Rheumatology and Immunology — MCQs

A 30-year-old male patient presents with complaints of weakness in the right upper and both lower limbs for the last 4 months. He developed digital infarcts involving the 2nd and 3rd fingers on the right side and the 5th finger on the left side. On examination, BP was 160/140 mm Hg. All peripheral pulses were palpable, and there was asymmetrical neuropathy. Investigations showed Hb 12 gm%, TLC 12,000 per cu. mm, Platelets 4,30,000, and ESR 49 mm. Urine examination showed proteinuria and RBC 10-15/hpf with no casts. What is the most likely diagnosis?

A 58-year-old man has the sudden onset late one evening of severe pain in his left great toe. There is no history of trauma. On examination there is edema with erythema and pain on movement of the left 1st metatarsophalangeal joint, but there is no overlying skin ulceration. A joint aspirate is performed and on microscopic examination reveals numerous neutrophils. Over the next 3 weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility. Which of the following laboratory test findings is most characteristic for his underlying disease process?

A 40-year-old obese man presents with intense pain in his left first metatarsophalangeal (MTP) joint for the past few hours. He has no history of trauma, fever, chills, and no previous similar episode. He has no history of renal disease or diabetes, though he has been told he is "prediabetic." He does not recall any recent skin infections and no family members have had any reported staphylococcal infection. On examination, he has a swollen, red, warm, tender first MTP joint on the left. Uric acid level is 9 mg/dL; serum creatinine is normal. What is the best treatment approach for this patient?

A 22-year-old female Asian immigrant presents with complaints of malaise, fever, arm pain, loss of appetite, and visual problems. Her mother states that she fainted one week ago. The physician cannot palpate the patient's lower extremity pulses and notes that the radial pulses are weak. The erythrocyte sedimentation rate (ESR) is elevated. Which of the following is the most likely diagnosis?

A 27-year-old man presents with a history of low back pain and stiffness. After several months of mild symptoms, he experiences more severe stiffness at night and hip pain. Physical examination reveals paravertebral muscle tenderness and limited lumbar spine flexion. X-ray of the lumbar spine shows sacroiliitis. In addition to recommending physiotherapy and exercise, what is the most appropriate next step in management?

A 55-year-old man presented with pain and swelling of his right great toe. The pain has been present for approximately 2 days and is worsening. He had a similar episode 4 years ago, but has been symptom-free since then. He denied trauma, fever, chills, or sweats and has been afebrile. On physical examination, his right great toe is swollen at the metatarsophalangeal joint with decreased range of motion. X-ray films are unrevealing and there was no other joint involvement. A joint aspiration is performed. Which of the following types of crystals in the joint aspirate would confirm the likely diagnosis?

A 50-year-old female with rheumatoid arthritis is being considered for infliximab therapy. Which of the following tests should be performed before beginning treatment?

Involvement of the joints of the hand is relatively uncommon in which of the following arthritides?

A 65-year-old lady underwent mastectomy for carcinoma of the breast. Later, she developed frontal headache, pain in the temple region, and around the eye. Her ESR is 55 mm/hour. What is the most probable diagnosis?

All of the following statements about primary gouty arthritis are true, EXCEPT?