A 40-year-old female presented with 1 year of bilateral symmetrical arthritis of hand joints, wrists, elbows and toes with morning stiffness lasting 4 hours. On examination, she had pallor and arthritis of involved joints but no deformities. The most likely diagnosis is rheumatoid arthritis (RA). RA is the best fitting diagnosis given the symmetrical polyarthritis and absence of features suggesting other diagnoses. A key diagnostic test for RA is anti-cyclic citrullinated peptide antibody (anti-CCP Ab) as it is highly specific for the disease. Normocytic normochromic anemia is an indicator of disease activity in RA. Soft tissue swelling but not bony ankylosis may be seen

1. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
RHEUMATOLOGY:
1. A 40 year old female patient C/O bilateral symmetrical arthritis of hand joints ,wrists
,elbows ,toes of one year duration, H/O morning stiffness 4 hrs. No H/O skin rash .
No H/O raynauds phenomenon
O/E:
Pallor ++ other GE unremarkable
Locomotor system ---arthritis of involved joints . no deformities
A. The most likely diagnosis is :
a. Scleroderma
b. RA
c. Behcets disease
d. CPPD
e. Gout
B. The most specific diagnostic test is:
a. Rheumatoid factor
b. ANA
c. Anti-cyclic citrullinated peptide AB
d. CRP level
e. Anti Ds DNA
C. The following are extra-articular manifestation of the disease except:
a. Carpel tunnel syndrome
b. Interstitial lung disease
c. Pleural effusion
d. Meneingoencephlitis
e. Sjogrens syndrome
D. All the following are indicators of disease activity except:
a. Normocytic normochromic anemia
b. Increased ESR
c. Increased s.amyloid level
d. Decreased s.albumin level
e. Thrombocytopenia
E. All of the followings are expected x-ary findings of hands except:
a. Soft tissue swelling
b. Juxtaarticular osteopenia
c. Erosions
d. New bone formation
e. ankylosis .
2. A 25 year old female patient with H/O polyarthritis of hand joints ,wrists ,elbows and
toes of 2 year duration. There was H/O photosensitive facial skin rash.
She is married with 2 kids and had 2 abortions
O/E:
Pallor ++ butter fly rash ++ diffuse alopecia
Pedal edema ++ BP 170/100
Systemic examination was unremarkable

2. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
A. The most likely diagnosis is :
a. RA
b. SLE
c. ASLERODERMA
d. DM
e. ACUTE GOUTY ARTHRITIS
B. All of the following investigations are expected to be positive except:
a. ANA
b. ANTI –DsDNA
c. Low C4 level
d. APL Ab
e. Anti –scl 70 AB
C. The following are systemic manifestation of the disease except:
a. Chorea
b. Transverse myelitis
c. Diffuse alveolar hemorrhage
d. Thrombocytosis
e. Libman schs endocarditis
D. The following are cutaneous specific lesions of the disease except:
a. Discoid lupus
b. Batter fly rash
c. SCLE
d. Heliotrope rash
E. Initial therapy include all the followings except:
a. Oral prednisolone
b. Hydroxyl chloroquine
c. Salazopyrine
d. Ca and vit D
e. ACE I
3. A 30 year old male patient C/O recurrent oral and genital ulcerations of one year
duration with H/O polyarthralgia.
a. The most likely diagnosis is
i. Ankylosing spondylitis
ii. Rheumatoid arthritis
iii. SLE
iv. Behcet disease
v. PSA
b. The most specific eye manifestation of the disease is :
i. Anterior uveitis
ii. Posterior uveitis
iii. Optic neuritis
iv. Scleritis
v. Conjunctivitis
c. The following are cutaneous manifestations of the disease except:
i. Erythema nodosum

3. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
ii. Acne like rash
iii. Pseudo folliculitis
iv. Pyoderma gangrenosum
v. Erythema marginatum
d. The following are clinical mainfestaions of the disease except:
i. Recurrent DVT
ii. Arterial aneurysm
iii. Sacroilitis
iv. Sicca syndrome
v. Ileocecal ulcerations
e. The following is expected lab findings:
i. RF
ii. ANA
iii. HLA B5
iv. ANTI—CCP AB
v. ANTI CENTROMERE AB
4. A 65 year old female patient C/O right sided hemicranial headache of 3 months
associated with attacks of decreased visual acuity on right eye.
she had H/O intermittent claudication in her LL with jaw claudication on mastication.
A. The most likely diagnosis is:
a. Takayausaus arteritis
b. PAN
c. WG
d. GCA
e. GCS
B. The disease is associated with all the following except:
a. Sudden blindness
b. Pulmonary fibrosis
c. Increased alkaline phosphatase
d. Increased IgA level
e. PMR
C. The most helpful diagnostic test is:
a. Temporal artery USS
b. Temporal artery angiography
c. Temporal artery biopsy
d. CT brain
e. MRA
D. Initial investigations will reveal all of the following except:
a. N.N. anemia
b. Increased ESR
c. Increased CRP
d. Increased CK MM
E. Initial management should include :
a. Oral methotrexate 15mg/wk
b. Oral prednisolone 1mg/kg/d

4. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
c. I.V. cyclophosphamide pulse therapy
d. Cyclosporine
e. Azathioprine
5. A 40 year old female patient with H/O raynuds phenomenion of 4 years duration .
She gave H/O thickness of skin of hands and face.
O/E: mask face , multiuple telengectasia ,peaked nose ,sclerodactly
A. The most likely diagnosis is:
a. Systemic sclerosis
b. RA
c. MCTD
d. SLE
e. PM/DM
B. renal involvement characterized by all of the following except:
a. daily increase in serum creatinine
b. increased serum rennin level
c. microangipathic hemolytic anemia
d. increased blood pressure
e. urinanalysis---RBCs and WBCs casts
C. the following are common pulmonary manifestation except:
a. IDL
b. Pleurisy
c. PAH
d. Bronchalveolar ca,
e. Massive pleural effusion
D. The most important poor prognostic sign is:
a. ILD
b. Raynauds phenomenon
c. Renal involvement
d. PAH
e. CNS involvement
E. Drug of choice in treatment of renal involvement is:
a. Oral prednisolone
b. Plasmaphresis
c. IVIG
d. ACE –I
6. A 20 year old male patient C/O low back pain of 2 years duration. The pain increased
with rest and deceased with activity. It is associated with morning stiffness of 2 HR.
No H/O peripheral arthritis ,no H/O skin rash
O/E:
Pallor +++ , General examination ---NAD
Tenderness both sacroiliac joints
Restriction of lumbar spine flexsion
A. The most likely diagnosis is:
a. PSA
b. Reactive arthritis

5. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
c. Enteropathic arthritis
d. BD
e. Primary AS
B. Radiological features of the disease include all except:
a. Sacroilitis
b. Squaring of vertebrae
c. Sydesmophytes
d. Bamboo spine
e. Erosive arthritis
C. Extraarticular manifestation include all except:
a. Apical pulmonary fibrosis
b. Anterior uveitis
c. Caude equine syndrome
d. Secondary amyliodosis
e. Sicca syndrome
D. Management of choice is:
a. NSAIDS + TNT blockers
b. Methotrexate
c. Salazopyrine
d. Oral prednisolone
7. A 60 year male patient known to have HTN on atenolol & hydroxyl chlorothiazide
,aspririn 75mg/d. presented with sudden onset of swelling and pain on his right knee
joint after high protein dinner and drinking alcohol .No H/O fever or trauma. .H e
have similar history before 3 attacks.
O/E:
Temp 37.5 , BP 160/90
Right knee hot swollen and tender
A. The most likely diagnosis is:
a. septic arthritis
b. acute gouty arthritis
c. Hemochromatosis
d. TB
e.SLE
B. The most appropriate investigation to confirm the diagnosis :
a. X ray right knee
b. Blood culture
c. USS
d. MRI knee
e. Joint aspiration
C. The following are clinical manifestation except:
a. Nephrolithium
b. ARF
c. CRF
d. Punched out erosions on x ray
e. Hypercalcemia

6. By PROF M.ABDSALAM UPLOADED BY DR MAGDI SASI 2013
E. The following are associated diseased except:
a. HTN
b. DM
c. Hyperlibidemia
d. Hyperthyroid
e. Cardiomyopathy