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Rheumatology

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Which antibody is most specific for rheumatoid arthritis?

A. Anti-nuclear antibody (ANA)
B. Anti-citrullinated protein antibody (ACPA)
C. Rheumatoid factor (RF)
D. Anti-dsDNA
E. Anti-Smith

Select an answer

Explanation

ACPA is the most specific diagnostic marker for RA; RF is sensitive but less specific.

Click to see question

1 / 65

Which antibody is most specific for rheumatoid arthritis?

B

What is the primary target tissue in rheumatoid arthritis?

C

Which clinical feature is most characteristic of early rheumatoid arthritis?

D

Which extra-articular manifestation is commonly associated with seropositive RA?

C

What is the typical synovial fluid white blood cell count range in inflammatory arthritis like RA?

B

Which genetic allele is strongly associated with increased RA risk?

A

Which medication is first-line disease-modifying therapy for newly diagnosed RA?

A

Which pair best describes palindromic rheumatism?

D

Which complication of RA affects the cervical spine and can risk spinal cord compression?

A

Which lab finding correlates with disease activity in RA?

D

Which feature distinguishes spondyloarthritis (SpA) inflammatory back pain from mechanical back pain?

B

Which extra-articular manifestation is most commonly seen in SpA?

A

Which HLA type is strongly associated with axial spondyloarthritis?

C

Which clinical sign is typical in ankylosing spondylitis?

B

Which imaging modality is essential to detect early non-radiographic axial SpA?

D

Which feature characterizes peripheral spondyloarthritis?

E

Which medication class is first-line for symptomatic axial SpA?

A

Dactylitis (sausage digit) is most characteristic of which condition?

B

Which clinical test indicates sacroiliac joint tenderness?

C

Which of the following is the defining feature of osteoporosis?

A

What T-score on DEXA defines osteoporosis?

C

Which is the first-line pharmacologic treatment for osteoporosis?

A

Which risk factor most strongly predisposes to osteoporosis?

B

Which lab pattern suggests osteomalacia rather than osteoporosis?

D

Which childhood condition reflects defective mineralization of growth plates?

A

Which of the following lab values is markedly elevated in active rickets?

D

Which treatment is first-line for severe Paget disease of bone?

A

Which feature best differentiates osteomalacia from osteoporosis?

B

Which joint is LEAST commonly affected by primary osteoarthritis?

C

What is the typical pattern of pain in osteoarthritis?

A

Which physical finding is typical in hand osteoarthritis?

B

Which medication is NOT routinely recommended for osteoarthritis?

D

What percentage weight loss approximately reduces knee pain by ~50% in knee OA?

A

Which condition is associated with calcium pyrophosphate deposition (CPPD)?

C

Which red flag in low back pain history requires urgent evaluation?

B

Which presentation is classic for cauda equina syndrome?

B

When is imaging indicated for acute nonspecific low back pain?

B

Which test measures lumbar flexion mobility and is used in ankylosing spondylitis?

B

Which pharmacologic class has no proven benefit in acute low back pain and should generally be avoided?

C

What proportion of adults experience low back pain at some point in life?

A

What percentage of cervical rotation occurs at the atlantoaxial (C1-C2) joint?

B

Lhermitte’s sign indicates which pathology?

B

Which is the first-line pharmacologic treatment for acute neck pain?

C

Which finding differentiates cervical radiculopathy from myelopathy?

B

Which of the following increases fracture risk by about 50% in RA patients?

B

Which medication class is an example of a targeted synthetic DMARD used in RA?

D

Which sign is common in late-stage rheumatoid arthritis of the hands?

C

Which of the following is TRUE about ultrasound in RA?

A

Which of these is a typical extra-articular cardiac manifestation of RA?

D

Which clinical pattern best suggests inflammatory rather than mechanical back pain?

A

Which SpA subtype is most strongly linked with IBD?

C

Which finding on spine radiograph characterizes advanced ankylosing spondylitis?

E

Which lab test is positive in the majority of axial SpA but is not diagnostic alone?

C

Which management strategy is recommended for patients with chronic SpA?

B

p.1

Which of the following is TRUE about bisphosphonate therapy?

A) They are anabolic agents that build bone in all patients
B) First-line for Paget disease only
C) Contraindicated in osteoporosis
D) Bisphosphonates (e.g., alendronate) are first-line antiresorptives for osteoporosis
E) They are used only for osteomalacia

Answer: D — Bisphosphonates are first-line antiresorptive therapy for osteoporosis (and IV zoledronic acid is used in Paget disease)

p.1

Which of the following is a key nonpharmacologic therapy for OA and SpA?

A) Extended bed rest
B) Lifelong smoking
C) Targeted exercise and physical therapy
D) Immediate use of opioids
E) Zero weight-bearing activities
Answer: C — Exercise and physical therapy improve mobility, pain, and function.

p.1

Which imaging is most sensitive for early bone erosions in inflammatory arthritis?

A) Plain radiographs only
B) Ultrasound cannot detect erosions
C) CT is always preferred
D) MRI detects early erosions, synovitis, bone marrow edema
E) DEXA measures erosions
Answer: D — MRI is sensitive for early bone erosions, synovitis, and bone marrow edema.

p.1

Which of these is a major modifiable risk factor for developing or worsening RA and SpA outcomes?

A) High BMI only
B) Smoking
C) Low calcium intake only
D) Family history only
E) Young age
Answer: B — Smoking is a modifiable risk factor linked to RA risk/severity and worse outcomes in SpA.

p.1

Which antibody is the most specific diagnostic marker for RA?

A) RF

B) ANA

C) ACPA

D) Anti-dsDNA

E) Anti-Smith

Answer: C — ACPA is most specific (duplicate concept to reinforce).

p.1

What is the first-line pharmacologic treatment for osteoarthritis?

A) Opioids
B) Oral corticosteroids
C) Acetaminophen or NSAIDs
D) DMARDs
E) Bisphosphonates
Answer: C — Acetaminophen or NSAIDs are first-line; NSAIDs preferred for inflammatory pain.

p.1

Which management strategy is recommended for patients with chronic SpA?

A) Complete bed rest to protect spine

B) Lifelong exercise, posture training, smoking cessation

C) High‑dose systemic steroids long‑term

D) Avoid physical therapy in all cases

E) Immediate spinal fusion for all patients

Answer: B — Chronic SpA care: lifelong exercise, posture training, and smoking cessation.

p.1

Which finding on spine radiograph characterizes advanced ankylosing spondylitis?

A) Periarticular osteopenia only
B) Asymmetric joint space narrowing like RA
C) Multiple osteophytes at DIP joints
D) Looser zones
E) Syndesmophytes and “bamboo spine” from vertebral fusion
Answer: E — Syndesmophytes and fused vertebrae create the bamboo spine.

p.1

Which lab test is positive in the majority of axial SpA but is not diagnostic alone?

  1. A) RF
    B) ACPA
    C) HLA‑B27
    D) ANA
    E) Anti‑dsDNA
    Answer: C — HLA‑B27 is frequent in axial SpA but must be interpreted clinically.

p.1

Which SpA subtype is most strongly linked with IBD?

A) Ankylosing spondylitis (purely axial)
B) Psoriatic arthritis
C) IBD‑associated arthritis
D) Reactive arthritis exclusively
E) Juvenile idiopathic arthritis
Answer: C — IBD‑associated arthritis occurs with Crohn’s or ulcerative colitis.

p.1

Which clinical pattern best suggests inflammatory rather than mechanical back pain?

A) Onset <40 years, insidious, improves with exercise, night pain
B) Sudden pain after heavy lifting, no night pain
C) Pain limited to lumbar region only and relieved by rest
D) Pain proportional to activity and worsens with exercise
E) Immediate improvement with bed rest
Answer: A — Inflammatory back pain: age <45, insidious, improves with exercise, worse at night.

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