1- A26-year-old woman develops a red rash over her cheeks and pain, and swelling in both wrists as well
as several small joints in her hands. The rash gets worse on sun exposure and involves her cheeks, nose,
ears, and chin. Medical evaluation reveals oral ulceration and 3+ proteinuria. Which of the following is
the most specific test for diagnosis of this condition?
(A) lupus erythematosus (LE) cells
(B) antinuclear antibody (ANA)
(C) anti-Sm antibody*
(D) anti-Ro antibody
(E) antiphospholipid antibody
2- A young woman presents with a facial rash,
arthralgias, and fatigue. The rash on her face is erythematous and raised, her heart and lungs
are normal, and wrists are swollen and tender on palpation. She has mild thrombocytopenia
(90,000/mL). Which of the following is the most appropriate initial autoantibody test?
(A) anti-double-stranded (ds) deoxyribonucleic acid (DNA)
(B) anti-Sm
(C) anti-Ro or La
(D) ANA*
(E) antiphospholipid antibodies
(lupus anticoagulant)
3- A 57-year-old woman is complaining of frequent headaches and scalp tenderness. She also has
arthralgias, fatigue, and discomfort in her jaw when she chews. On examination, her head and neck is
normal, but the right temporal artery is tender on palpation. Her erythrocyte sedimentation rate (ESR) is
50 mm/h and hemoglobin 10.5 g/dL. A temporal artery biopsy is obtained for diagnostic confirmation.
Which of the following is the most appropriate next step in management?
(A) intravenous high-dose steroids
(B) acetylsalicylic acid
(C) indomethacin
(D) low-dose (prednisone 40 mg/day)steroids by mouth*
(E) topical steroid creams
4- A63-year-old man develops pain and swelling in his knee. It appears warm, red, and swollen with
decreased range of movement. A diagnostic aspiration is performed. Which of the following will most
likely distinguish pseudogout from gout?
(A) positive birefringent crystals*
(B) acute onset
(C) involvement of single joints
(D) involvement of large joints
(E) association with diabetes
5- A54-year-old woman with rheumatoid arthritis (RA) presents with fatigue and low white count (white
blood cells [WBC] 2500/mL) on routine blood work. She has no active joint symptoms and her RA is
controlled on low dose methotrexate and NSAIDs. On examination, she has chronic joint deformities of
her hands and a palpable spleen, which is a new finding. Which of the following is the most likely
diagnosis for her low white count?
(A) methotrexate therapy
(B) rheumatoid nodules disrupting bone marrow architecture
(C) Felty’s syndrome*
(D) normal variation
(E) myelofibrosis
6- A75-year-old woman has abrupt onset of soreness, and severe stiffness of the shoulders and upper
thighs with low grade fever. Physical examination is entirely normal, but ESR is over
100 mm/h. Which of the following is the most likely diagnosis?
(A) takayasau arteritis
(B) temporal arteritis
(C) polymyalgia rheumatica*
(D) rheumatoid arthritis
(E) systemic lupus erythematosus
7- A 27-year-old man has a history of low back pain and stiffness. After several months of mild
symptoms, he notes more severe stiffness at night and hip pain. He has 5 oral ulcers per year. On
physical examination, there is paravertebral muscle tenderness and
limited flexion of the lumbar spine. X-ray of the lumbar spine was normal. In addition
to recommending physiotherapy and exercise, which of the following is the most appropriate next step
in management?
(A) diclofenac sodium*
(B) phenylbutazone
(C) azathioprine
(D) acetaminophen
(E) prednisone
8- A 24-year-old woman notices pain in her left arm, made worse with use. She also has fatigue, fever,
night sweats, and arthralgias. On examination, there are no palpable lymph nodes, and the joints and
muscle strength are normal. The left radial pulse is absent, and there is a bruit over the left subclavian
and common carotid arteries. Preliminary laboratory investigations reveal an elevated ESR and mild
anemia. Which of the following vascular findings is most likely to be found in her?
(A) high pressure in the legs and low pressure in the arms*
(B) low pressure in the legs and high pressure in the arms
(C) high-pitched diastolic murmur
(D) a relentless course to death
(E) hypotension
9- A 34-year-old woman develops a red rash over her cheeks, frequent oral ulcers, and pain and swelling
in both wrists as well as in several small joints in her hands. Medical evaluation reveals a positive ANA,
and 3+ proteinuria. Which of the following organ involvement will cause the most symptoms during the
course of this disease?
(A) central nervous system pathology
(B) cardiopulmonary pathology
(C) musculoskeletal pathology
(D) thrombotic events
(E) renal pathology*
10- A 29-year-old woman develops painful swelling of both hands of one month duration. She is also
very stiff in the morning. Physical examination reveals involvement of the proximal interphalangeal
joints and metacarpophalangeal (MCP) joints. Her RF is positive and ANA is negative. Which of the
following medications is most likely to improve her joint pain symptoms?
(A) D-penicillamine
(B) an antimalarial
(C) methotrexate
(D) NSAID or aspirin*
(E) gold
11- A 27-year-old man has a history of low back pain and stiffness. Recently, he has noticed more severe
stiffness at night and hip pain. The symptoms improve in the morning after doing some “stretching”
exercises. On physical examination, there is paravertebral muscle and sacroiliac joint tenderness with
limited flexion of the lumbar spine. A2/6 diastolic murmur is also heard at the left sternal border
radiating to the apex. Which of the following is the most likely diagnosis for the diastolic murmur?
(A) mitral stenosis
(B) tricuspid stenosis
(C) aortic insufficiency*
(D) pulmonic insufficiency
(E) tetralogy of Fallot
12- A77-year-old woman presents with a swollen, painful right knee. She fell on the knee 3 days ago
while hurrying up the stairs. On examination, there is a swollen knee with palpable effusion and
decreased range of motion. A diagnostic tap is preformed and 5 cc of opaque fluid is removed. The WBC
count is 6,000/mL 50% PMNs), glucose is lower than plasma, viscosity is low, and the LDH is high.This
synovial fluid analysis is compatible with:
(A) normal synovial fluid
(B) noninflammatory effusion
(C) inflammatory effusion*
(D) septic arthritis
(E) hemorrhagic effusion