass in the hamstring ms. No bone tenderness or palpable
defect. Mx:
a) Surgery
b) Splint
c) Bandage
d) Ice, elevation and bandage
e) Cast.

63. Patient came with left arm stiffness and pain, he can’t abducted his arm .. dx
a) subcromial bursitis
b) glenohumoral arthritis

 Subacromial bursitis is a condition caused by inflammation of the bursa that separates the superior
surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying
coraco-acromial ligament, acromion, coracoid (the acromial arch) and from the deep surface of the
deltoid muscle.
 Subacromial bursitis often presents with a constellation of symptoms called impingement syndrome.
Pain along the front and side of the shoulder is the most common symptom and may cause
weakness and stiffness. If the pain resolves and weakness persists other causes should be evaluated
such as a tear of the rotator cuff or a neurological problem arising from the neck or entrapment of
the suprascapular nerve.
 The onset of pain may be sudden or gradual and may or may not be related to trauma.
 Impingement may be brought on by sports activities, such as overhead throwing sports and swimming,
or overhead work such as painting, carpentry or plumbing.
 Activities that involve repetitive overhead activity, or directly in front, may cause shoulder pain. Direct
upward pressure on the shoulder, such as leaning on an elbow may increase pain.
 Night time pain, especially sleeping on the affected shoulder, is often reported.
 Localized redness or swelling are less common and suggest an infected subacromial bursa.
 The patient actively abducts the arm and a painful arc occurs between 80° and 120°.
 Shoulder arthritis can be one of three types of arthritis in the glenohumeral joint of the shoulder
 The main symptom of shoulder arthritis is pain; this is due to the grinding of the bones against each
other because of the lack of cartilage. Pain usually occurs in the front of the shoulder and is worse
with motion. People with shoulder arthritis will also experience moderate to severe weakness,
stiffness developing over many years, and the inability to sleep on the affected shoulder.
 Diagnosis is simple; usually the doctor can tell if you have shoulder arthritis by your symptoms, but
he she will most likely also take an x-ray or MRI
.
64. Case about patient came with unilateral knee swelling for 2 days under microscope he has needle-like
morphology and strong negative birefringence what's your ttt :
a) Allopurinol
b) Indomethacin

65. An 80 year old retired carpenter complains of a pain in his left shoulder, he can't sleep on his Lt side
because of it, can't raise his hand up, on examination, limited range of motion, x-ray showed
osteopenia, Dx:
a) Osteoporosis.
b) Adhesive capsulitis.
c) Sub-acromial bursitis.
d) Biceps muscle tear.

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66. Patient with dysphagia, ptosis, and double vision , his disease is due to;
a) Antibodies to acetylcholine receptors.

67. Patient with pain in first metatarsophalangeal joint swelling edema normal WBC
a) Monosodium Urate
b) Calcium ….

68. Patient came with excruciating pain in the 1st toe on examination there was pain on moving the 1st
MTP Joint and the overlying skin was skin was erythematous “NOTE: no any INX result was
mentioned”
a) Sodium urate
b) Ca pyrophosphate

69. other version of this Q Yung pt came with hx of acute painful swelling of the first
metatarsophalangeal joint, redness, tenderness, fever 38c, what is the etiology:
a) Staph aureus = septic artheritis
b) Sodium urate deposition
c) Pyro phosphate calcium deposition

70. Pt get a deep laceration in the anterior surface of the wrist, what abnormality is expected “NOTE :
no name of any nerve was mentioned”
a) The pt will not be able to flex the MCP
b) Wrist drop
c) Clow hand
d) Loss sensation....I think the hand
e) Unable to oppose the thumb infront of other fingers
71. 20 years old man sustained a deep laceration on the anterior surface of the wrist. Median nerve
injury would result in:
a) Claw hand defect
b) wrist drop
c) Sensory deficit only.
d) Inability to oppose the thumb to other fingers
e) The inability to flex the metacarpophalangeal joints.

72. Group A Hemolytic streptococcus, causes rheumatic fever when:

a) Invade blood stream
b) Invade myocardium
c) After tonsillitis and pharyngitis
d) Skin infection
 Acute rheumatic fever is a complication of respiratory infections
 Post-streptococcal glomerulonephritis is a complication of either strep throat or streptococcal skin
infection

73. Patient had arthritis in two large joints & pansystolic murmur “carditis” Hx of URTI, the most
important next step:
a) ESR
b) ASO titre
c) Blood culture
 The diagnosis of Rheumatic fever can be made when two of the major Modified Jones criteria, or
one major criterion plus two minor criteria, are present along with evidence of streptococcal
infection: elevated or rising Antistreptolysin ‘ASO’ titre or DNAase
74. The drug with the least side effects for the treatment of SLE is:
a) NSAIDs
b) Methotrexate
c) Corticosteroid
d) Hydroxychloroquin
 Methotrexate, corticosteroid and hydroxychloroquin.

75. Duration of drug in Rheumatoid fever is :

a) 6 years
b) 15 years
c) Primary prevention lasts for 10 days and 2ry prevention lasts for 5years or 10 years depending
on presence of cardiatis

76. An elderly lady presented with chronic knee pain bilaterally that increases with activity & decreases
with rest, The most likely diagnosis is:
a) Osteoarthritis
b) Rheumatoid arthritis
c) Septic arthritis

77. An old woman complaining of hip pain that increases by walking and is peaks by the end of the day
and keeps her awake at night, also morning stiffness:
a) Osteoporosis
b) Osteoarthritis
c) Rh. Arthritis

78. Old patient with bilateral knee swelling, pain, normal ESR:
a) Gout
b) Osteoarthritis
c) RA

79. What is the initial management for a middle age patient newly diagnosed knee osteoarthritis.
a) Intra-articular corticosteroid.
b) Reduce weight
c) Exercise.
d) Strengthening of quadriceps muscle.

80. The useful exercise for osteoarthritis in old age to maintain muscle and bone:
a) Low resistance and high repetition weight training
b) Conditioning and low repetion weight training
c) Walking and weight exercise

81. Male patient present with swollen erythema, tender of left knee and right wrist, patient give history of
international travel before 2 month, aspiration of joint ravel, gram negative diplococcic, what is most
likely organism?
a) Neisseria gonorrhea
b) staphcoccus
c) streptococcus
82. Triad of heart block, uveitis and sacroiliitis, diagnosis:
a) Ankylosing Spondylitis
b) lumbar stenosis
c) multiple myeloma

83. Patient have urethritis now com with left knee, urethral swap positive
puss cell but negative for neisseria meningitides and chlamydia
a) RA
b) Reiter's disease
c) Gonococcal
 Reiter's arthritis : characteristic triad of symptoms: an inflammatory
arthritis of large joints, inflammation of the eyes in the form of
conjunctivitis or uveitis, and urethritis in men or cervicitis in women

84. Patient with Rheumatoid Arthritis he did an X-Ray for his fingers and show
permanent lesion that may lead to permanent dysfunction, what is the
underlying process?
a) Substance the secreted by synovial

85. What's correct regarding ankylosing spondylitis:

a) Upper lung fibrosis is known to occur (my answer, not sure).
b) Mostly happen after the age of 45 years.
c) Has +ve rheumatoid factor.
d) Joints of the hands & feet are affected.
e) Aortic incompetence occurs due to valvitis (or something like this).

86. Patient has HTN recurrent attack of gouts 3-4 per year , BUN and creatine are high ,
treatment :
a) Probenecid
b) allopurinol
c) indomethacin

87. Female came complaining of photosensitivity, malar rash, joint pain and
had RBCS in urine, what the diagnosis:
a) rheumatoid arthritis
b) lupus nephritis
c) gout
d) SLE

88. Patient with early rheumatoid arthritis, what is your management to

decrease the limitation of movement:
a) Do not use analgesics or steroids
b) Use DMARDs like methotrexate or antiTNF, hydroxychloroquine
 Explanation: RA usually requires lifelong treatment, including medications,
physical therapy, exercise, education, and possibly surgery. Early,
aggressive treatment for RA can delay joint destruction.
 MEDICATIONS: Disease modifying antirheumatic drugs (DMARDs): These
drugs are the first drugs usually tried in patients with RA. They are
prescribed in addition to rest, strengthening exercises, and anti-
inflammatory drugs.