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MODULE > MODULE 3: MS SYSTEM > Flashcards

MODULE 3: MS SYSTEM Flashcards

1
Q

Autoimmune disease characterized by widespread damage of small blood vessels with perivascular fibrosis of the skin and other organs

A. RA
B. MCT
C. SLE
D. Scleroderma

A

D. Scleroderma

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2
Q

Which of the factors is the pivotal inflammatory mediator in gouty arthritis?

A. TNF
B. IL-6
C. IL-1
D. COX2

A

C. IL-1

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3
Q

This criteria will rule out an autoimmune etiology of a particular disease

A. Evidence that such disease is not secondary to tissue damage but the presence of antibodies
B. The absence of another well-defined cause of the disease
C. The presence of bacterial growth on blood culture
D. The presence of an immune reaction specific for some self-antigen

A

C. The presence of bacterial growth on blood culture

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4
Q

The following are events occurring in OA, EXCEPT

A. Pro-inflammatory microenvironment stimulates the expression of 11β-HSD1
B. Innate immune activation contributes to OA progression
C. Cartilage damage is driven by age and biochemical related mechanisms
D. Cellular senescence releases SASP which triggers joint inflammation

A

A. Pro-inflammatory microenvironment stimulates the expression of 11β-HSD1

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5
Q

In the pathophysiology of RA,

A. rheumatoid nodule show central area of fibrinoid necrosis
B. there is proliferation of blood vessels induced by hypoxia, chemokines in synovium
C. bone erosion is usually adjacent to cartilage-pannus junction
D. there is infiltration of synovium by neutrophils

A

A. rheumatoid nodule show central area of fibrinoid necrosis

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6
Q

Which of the following statements regarding the pathogenesis of rheumatoid arthritis is FALSE?

A. FLSs, which are normal residents of the synovium, proliferate and change their phenotype in the setting of RA
B. Altered MLSs invade the cartilage of the joint
C. In the setting of RA, the inflammatory response is not terminated following clearance of the pathogen but rather
remains chronically activated
D. Hyperactive osteoclasts are abundant in the RA microenvironment

A

A. FLSs, which are normal residents of the synovium, proliferate and change their phenotype in the setting of RA

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7
Q

If reactive T-cells re-escapes peripheral activation, this mechanism will take place by converting a potentially harmful
immune response to a lesser one by antigen-specific exclusion between cell-mediated and humoral immunity?

A. Secretion of immunosuppressive cytokines
B. Immune deviation
C. Converting tissues through a phenomenon called immune privilege
D. Regulatory T cell activation

A

B. Immune deviation

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8
Q

Cartilage damage in OA results from the following, EXCEPT

A. increased expression of endogenous 11β-HSD1 with age
B. endogenous 11β-HSD1 expression and local endogenous GC activity are increased in the joint
C. effects of endogenous GC signaling in both osteoblasts and chondrocytes has destructive effects in OA
D. phenotype switch in macrophage-like synoviocytes

A

D. phenotype switch in macrophage-like synoviocytes

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9
Q

Which of the following statements regarding features of RA is most accurate?

A. There is an increased incidence of RA in HLA-DRB1 individuals who smoke cigarettes
B. Destruction of both cartilaginous and bony elements of the joint with resulting pain and disability
C. Characterized by dysregulated inflammatory processes in the cartilage of the joint
D. Initiation of RA result from an interaction among genetic susceptibility, environmental triggers, and chance

A

D. Initiation of RA result from an interaction among genetic susceptibility, environmental triggers, and chance

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10
Q

The process wherein immature B cells activate the machinery of antigen-receptor gene rearrangement and begin to express new antigen receptors in the bone marrow, not specific for self-antigens

A. Non-selection
B. Positive selection
C. Deletion
D. Receptor editing

A

D. Receptor editing

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11
Q

Autoimmune disease common in patients showing xerostomia and keratoconjunctivitis

A. Mixed connective tissue disease
B. Sjorgen syndrome
C. RA
D. SLE

A

B. Sjorgen syndrome

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12
Q

Chronic inflammatory disease commonly affecting joints ad may be systemic affecting most organs?

A. SLE
B. Sjorgen syndrome
C. Mixed connective tissue disease
D. Rheumatoid arthritis

A

D. Rheumatoid arthritis

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13
Q

The following are true of gouty arthritis, EXCEPT

A. tophus results from prolonged accumulation of MSU crystals
B. neutrophils release proinflammatory cytokines that perpetuate gouty arthritis inflammatory process
C. osteoclasts produced locally within tophi result in progressive bone erosion
D. MSU crystals are phagocytosed by neutrophils

A

C. osteoclasts produced locally within tophi result in progressive bone erosion

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14
Q

A process where B lymphocytes that recognize self-antigens may be rendered functionally unresponsive due to
binding with monovalent antigens?

A. Immune complex rearrangement
B. Beta selection
C. Anergy
D. Deletion

A

C. Anergy

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15
Q

In osteoarthritis (OA), alarmins secreted by joint cells promote the following events EXCEPT

A. pannus formation
B. angiogenesis
C. osteophyte formation
D. cartilage matrix catabolism

A

B. angiogenesis

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16
Q

A phenomenon where immature T lymphocytes die by apoptosis once it encounters and strongly binds self antigen in the thymus during development?

A. Positive selection
B. Non-selection
C. Negative selection
D. Beta selection

A

C. Negative selection

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17
Q

Autoantibody against the following antigenic sites that is most specific for SLE

A. Double stranded DNA
B. Ro (SS-A)/La (SS-B) nucleoproteins
C. U1-RNP
D. Phospholipid protein complex

A

A. Double stranded DNA

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18
Q

In the pathophysiology of rheumatoid arthritis (RA), the following are TRUE, EXCEPT

A. the interior of the inflamed synovium is hypoxic
B. T cells play an active role in the pathophysiology of RA
C. synovitis occurs as a consequence of neutrophilic infiltration into the synovium
D. systemic autoantibody production precedes
inflammation

A

A. the interior of the inflamed synovium is hypoxic

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19
Q

The following contribute to pannus formation, EXCEPT

A. FLSs/MLSs induces production of the inflammatory cytokines
B. Production of IL-17A stimulates fibroblast-like synoviocytes (FLSs) and macrophage-like synoviocytes (MLSs)
C. Cell-mediated adaptive immunity plays an integral role in pannus formation
D. Inflammatory lymphocytes, plasma cells, macrophages make up the cellular population

A

D. Inflammatory lymphocytes, plasma cells, macrophages make up the cellular population

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20
Q

Lacrimal and salivary gland enlargement due to lymphoma associated with Sjorgen syndrome

A. Mikulicz syndrome
B. HELLP syndrome
C. Raynaud’s phenomenon
D. Sicca syndrome

A

A. Mikulicz syndrome

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21
Q

Based on the WHO classification, how will you interpret a BMD test result of -2.0?

A. Normal
B. Osteopenia
C. Severe osteoporosis
D. Osteoporosis

A

B. Osteopenia

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22
Q

Four patients were waiting in the clinic with their BMD results. Based on the 2020 AACE guideline, which of the following results is osteoporosis considered?

A. T-score of -1.0 to -2.5 with low FRAX fracture probability
B. High trauma spine or hip fracture regardless of bone mineral density
C. T-score of -2.5 or below, in the lumbar spine, femoral neck, tibial proximal femur or 1/3 radius
D. T-score -1.0 to -2.5 without fragility fracture of proximal humerus, pelvis, or distal forearm

A

C. T-score of -2.5 or below, in the lumbar spine, femoral neck, tibial proximal femur or 1/3 radius

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23
Q

Which of the following is considered as a systemic autoimmune disease?

A. Autoimmune hemolytic anemia
B. Sjorgen’s syndrome
C. Autoimmune polyglandular syndrome
D. Acute rheumatic fever

A

B. Sjorgen’s syndrome

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24
Q

Which among the following patients is Bone Mineral Density testing indicated?

A. Women in menopausal transition regardless of clinical risk factors for fracture
B. In men aged 70 years old and above regardless of clinical risk factors
C. Women after age 50 years old l regardless of clinical risk factors
D. Adults with low bone mass and a fracture at age 30

A

B. In men aged 70 years old and above regardless of clinical risk factors

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25
Q

Which of the following is TRUE of systemic autoimmune diseases?

A. The most common cause of FUO (fever of unknown origin) are autoimmune diseases
B. Most are caused by mutations in genes controlling inflammatory pathways that result in overactivation and consequent tissue injury
C. Most diseases often share overlapping patterns of autoantibodies
D. Most laboratory tests directly related to the pathogenesis and are therefore diagnostic

A

C. Most diseases often share overlapping patterns of autoantibodies

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26
Q

Which of the following tests is recommended tool to use to stratify risk for osteoporosis in the absence of central DXA?

A. Spine Radiograph
B. Osteoporosis Screening Tool for Asians
C. Peripheral DXA
D. Osteoporosis Screening Tool for the Aged

A

B. Osteoporosis Screening Tool for Asians

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27
Q

Which of the following is a T-cell mediated autoimmune disease?

A. Pemphigus vulgaris Antibody
B. Rheumatoid arthritis
C. Type 2 diabetes mellitus
D. Systemic lupus erythematosus

A

B. Rheumatoid arthritis

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28
Q

Which of the following best defines a successful treatment of osteoporosis?

A. Evidence of two fragility fractures while on therapy
B. Significant increases in bone formation markers as pharmacologic response to antiresorptive therapy
C. Bone turnover markers at or below the median value for premenopausal women as a target for response to antiresorptive therapy
D. Stable or increasing bone mineral density regardless of evidence of new fractures

A

C. Bone turnover markers at or below the median value for premenopausal women as a target for response to antiresorptive therapy

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29
Q

Which of the following systemic manifestations seen in autoimmune diseases is correctly matched?

A. Keratoconjunctivitis sicca – Behcet’s syndrome
B. Deep vein thrombosis – Antiphospholipid syndrome
C. Raynaud’s phenomenon- Rheumatoid arthritis
D. Gottron’s papule – Systemic sclerosis

A

C. Raynaud’s phenomenon- Rheumatoid arthritis

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30
Q

In a patient suspected with a systemic autoimmune disease, which of the following tests would be most beneficial in
the diagnosis?

A. ANA
B. ESR and CNP
C. Biopsy
D. No specific test

A
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31
Q

A 45-year-old patient complains of progressive dyspnea and hoarseness of voice for 3 months. Preliminary ultrasound of the neck showed a solitary thyroid nodule on the left lobe. Thyroid panel was within normal limits however FNAB of the nodule revealed the histopathologic findings consistent with medullary thyroid carcinoma. As the attending physician, which of the following markers will you determine to confirm the diagnosis?

A. CA125
B. Calcitonin
C. PTH
D. Thyroglobulin

A

B. Calcitonin

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32
Q

Which of the following manifestations of SLE warrants treatment with high-dose glucocorticoids?

A. Class IV lupus nephritis
B. Class I lupus nephritis
C. CNS lupus
D. Discoid lupus erythematosus

A

A. Class IV lupus nephritis

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33
Q

Which of the following mechanisms related to estrogen deficiency would result in a permanent decrement in bone
mass?

A. Indirect modification estrogen metabolism
B. Genetic alteration
C. Remodeling imbalance between bone formation and resorption
D. Change in activation frequency of new bone remodeling sites

A

C. Remodeling imbalance between bone formation and resorption

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34
Q

Which of the following is an X-linked disorder of vitamin D metabolism responsive to treatment with large doses of
vitamin D?

A. Hypophosphatemic vitamin D-resistant rickets
B. CKD-MBD (renal rickets)
C. Vitamin D-dependent rickets (VDDR-1/PDDR)
D. HVDDR (vitamin D-dependent rickets type II)

A

A. Hypophosphatemic vitamin D-resistant rickets

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35
Q

Osteoporosis is best managed by prevention. One of the best prevention strategies is the supplementation of dietary
calcium. As a 21-year-old medical student, what will be the recommended daily allowance for calcium intake for you?

A. 260 mg
B. 600 mg
C. 1200 mg
D. 1000 mg

A

D. 1000 mg

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36
Q

A 60-year-old male patient consulted a doctor because of his osteoarthritis. Previous medical history revealed the
patient had a previous heart attack. Which of the following medications poses an increased risk for another heart attack?

A. Celecoxib
B. Oxycodone
C. Acetaminophen
D. Tramadol

A

A. Celecoxib

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37
Q

The likelihood of extra-articular manifestation in RA is increased in which of the following settings?

A. Involvement of 3 or more joints
B. History of smoking
C. Family history of RA
D. Longer episodes of morning stiffness

A

B. History of smoking

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38
Q

According to Philippine Rheumatology Association Guidelines, management of intercritical gout and chronic tophaceous gout include

A. ideally maintaining the serum uric acid levels at 0.36 mmol/L
B. loose stools during chloride treatment must be managed with prompt discontinuation of drug and initiation of
symptomatic treatment for diarrhea
C. gout flare effectively resolved and prevented by the drug indomethacin
D. lowering the uric acid to its ideal level is achieved using once daily colchicine 0.6 mg

A

A. ideally maintaining the serum uric acid levels at 0.36 mmol/L

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39
Q

Which of the following conditions present with decreased uric acid secretions?

A. Partial HGPRT deficiency
B. Lesch-Nyhan syndrome
C. Chronic renal disease
D. Leukemia

A

C. Chronic renal disease

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40
Q

Which of the following hypocalcemic hormones is produced by the thyroid parafollicular cells?

A. CTR
B. Calcitonin
C. FGF19
D. FGF23

A

B. Calcitonin

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41
Q

Aside from renal failure, which of the following is one of the leading causes of mortality in the first decade of SLE
patients?

A. Cardiovascular disease
B. Vascular thromboembolism
C. Infections
D. Interstitial lung disease

A

C. Infections

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42
Q

Which of the following statements about diagnostic tests utilized for acute/chronic arthritis is true?

A. Leukocyte and abundance of MSU crystals produce thick and pasty effusion
B. Needle-shaped MSU crystals are often seen in areas not actually involved
C. Characteristic radiologic findings shows double contour sign in one articular cartilage
D. Arthrocentesis has lesser benefit in gout especially in between attacks

A

A. Leukocyte and abundance of MSU crystals produce thick and pasty effusion

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43
Q

Which of the following associations with autoantibodies of SLE are correctly matched?

A. Anti-Ro : drug-induced lupus
B. Anti-Sm : specific for SLE
C. Anti-dsDNA : best screening test
D. Anti-ribosomal P : CNS lupus

A

B. Anti-Sm : specific for SLE

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44
Q

Which of the following constitutes a clinical manifestation of systemic lupus erythematosus?

A. Waxy crystals on urinalysis
B. Megaloblastic anemia
C. Mononeuritis
D. Neutropenia

A

C. Mononeuritis

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45
Q

Which cytokine has been firmly implicated in the pathogenesis of RA?

A. TNF
B. RANKL
C. IL-1
D. IFN-y

A

A. TNF

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46
Q

Choose the reason why probenecid is useful in treating gout

A. Enhance renal excretion of uric acid
B. Increases reabsorption of uric acid
C. Decreases uric acid clearance from the blood
D. Dissolves uric acid crystals

A

A. Enhance renal excretion of uric acid

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47
Q

Which of the following is the most common cause of hypercalcemia among the outpatient setting?

A. Vitamin D excess
B. Adrenocortical deficiency
C. Primary hyperparathyroidism
D. Hyperthyroidism

A

C. Primary hyperparathyroidism

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48
Q

Second year medical residents are giving health lectures on acute arthritis in Alubijid. A question was raised on what specific location is most commonly affected with this condition. Based on the patient’s experience the most commonly affected location is

A. radiocarpal joint
B. talocrural joint
C. calcaneus
D. knee

A
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49
Q

Which of the following is the major factor regulating parathyroid hormone secretion?

A. Organic phosphate
B. Calcium
C. Calcitriol
D. Phosphorus

A

B. Calcium

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50
Q

Most common cause of hypercalcemia among outpatients

A. Primary hyperparathyroidism
B. Immobilization
C. Systemic malignancy
D. Paget disease

A

A. Primary hyperparathyroidism

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51
Q

Virginia is in her third trimester of pregnancy. She has muscle pain and asks for a safe OTC pain reliever. Which of the following would be the best choice?

A. Paracetamol (Biogesic)
B. Aspirin (Aspilet)
C. Ibuprofen (Advil)
D. Mefenamic acid (Dolfenal)

A

A. Paracetamol (Biogesic)

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52
Q

Pain that is usually felt by a person in the later stage of osteoarthritis may be due to

A. loss of cartilage integrity with neurovascular invasion
B. capsular stretching and joint effusion
C. synovial inflammation
D. microcracks and bone marrow edema

A

A. loss of cartilage integrity with neurovascular invasion

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53
Q

Which of the following is the regulator of intestinal phosphate absorption?

A. Intracellular volume
B. Acid-base status
C. Estriol
D. VEGF

A

B. Acid-base status

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54
Q

Which of the following would best differentiate lupus arthritis from rheumatoid arthritis?

A. Absence of erosions
B. Normal acute phase reactant levels
C. Absence of inflammation
D. Sparing of hand joint

A
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55
Q

A glycoprotein required for bone mineralization and is used as a marker for new bone formation

A. Osteoprotegerin
B. Osteopontin
C. Osteocalcin
D. Osteonectin

A

C. Osteocalcin

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56
Q

In osteoarthritis, which of these joints is not affected because it is unyielding to loading stresses?

A. Ankle
B. 1st MTP
C. Knee
D. Elbow

A

A. Ankle

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57
Q

Which of the following features of subacute cutaneous lupus erythematosus is most accurate?

A. Most common SLE rash
B. Have antibodies to Ro
C. May involve the ears, chin, V region of the neck and upper back
D. Presents as roughly circular with slightly scaled, scaly hyperpigmented erythematous rims and depigmented atrophic centers

A

B. Have antibodies to Ro

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58
Q

Identify the physical ramifications of the excessive use of acetaminophen

A. The excessive use of acetaminophen causes a reduction in blood supply and oxygen to localized areas of the body or tissue
B. The excessive use of acetaminophen causes metabolites of the drug to bind to tissue groups in kidney and liver, causing hepatotoxicity
C. The excessive use of acetaminophen causes inflammation of the joints accompanied by elevated body temperature, which leads to rheumatic fever
D. None of these choices are correct

A

B. The excessive use of acetaminophen causes metabolites of the drug to bind to tissue groups in kidney and liver, causing hepatotoxicity

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59
Q

_____ fractures are the most common early consequences of estrogen deficiency.

A. Forearm
B. Proximal humerus
C. Vertebral
D. Femoral neck

A

C. Vertebral

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60
Q

Which of the following statements about COX-2 inhibitors are TRUE?

A. NSAIDs and COX-2 inhibitor drugs do not promote sodium and water retention
B. COX-2 inhibitors do not have anti thrombotic (clot prevention) protective action as aspirin and other COX-1 inhibitors because platelets are predominant
C. Selective COX-2 inhibitors exhibit potentially less serious cardiac or renal adverse effects than do other NSAIDs
D. All of the options are correct

A

B. COX-2 inhibitors do not have anti thrombotic (clot prevention) protective action as aspirin and other COX-1 inhibitors because platelets are predominant

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61
Q

Why do aspirin-sensitive patients substitute aspirin with acetaminophen to relieve pain?

A. Acetaminophen does not produce GI irritation or ulceration in therapeutic doses
B. Acetaminophen does not affect platelet aggregation
C. Acetaminophen does not affect prothrombin response
D. All of the choices are correct

A

D. All of the choices are correct

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62
Q

A 26-year-old female was involved in a two-wheel motor vehicle accident in which she was the driver. She was conscious but complains of pain on the left side of her chest, 9/10 in severity aggravated by respiratory movement. Which of the following statements is correct regarding a special technique to identify a fractured rib?

A. Gently squeeze the chest and note for deformities in the rib area
B. The test involves application of anteroposterior compression of the chest
C. Pain on the thoracic spine suggest multiple rib fractures
D. The examiner’s one hand should be positioned on the anterior abdomen and the other on the thoracic spine

A

B. The test involves application of anteroposterior compression of the chest

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63
Q

Select a true statement related to the treatment of gout with febuxostat

A. Febuxostat is metabolized by the kidney and excreted by the liver
B. Febuxostat is used for the management of hyperuricemia in patients with gout
C. Febuxostat is the first selective xanthine oxidase inhibitor that is not a purine analog
D. Administration of febuxostat with food and antacid affects the absorption of febuxostat

A

C. Febuxostat is the first selective xanthine oxidase inhibitor that is not a purine analog

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64
Q

Which of the following is the most common neurologic manifestation of SLE?

A. Stroke
B. Seizure
C. Cognitive disorder
D. Headache

A

C. Cognitive disorder

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65
Q

A patient presents with symptoms of dysmenorrhea. Which of the following OTC medications can be used to treat this patient’s condition?

A. Propranolol
B. Prednisone
C. Mefenamic acid
D. Morphine

A

C. Mefenamic acid

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66
Q

A 56-year-old female, known case of breast adenocarcinoma stage IIIA. right, came in for follow-up due to intense pain at the lower back. Subsequent work-up by the oncologist revealed finding consistent with bone metastasis and was advised treatment with a bisphosphonate. Which of the following statements is TRUE with regards the administration of the drug?

A. Its effects are decreased by calcium supplements, antacids, and iron
B. Clearance of bisphosphonate is primarily hepatic
C. It is not recommended for patients with creatinine clearance less than 60 ml/min
D. Oral bisphosphonates have increased bioavailability

A

A. Its effects are decreased by calcium supplements, antacids, and iron

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67
Q

Which of the following statements regarding the regulation of calcium and phosphate by calcitriol is true?

A. Calcitriol facilitates absorption of calcium and phosphate in large intestine
B. Increase calcium renal excretion
C. Calcium inhibits mobilization of calcium from bone
D. Decrease calcium renal excretion

A

D. Decrease calcium renal excretion

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68
Q

What is the specific mechanism of action of bisphosphonate?

A. Promote osteoblastic activity by increasing number of osteoblast in bones
B. Impair osteoblastic function and decrease number by inducing apoptosis of osteoclasts
C. Promote vitamin D absorption in the skin
D. Allow more dietary calcium in the intestinal mucosa

A

B. Impair osteoblastic function and decrease number by inducing apoptosis of osteoclasts

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69
Q

Which of the following regulatory effects is observed when parathyroid hormone is suppressed in response to increase
in plasma calcium levels?

A. Decrease in tubular Ca2+ reabsorption
B. Decrease in renal phosphate reabsorption
C. Increase in calcitriol
D. Increase in intestinal Ca2+ reabsorption

A

A. Decrease in tubular Ca2+ reabsorption

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70
Q

Which among these osteoarthritis risk factors increases the vulnerability of the joint?

A. BMI of 36 kg/m2
B. 55-year-old female (age, gender)
C. Dietary insufficient of calcium and vitamin D
D. Basketball player who underwent arthroscopic meniscectomy following torn meniscus cartilage

A

D. Basketball player who underwent arthroscopic meniscectomy following torn meniscus cartilage

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71
Q

Which of the following describes swan neck deformity?

A. Hyperextension of the PIP joint with flexion of the DIP joint
B. Flexion of the PIP joint with hyperextension of the DIP joint
C. Subluxation of the first MCP joint with hyperextension of the PIP joint
D. Hyperflexion of the PIP joint with extension of the DIP joint

A

A. Hyperextension of the PIP joint with flexion of the DIP joint

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72
Q

A 31-year-old female presents with hematuria, oliguria, neutropenia, and elevated creatinine. Renal biopsy revealed
focal nephritis. Which of the following statements is true regarding this case?

A. The presence of only one clinical and one
immunologic manifestations is enough to confirm the diagnosis of SLE
B. The patient did not fulfill 4 manifestations of SLICC criteria, SLE is unlikely
C. The patient did not fulfill the 4 manifestations of SLICC criteria however, the renal biopsy confirms the diagnosis of SLE
D. The patient fulfilled the 4 manifestations, SLE is confirmed

A

A. The presence of only one clinical and one immunologic manifestations is enough to confirm the diagnosis of SLE

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73
Q

In patients with life-threatening SLE, which of the following drugs would be LEAST useful as an add-on to high doses of glucocorticoids?

A. Methotrexate
B. Cyclophosphamide
C. Azathioprine
D. Mycophenolate mofetil

A

C. Azathioprine

74
Q

Which of the following is correct regarding the clinical manifestations of RA?

A. Large joints are often affected at presentation
B. Most commonly affected joints in established disease are the DIP, PIP, and wrist joints
C. Early in the course of the disease, the ankle and the metatarsal region of the feet are affected
D. Majority of the patients have persistent and progressive disease that waxes and wanes in intensity over time

A

D. Majority of the patients have persistent and progressive disease that waxes and wanes in intensity over time

75
Q

Which of the following NSAIDs is commercially available for parenteral administration to induce closure of the atrial opening in premature infants with patent ductus arteriosus?

A. Mefenamic acid
B. Ketorolac
C. Celecoxib
D. Ibuprofen

A

D. Ibuprofen

76
Q

The following are contributory to the conversion of asymmetric hyperuricemia to gout, EXCEPT

A. Chronic alcoholic beverage drinker
B. BMI is 29
C. Hypertensive person…
D. 45-year-old male with elevated blood uric acid since 2015

A
77
Q

A 23-year-old female is evaluated during a follow-up visit for SLE. She was diagnosed 6 months ago and now presents with malar rash and arthritis. Which of the following should be the mainstay of her treatment?

A. Cyclophosphamide
B. Methylprednisolone
C. Hydroxychloroquine
D. Methotrexate

A
78
Q

A 70-year-old woman was diagnosed with Osteoporosis. What could be in this patient’s fracture risk assessment that Teriparatide is considered rather than Alendronate, Risedronate and Zoledronate?

A. Recent Fracture within the past 24 months
B. No history of injurious falls
C. No history of fractures while on medication with long-term glucocorticoids
D. Very low T-score less than -3.0

A

D. Very low T-score less than -3.0

79
Q

Which of the following statements is TRUE in patients with Connective Tissue Disease?

A. Laboratory tests will determine treatment options
B. Laboratory tests will identify risk factors
C. Laboratory tests will establish and rule out the diagnosis
D. Laboratory tests will determine disease activities alone

A

C. Laboratory tests will establish and rule out the diagnosis

80
Q

A 36-year-old female complains of back pain radiating to the back of her right leg. She has taken the week off from work as a dance choreographer but wants to go back as soon as possible. Which among the following is the best course of management for the patient?

A. Rest for another week, consider surgery if symptoms worsen
B. Gradual return to usual physical activities and prescribe NSAIDS
C. Take high dose oral glucocorticoids for five days with rapid tapering off for a week
D. Gradual return to usual physical activities, prescribe opioid analgesics

A

B. Gradual return to usual physical activities and prescribe NSAIDS

81
Q

Rheumatoid arthritis is a chronic inflammatory disease of unknown etiology characterized by a symmetric polyarthritis. Which of the following is TRUE regarding its epidemiology?

A. It affects 10-15% of the adult population worldwide
B. RA among the Latin American and African countries show an even greater predominance of disease in males compared to females, with ratios of 6–8:1
C. Its incidence increases between 25 and 55 years of age, after which it plateaus until the age of 75 and then decreases
D. It occurs more commonly in males than in females, with a 2–3:1 ratio

A

C. Its incidence increases between 25 and 55 years of age, after which it plateaus until the age of 75 and then decreases

82
Q

In the pathogenesis of Rheumatoid Arthritis, The T cells produce cytokines that stimulate other inflammatory cells to effect tissue injury. The most firmly implicated in the pathogenesis of RA is:

A. IL-γ
B. RANKL
C. TNF
D. TH 2

A

C. TNF

83
Q

Which medication for Osteoporosis should not be given for those who have high risk for Hip fracture?

A. Teriparatide
B. Risedronate
C. Zoledronic Acid
D. Alendronate

A

A. Teriparatide

84
Q

In patients with chronic low back pain suspected of radiculopathy, which of the following procedures/studies may be requested to detect nerve injury?

A. Bone morphogenetic protein
B. EMG/NCS
C. Computed tomography
D. Magnetic resonance imaging

A

B. EMG/NCS

85
Q

Dr. Zue is practicing as an Internist in a remote town of Bukidnon where most of his patients were elderly. There is no central Dual Xray Absorptiometry available in the local setting. To stratify risk of these patients for osteoporosis:

A. Use of Osteoporosis Screening Tool for Asians is recommended
B. Ultrasound is a good alternative
C. Single Xray Absorptiometry can be used
D. Spine Radiograph is recommended

A

A. Use of Osteoporosis Screening Tool for Asians is recommended

86
Q

New strategies in the management of Rheumatoid Arthritis keeps evolving as new information comes to light. Which of the following treatment goals is CORRECT?

A. Early, aggressive therapy to correct joint damage and disability
B. Frequent modification of therapy with utilization of combination therapy where appropriate
C. Achieving, whenever possible, cure of the disease
D. Strict compliance to protocol to achieve desired response

A

B. Frequent modification of therapy with utilization of combination therapy where appropriate

87
Q

A 65-year-old woman was diagnosed with osteoporosis following complaints of recurrent falls. Fragility fracture was noted in the distal forearm. Which of the following anabolic agents is FDA-approved for this
case?

A. Teriparatide
B. Abaloparatide
C. Romosozumab
D. Alendronate

A

A. Teriparatide

88
Q

Which of the following is LEAST useful in the evaluation of secondary causes of osteoporosis?

A. Corrected calcium
B. 25-OH Vitamin D
C. Spot urine calcium/creatinine ratio
D. Complete blood count

A

D. Complete blood count

89
Q

Sheena, 21 years old female, known with SLE since she was 19 years old, stopped her medications for 3 months already due to financial constraints. She developed a flare presenting with shortness of breath, chest pain, polyarthralgia and seizure warranting treatment with 1g Intravenous Methylprednisolone for 3 days followed by 60mg of daily prednisone and was also started with Mycophenolate mofetil. At day 3 of hospitalization, there was no recurrence of seizure for more than 48hrs already. Patient no longer complained of shortness of breath and chest pain. She insists on going home as soon as possible. Which of the following is the next appropriate step for this patient?

A. Consider Belilumab or Rituximab
B. Taper dose of Mycophenolate Mofetil and Prednisone to as low as 5mg per day
C. Discontinue glucocorticoids and advise patient for conservative management
D. Taper prednisone to 5mg/day and discontinue Mycophenolate Mofetil

A

B. Taper dose of Mycophenolate Mofetil and Prednisone to as low as 5mg per day

90
Q

What antibody is frequently seen in drug induced SLE?

A. ANA
B. Anti-Sm
C. Anti-RNP
D. Anti-histone

A

D. Anti-histone

91
Q

KS, a 35-year-old woman diagnosed with Rheumatoid Arthritis received treatment for persistent moderate disease activity. After a few sessions, she developed fevers, night sweats and occasional cough. Chest Xray is highly suggestive of tuberculosis. Which of the following agents was given to KS?

A. Abatacept
B. Etanercept
C. Tofacitinib
D. Rituximab

A

B. Etanercept

92
Q

Patient X.Y.Z. was on oral Alendronate for 5 years now. Recent BMD showed T-score of -1.0 from -2.5. And patient remained fracture free during treatment. What is the next recommended step?

A. Continue treatment to an additional 2 years
B. Consider Bisphosphonate Holiday at this time
C. Consider Bisphosphonate Holiday after 6 to 10 years more
D. Consider shifting to another antiresorptive therapy

A

B. Consider Bisphosphonate Holiday at this time

93
Q

Patient C.T.X., a 53-year-old woman is diagnosed with Osteoporosis. Her mother notably died due to Breast Cancer. Which medication is beneficial for this patient?

A. Raloxifene
B. Alendronate
C. Ibandronate
D. Denosumab

A

A. Raloxifene

94
Q

Which of the following test is specific for lupus with renal involvement?

A. Anti-dsDNA
B. Anti-Sm
C. C3
D. ANA

A

A. Anti-dsDNA

95
Q

What is the mainstay of treatment in patients with CTD/SLE?

A. Glucocorticosteroid
B. Azathioprine
C. Methotrexate
D. Hydroxychloroquine

A

A. Glucocorticosteroid

96
Q

What is the DMARD of first choice for the treatment of early Rheumatoid Arthritis?

A. Tocilizumab
B. Methotrexate
C. Leflunomide
D. Sulfasalazine

A

B. Methotrexate

97
Q

A 39 year old woman presented to the hospital with a 3-month history of generalized weakness and significant weight loss of 40 lbs over the past 2 months; there were bald patches on the scalp and facial rash. She reported progressive dyspnea for the past 2 weeks.
Pertinent findings are as follows:
BP: 130/80 mm/Hg. HR: 103 bpm, RR: 24cpm, Oxygen saturation: 92%; Lab results revealed anemia, leukopenia, elevated blood urea nitrogen, and elevated creatinine (3.26mg/dl). Urinalysis showed 2+ proteinuria and RBC casts.
Serological work-up: high anti-nuclear antibody, anti-double stranded DNA antibody, and anti-Smith antibody
titers. Which of the following is appropriate for this case?

A. Belimumab
B. Renal Replacement Therapy
C. Systemic Glucocorticoids
D. Prednisone 10mg

A

C. Systemic Glucocorticoids

98
Q

Which of the following is TRUE regarding osteoporosis-related fractures?

A. Women have a lifetime risk of 50% by the time they are 50 years old
B. Osteoporosis-related fractures are adulthood fractures of any bone that occur in the setting of trauma less than or equal to a fall from standing height
C. Osteoporosis-related fractures do not often affect the hips and vertebrae
D. Men have a lifetime risk of only 30% by the time they are 50 years old

A

A. Women have a lifetime risk of 50% by the time they are 50 years old

99
Q

Three-day course of methylprednisolone sodium succinate for severe SLE should be:

A. 5g IV once a day
B. 1g IV once a day
C. 0.5g IV three times
D. 1g IV four times

A

B. 1g IV once a day

100
Q

Which of the following is the most common cause of death in patients with Rheumatoid Arthritis?

A. Ischemic heart disease
B. Infection
C. Pneumonia
D. Hepatitis

A

A. Ischemic heart disease

101
Q

Joan, 20 years old female, who was admitted 3 months ago due to SLE flare, was advised to follow-up with her attending physician. To monitor response to therapy, this laboratory test can be included upon follow-up:

A. Anti-Sm Antibody
B. Anti-Ro
C. C3
D. ANA

A

C. C3

102
Q

How is excessive alcohol intake associated with increased fracture risk?

A. Negative effect on bone resorption
B. Acute liver injury
C. Predisposition to fall
D. Increased metabolism of endogenous estrogen

A

C. Predisposition to fall

103
Q

In postmenopausal women, criteria for Diagnosis of Osteoporosis include:

A. Regardless of T-score, there is presence of lowtrauma spine or hip fracture
B. T-score of + 2.5
C. T-score between -1.0 and -2.5 and a fragility fracture of the distal humerus
D. T-score between -1.0 and -2.5 with low FRAX fracture probability

A

A. Regardless of T-score, there is presence of lowtrauma spine or hip fracture

104
Q

Which of the following is a requirement for a disorder to be considered as caused by autoimmunity?

A. Presence of self-antigen that mimics a foreign body
B. Dysfunctional innate immune response
C. Absence of another well-defined cause of disease
D. Evidence of an immune reaction secondary to tissue damage

A

C. Absence of another well-defined cause of disease

105
Q

Which of the following tests will establish the diagnosis of SLE?

A. Low C3
B. ANA
C. Anti-Sm
D. Elevated ESR

A

C. Anti-Sm

106
Q

Which of the following is factors at the time of diagnosis is associated with poor prognosis (~50% mortality in 10 years) in most cases of lupus?

A. Female
B. Serum Albumin of 4g/L
C. Hemoglobin less than 124 g/L
D. Nephrotic syndrome (24h urine protein excretion less than 2.6 g)

A

C. Hemoglobin less than 124 g/L

107
Q

What is the central immunologic disturbance in SLE?

A. Immune complex deposition
B. Immune system regulation abnormality
C. Autoantibody production
D. Loss of self-tolerance

A

A. Immune complex deposition

108
Q

Which of the following best describes anergy?

A. TNF-induced cell death
B. Antigen sequestration
C. Unresponsive auto-reactive lymphocytes
D. Death of auto-reactive lymphocytes

A

C. Unresponsive auto-reactive lymphocytes

109
Q

Patient M.B.P. 66 years old female, who was diagnosed with Osteoporosis, suffered reflux gastritis and could not tolerate oral medications. What antiresorptive agent can be given to this patient?

A. Risedronate
B. Raloxifene
C. Zoledronic acid
D. Alendronate

A

C. Zoledronic acid

110
Q

The most frequent cardiac manifestation of SLE is:

A. Pericarditis
B. Myocarditis
C. Embolic Events
D. Endocarditis

A

A. Pericarditis

111
Q

A morbidly obese male patient was brought to the emergency room for severe pain on his lower back that radiates to both his soles, posterior calves, posterior thighs and buttocks. Pain was noted to gradually increase in severity for the past 5 days, which was not relieved by his pain medications. Knowing the areas of pain distribution, which specific lumbosacral nerve root is most likely affected?

A. L4
B. L3
C. S1
D. L5

A

C. S1

112
Q

Which of the following immunologic aberrations contribute to the development of SLE?

A. Defective central and/or peripheral tolerance involving B cells
B. Nuclear DNA and RNA-induced cell cytotoxicity
C. TNF-mediated CD4+ helper T cell survival
D. Toll-like receptor engagement by bacterial antigens activate B lymphocytes

A

A. Defective central and/or peripheral tolerance involving B cells

113
Q

Which of the following most likely has SLE?

A. 34-year-old male with febrile episodes associated with seizure, thrombocytopenia, and anemia
B. 35-year-old female presents with butterfly rash on face, with iron deficiency anemia of 10mg/dl, dizziness and episodes of vomiting
C. 37-year-old female noted with lupus nephritis on renal biopsy
D. A young male with noted positive RF, symmetrical joint pains, anemia and pleural effusion

A

C. 37-year-old female noted with lupus nephritis on renal biopsy

114
Q

A 35-year-old female presents with anemia, joint pains, proteinuria and episodes of elevated BP, positive for anti-dsDNA. Which of the following features will strengthen the diagnosis of SLE for this case?

A. Symmetrical joint pains
B. Negative Coombs test
C. Elevated serum creatinine
D. Positive ANA

A

C. Elevated serum creatinine

115
Q

Which serum bone turn-over marker is appropriate in a patient taking medications for osteoporosis and has chronic kidney disease?

A. Osteocalcin
B. Carboxy-terminal propeptide of type-1 collagen
C. C-terminal telopeptide type-1 collagen
D. Bone specific alkaline phosphatase

A

D. Bone specific alkaline phosphatase

116
Q

A 60-year-old female complains of low back pain. She has no history of trauma or fall. Palpation of the back revealed tenderness over the area of L4. Plain Xray of the area on flexion and extension showed movement at that spinal segment. Which of the following is the most likely cause in this case?

A. Lumbar disk disease
B. Lumbar stenosis
C. Spondylolisthesis
D. Spondylosis

A

C. Spondylolisthesis

117
Q

Laboratory tests serve to establish or rule out the diagnosis, to follow the course or disease, particularly to suggest that a flare is occurring, or organ damage is developing, and to identify adverse effects of therapies. Which of the following antibody tests would you recommend for a woman who have a history of 3 consecutive unexplained abortions and suspected of having an autoimmune disorder?

A. Antiphospholipid
B. Anti-Sm
C. Antiribosomal P
D. Anti-RNP

A

A. Antiphospholipid

118
Q

Which of the following is a characteristic feature of rheumatoid arthritis?

A. Inflammatory synovitis
B. Polyarthritis
C. Non-inflammatory synovitis
D. Rheumatoid nodules

A

A. Inflammatory synovitis

119
Q

Jovy, 33 years old female, with no known comorbidities, was brought to the ER due to chest pain associated with progressive shortness of breath over the past 2 months. She has oral ulcers, alopecia, arthralgia in both knees and both elbows, pallor and lower extremity edema. ECG 12L and cardiac markers were within normal. Chest xray showed bilateral pleural effusion and mild cardiomegaly. CBC showed wbc 2,000/uL, Hg 9g/dL, platelet 95,000/uL. Serum creatinine was 3.68mg/dL with 3+ proteinuria and 3+ hemoglobin in the urinalysis. ANA was requested and resulted to greater than the reference negative value.
Which of the following is the most appropriate initial management for this patient?

A. Low Glucocorticoids plus Belimumab
B. NSAIDS plus low-dose glucocorticoids
C. High-dose glucocorticoids plus Belimumab
D. High-dose glucocorticoids plus
Cyclophosphamide

A

D. High-dose glucocorticoids plus
Cyclophosphamide

120
Q

Which of the following is the most serious manifestation of SLE?

A. Cognitive dysfunction
B. Nephritis
C. Discoid Lupus erythematosus
D. Thrombocytopenia

A

B. Nephritis

121
Q

What is the most common manifestation in patients with CNS lupus?

A. Seizures
B. Headache
C. Cognitive dysfunction
D. Stroke

A

C. Cognitive dysfunction

122
Q

Which of the following is true regarding pathologic findings in SLE?

A. Pattern of vasculitis is specific and is diagnostic of SLE
B. Class V classification of lupus nephritis refers to >90% of glomeruli globally sclerosed without residual activity
C. Biopsy of clinically unaffected skin shows normal pathology
D. Lymph node biopsies show nonspecific chronic inflammation

A

D. Lymph node biopsies show nonspecific chronic inflammation

123
Q

Which of the following is considered a major process in the pathogenesis of Rheumatoid Arthritis?

A. TLR engagement by nuclear DNA and RNA
contained in immune complexes may activate B lymphocytes
B. UV irradiation may induce apoptosis in cells and may alter the DNA in such a way that it becomes immunogenic
C. Sclerosis/fibrosis with irreversible tissue damage can occur in multiple tissues including kidneys, lungs, blood vessels, and skin
D. CCPs are produced during inflammation creating new epitopes that trigger autoimmune reactions

A

D. CCPs are produced during inflammation creating new epitopes that trigger autoimmune reactions

124
Q

What is the most common drug that will have lupus-like symptoms?

A. Hydralazine
B. Pyrazinamide
C. Rifampicin
D. Amlodipine

A

A. Hydralazine

125
Q

What is the most common cause of pulmonary infiltrates in patients with lupus?

A. TB
B. Infection
C. Congestion
D. Pleural effusion

A

D. Pleural effusion

126
Q

Zyra, 65 years old woman, who presented with a fragility fracture, was advised to have bone mineral test. If her T-score result was – 2.5, it would be classified as:

A. Normal
B. Severe Osteoporosis
C. Osteoporosis
D. Osteopenia

A

B. Severe Osteoporosis

127
Q

A pannus is mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblasts that grows over the articular cartilage and causes its erosion. The characteristic histologic features include:

A. Osteoblasts are activated activity in underlying bone, allowing the synovium disperse
B. Synovial cell hypoplasia and apoptosis
C. Decreased vascularity due to apoptosis
D. Dense inflammatory infiltrates (frequently forming lymphoid follicles) of CD4+ helper T cells, B cells, plasma cells, dendritic cells, and macrophages

A

D. Dense inflammatory infiltrates (frequently forming lymphoid follicles) of CD4+ helper T cells, B cells, plasma cells, dendritic cells, and macrophages

128
Q

Highly selective COX-2 inhibitors are anti-inflammatory drugs with fewer GI side effects compared to traditional non-selective COX inhibitors, such as aspirin. What other effect do COX-2 inhibitors lack, in contrast to aspirin?

A. Analgesic
B. Antipyretic
C. Antiplatelet
D. Anti-inflammatory

A

C. Antiplatelet

129
Q

Among which of the following patients is the administration of Teriparatide avoided?

A. 62/M, with serum Alkaline phosphatase: 92 IU/L
B. 52/M, with serum LDH: 160 U/L
C. 33/F, diagnosed with Invasive Ductal Carcinoma Stage IV, S/P radiation therapy for bone metastasis
D. 44/F with bilateral knee pain, Xray done revealed (+) osteophyte

A

C. 33/F, diagnosed with Invasive Ductal Carcinoma Stage IV, S/P radiation therapy for bone metastasis

130
Q

Which of the following NSAIDs can be used once a day because of its long half-life?

A. Mefenamic acid
B. Ibuprofen
C. Piroxicam
D. Paracetamol

A

C. Piroxicam

131
Q

A 52-year old female, known case of Invasive Ductal Carcinoma Stage IV with bone metastasis, came in for routine administration of bisphosphonates at the Oncology Treatment Center. She recently has been complaining of burning epigastric pain associated with occasional vomiting. As the Oncology resident rotator, what will you advise the patient? Choose the best answer.

A. Send patient home and advise to rest and observe symptoms.
B. Take oral Alendronate instead of parenteral administration.
C. Request for serum creatinine and BUN.
D. Start IV infusion with Pamidronate immediately to alleviate symptoms.

A

C. Request for serum creatinine and BUN.

132
Q

Which of the following statements is TRUE regarding the hormone calcitonin?

A. It is produced by the parathyroid follicular cells.
B. It acts through the CTR.
C. It is a hypercalcemic hormone whose actions generally stimulate those of PTH
D. It is the most potent peptide inhibitor of osteoblast mediated bone resorption.

A

B. It acts through the CTR.

133
Q

Which of the following values of serum calcitonin is expected in a 35-year old male diagnosed with thyroid C cell hyperplasia?

A. Greater than 10 pg/mL
B. Greater than 15 pg/mL
C. Lesser than 12 pg/mL
D. Lesser than 10 pg/mL

A

B. Greater than 15 pg/mL

134
Q

Your 10-yo neighbor is running a fever of 39 C after developing a cold. To help him feel better you tell the mother to go to the local pharmacy to buy a fever-lowering medication. However, as a medical student, you recall that there are warnings about the risk of drug-induced Reye’s syndrome in children given the wrong type of NSAID. Which NSAID is associated with this potentially serious condition?

A. Aspirin
B. Mefenamic acid
C. Celecoxib
D. Acetaminophen

A

A. Aspirin

135
Q

In which of the following conditions should calcimimetics be used with caution.

A. Serum Ca2+ 8.5 mg/dL
B. CKD, on Calcium carbonate 1 tab TID
C. Serum PTH 180 pg/mL
D. Post-stroke seizure, on Phenytoin 100 mg

A

D. Post-stroke seizure, on Phenytoin 100 mg

136
Q

. A 42-year old male, diagnosed with Non-Hodgkin’s Lymphoma, S/P Chemoradiation x 3 cycles, came in for consult due to anorexia, nausea and vomiting for 2 days already associated with fatigue. Initial laboratory work-up was done which revealed the following results:
BUN 35 mg/dL, Crea 1.7 mg/dL, Na+ 136 mEq/L, K+ 3.4 mEq/L, Ca2+ 10.2 mg/dL, Albumin 2.0 mg/dL. What is the patient’s corrected total calcium level?

A. 11.8 mg/dL
B. 13.8 mg/dL
C. 12.2 mg/dL
D. 10.5 mg/dL

A

A. 11.8 mg/dL

137
Q

What uricosuric agent should be taken while still on XO inhibitor therapy due to risk of kidney damage if used alone?

A. Probenecid
B. Lesinurad
C. Allopurinol
D. Febuxostat

A

B. Lesinurad

138
Q

A 64-year old male, known case of Chronic Kidney Disease Stage V sec to DM Nephropathy, on routine hemodialysis 2x/week, was rushed to the ER due to persistent spasms of the upper extremities then progressed to generalized tonic-clonic seizures, 2 episodes, lasting for 1 min. He apparently missed his sessions of hemodialysis for the past two weeks due to financial constraints. Patient was examined at the ER in post-ictal state, BP 200/100 mmHg, HR 120 bpm, RR 28 cpm, O2 sat 92%. CBG taken: 114 mg/dL. STAT blood chem results as follows:
BUN 104 mg/dL, Crea 6.8 mg/dL, Na 129 meq/L, K 7.1 meq/L, BUA 9 mg/dL,
Ca2+ 5.8 mg/dL. Which of the following emergent medications should be given?

A. Calcium chloride 10% 1 amp IM
B. Calcium gluceptate 22%, 10 mL 1 amp SQ
C. Calcium gluconate 10% 1 amp IV
D. Calcium carbonate 1 tab TID

A

C. Calcium gluconate 10% 1 amp IV

139
Q

Which NSAID is a potent COX inhibitor that inhibits PMN motility, but is avoided because it also causes hallucinations and severe headache?

A. Diclofenac
B. Indomethacin
C. Ketorolac
D. Ibuprofen

A

B. Indomethacin

140
Q

Which of the following statements is TRUE regarding calcitriol and its physiologic functions and mechanism of action?

A. Calcitriol downregulates the synthesis of FGF23.
B. Calcitriol enhances intestinal Ca2+ absorption via passive extrusion across serosal plasma membranes
C. The actions of calcitriol are mediated by the nuclear receptor VDR.
D. It acts dependently together with PTH to enhance bone resorption.

A

C. The actions of calcitriol are mediated by the nuclear receptor VDR.

141
Q

Which of the following does NOT correctly describe arachidonic acid?

A. It is formed from dietary linoleic acid.
B. It contains 20 carbons and 4 double bonds.
C. It is a saturated, essential fatty acid.
D. It is considered the most abundant eicosanoid in the body.

A

C. It is a saturated, essential fatty acid.

142
Q

A patient is brought to you at the ER. The patient is a 63-yo alcoholic with a history of ulcers for 5 years.
Twelve hours prior, patient had onset of back pain, for which he self-medicated with 5 times the recommended daily dose of an over-the-counter pain reliever. Soon afterwards he developed a severe
episode of nausea and vomiting. After extracting the patient’s history, your ER consultant draws blood samples for drug analysis and administers N-acetyl cysteine 140 mg/kg orally to prevent further toxicity.
What analgesic did the patient most likely take to cause this problem?

A. Celecoxib
B. Mefenamic acid
C. Aspirin
D. Paracetamol

A

D. Paracetamol

143
Q

Which of the following statements is TRUE regarding bisphosphonates?

A. Excretion of bisphosphonates is primarily hepatic.
B. Oral bisphosphonates should be given with a full glass of water following an overnight fast.
C. They are not recommended for patients with Crea Clearance of less than 60 mL/min
D. The bioavailability of bisphosphonates is enhanced by calcium supplements.

A

B. Oral bisphosphonates should be given with a full glass of water following an overnight fast.

144
Q

What nonpurine inhibitor is used in gout but is not recommended for asymptomatic hyperuricemia?

A. Oxypurinol
B. Allopurinol
C. Febuxostat
D. Probenecid

A

C. Febuxostat

145
Q

The following statements regarding FGF23 are true EXCEPT

A. Suppresses intestinal phosphate absorption
B. It is a member of the FGF19 family found in osteocytes
C. Decreases the metabolism of Vitamin D to inactive forms
D. It has a phosphaturic action mediated by FGFR1c

A

C. Decreases the metabolism of Vitamin D to inactive forms

146
Q

The most acceptable reason why the self-antigens of the brain tissues and testes fails to elicit an immune response?

A. Self-antigens of these tissues are sequestered and less exposed to the blood and lymph
B. Available immunosuppressive cytokines are always present in these organs
C. Regulatory cells are always activated in these areas
D. T-helper cells do not activate the humoral response in these privilege sites

A

A. Self-antigens of these tissues are sequestered and less exposed to the blood and lymph

147
Q

Polymorphism of NOD 2 genes will likely result to this kind of disease?

A. Crohn’s disease
B. MCTD
C. SLE
D. Scleroderma

A

A. Crohn’s disease

148
Q

A 25 y.o. female patient presented with joint pains, malar rashes that is prominent of sun exposure and with several oral ulcers. Hemogram reveals anemia and leukopenia. What diagnostic modality would you ask to confirm your impression of this autoimmune disease?

A. Do an Anti-nuclear antibody test using patient’s serum
B. Request for liver profile examination
C. Test for Ro/SS-A and La/SS-B by immunofluorescence
D. Ask for renal function test

A

A. Do an Anti-nuclear antibody test using patient’s serum

149
Q

Select the joint usually spared in osteoarthritis:

A. Hip
B. Cervical spine
C. Ankle
D. Distal interphalangeal joint

A

C. Ankle

150
Q

The process wherein developing immature B- cells reactivate the machinery of antigen receptor gene rearrangement and begin to express new antigen receptors in the bone marrow, not specific for self-antigens?

A. Deletion
B. Receptor editing
C. Non-selection
D. Positive selection

A

B. Receptor editing

151
Q

Raynaud Phenomenon is a sign of mixed connective tissue disease (MCDT). This
pathophysiologic/etiologic basis rules out MCDT?

A. Vasospasms
B. Turn the hand into white or blue
C. Most commonly seen in the hands and feet
D. Symptoms occur on heat exposure

A

D. Symptoms occur on heat exposure

152
Q

Mr. Lee presented with pain and swelling of right wrist joint and right knee joint. Based on the extent or distribution it is classified as:

A. Non articular
B. Pauci-articular
C. Polyarticular
D. Monoarticular

A

B. Pauci-articular

153
Q

A process where B- lymphocytes that recognize self-antigens may be rendered functionally unresponsive due to binding with monovalent antigens:

A. Anergy
B. Immune complex rearrangement
C. Beta selection
D. Deletion

A

A. Anergy

154
Q

This criterion will rule out an autoimmune etiology of a particular disease:

A. The presence of bacterial growth on blood culture
B. Evidence that such disease is not secondary to tissue damage but the presence of autoantibodies
C. The absence of another well-defined cause of the disease
D. The presence of an immune reaction specific for some self-antigen

A

A. The presence of bacterial growth on blood culture

155
Q

A 72-year-old male patient presents with worsening pain in his left wrist with activity and he notices a crunching sensation when he flexes his knee. His clinical examination reveals mild tenderness at the wrist joint. His synovial fluid aspirated from the knee joint reveals clear fluid with a white cell count of 800/mm3. What is the most specific radiographic marker for this disease?

A. Cyst
B. Subchondral sclerosis
C. Joint space narrowing
D. Osteophyte

A

D. Osteophyte

156
Q

A synovial fluid specimen is noted to be turbid with a WBC count of 2500//L-polymorphonuclear cell predominate. Crystals seen are birefringent. Which of the following is the most likely source of this specimen?

A. Gout
B. Rheumatoid arthritis
C. Pseudogout
D. Septic arthritis

A

C. Pseudogout

157
Q

A phenomenon where immature T-lymphocytes die by apotosis once it encounters and strongly binds self-antigen in the thymus during development?

A. Negative selection
B. Non-selection
C. Positive selection
D. Beta selection

A

A. Negative selection

158
Q

Which of the following is the LEAST likely source of pain in a patient with osteoarthritis?

A. Muscles
B. Cartilage
C. Joint capsule
D. Subchondral bone

A

B. Cartilage

159
Q

If reactive T-cells re-escapes peripheral inactivation, this mechanism will take place by converting a potentially harmful immune response to a lesser one by antigen-specific exclusion between cell-mediated and humoral immunity?

A. Converting tissues through a phenomenon called immune privilege
B. Immune deviation
C. Secretion of immunosuppressive cytokines
D. Regulatory T-cell activation

A

B. Immune deviation

160
Q

Albert, 41-year old/M, went to the OPD because of swollen left big toe. Four weeks prior there was pain in his left foot to the extent that he would limp when walking. Mefenamic acid 500mg tab OD as needed
afforded temporary relief. Three days ago, he had a drinking spree in his friend’s birthday party. What is the next ideal thing to do for this patient?

A. Perform xray of left toe
B. Request for serum uric acid
C. Do needle aspiration on his left big toe
D. Prescribe patient with allopurinol

A

C. Do needle aspiration on his left big toe

161
Q

Why are current diagnostic tests utilize serologic assays rather than using the conventional immunofluorescence studies?

A. The florescence test is very expensive
B. Due to interobserver variability in most immunofluorescence studies
C. Very difficult to obtain test samples
D. The florescent reagents are unstable

A

B. Due to interobserver variability in most
immunofluorescence studies

162
Q

Which of the following describes the morphologic changes in osteoarthritis?

A. Sclerosis of the underlying cancellous bone
B. Osteophytes develop at the margins of articular surfaces capped only by fibrocartilage
C. Chondrocytes forming clusters called cloning during the late stages
D. Vertically arranged type II collagen are cleaved

A

A. Sclerosis of the underlying cancellous bone

163
Q

Autoimmune disease common in patients showing xerostomia and keratoconjuctivitis:

A. SLE
B. RA
C. Mixed connective tissue disease
D. Sjogren syndrome

A

D. Sjogren syndrome

164
Q

A 45-year-old female with a 4-year history of arthritis presents with symmetrical joint pain in both hands.
Examination reveals the presence of hard nodules around the distal interphalangeal joints. What is the term for these swellings?

A. Heberden nodules
B. Bouchard nodules
C. Rheumatoid nodules
D. Osler nodes

A

A. Heberden nodules

165
Q

A 61-year old taxi driver complains of bilateral hand pain after driving the whole day. He experiences morning stiffness on both hands that lasts 20-30 minutes. Bony enlargement on the DIP and PIP joints are noted. Which of the following are least likely affected in his case?

A. Hip, knee and ankle
B. Wrist, elbow and knee
C. Wrist, elbow and ankle
D. Cervical and lumbosacral spine

A

C. Wrist, elbow and ankle

166
Q

A 74-year-old female with pain both of her knees presents to the clinic. The pain is worst with prolonged ambulation, and there are noticeable effusions in the infrapatellar bursae bilaterally. Radiographs show she has progressive osteoarthritis. To best assess the function of a patient with arthritis, when should the evaluation be done?

A. First thing in the morning
B. During the afternoon
C. First thing in the morning and again in the afternoon
D. At the end of the day

A

C. First thing in the morning and again in the afternoon

167
Q

A senior citizen with arthritis suffers a massive stroke and dies. At autopsy, the proximal phalangeal joint tissue shows pannus, synovial cell hyperplasia. Which of the following best describes the pathogenesis of pannus formation in this patient?

A. Chronic inflammation of synovium
B. Granulation-reactive fibrovascular tissue
C. Degeneration of cartilage
D. Synovial cell proliferation

A

A. Chronic inflammation of synovium

168
Q

The type of necrosis commonly seen in most autoimmune diseases affecting walls of blood vessels:

A. Coagulation necrosis
B. Caseation necrosis
C. Fibrinoid necrosis
D. Liquefactive necrosis

A

C. Fibrinoid necrosis

169
Q

A physician examining the affected joint noted that the range of motion during passive movement exceeded that of active motion. Which of the following features will this physician most likely to elicit?

A. Crepitation
B. Deep pain
C. Locking
D. Point tenderness in the adjacent areas

A

D. Point tenderness in the adjacent areas

170
Q

A 66-year-old woman presents with a 2-year history of bilateral hand pain and morning stiffness that lasts about 15 minutes. On examination, bony enlargement of the proximal and distal interphalangeal joints is noticed as well as squaring of the first carpometacarpal joint. There is no erythema, warmth, or swelling of the joints. X-ray of the hand reveals joint space narrowing and subchondral sclerosis of the distal and
proximal interphalangeal joints. Which of the following is the earliest finding seen under light microscopy in this condition?

A. Mononuclear cell infiltration
B. Angiogenesis
C. Chondral shredding
D. Synovial cell lining hypertrophy

A

C. Chondral shredding

171
Q

A 52 y.o. female is a known case of Sjogren syndrome. She was lost to follow-up for many years and currently presented with a huge submandibular mass with lymphadenopathies in other areas of the neck. Surgical intervention of the said mass was made. What is the most likely histopathologic findings of this
tumorous lesion?

A. Granulomatous inflammation
B. Salivary gland carcinoma
C. Non-Hodgkin lymphoma
D. Abscess with gram negative bacterial culture

A

C. Non-Hodgkin lymphoma

172
Q

This refers to the lack of immune responsiveness of an individual’s own antigen:

A. Self-tolerance
B. Deletion
C. Tissue tolerance
D. Barrier tolerance

A

A. Self-tolerance

173
Q

An 18 y.o. old female presented with butterfly facial skin rash with oral ulcers, joints pains with discoid skin rashes of sun exposure and seizures. In areas where there is limited access to diagnostic tests, what would you likely expect to see in the blood sample of this patient?

A. Presence of neutrophils and macrophages engulfing a globoid eosinophilic materials
B. Giant platelets and large red blood cells
C. Numerous lymphocytes and neutrophils
D. Presence of toxic granules in the cytoplasm of neutrophils

A

A. Presence of neutrophils and macrophages engulfing a globoid eosinophilic materials

174
Q

Autoantibody against the following antigenic sites that is most specific for SLE:

A. U1-RNP
B. Double stranded DNA
C. Ro(SS-A)/La(SS-B) nucleoproteins
D. Phospholipid protein complex

A

B. Double stranded DNA

175
Q

A 74-year-old female patient presents with increasing right hip pain over the last 2 months. She has no history of trauma or falls and it has decreased her mobility and made her more dependent on family. BP 130/90, PR 80, BMI 32 kg/m2. Clinical examination reveals palpable swellings on proximal interphalangeal joints of hands and painful restricted movements at the hip joint. Investigations reveal negative rheumatoid factor (RA) and anti-nuclear antibodies (ANA). Plain radiograph suggests a narrowing of joint space and cartilage erosions. What is the most common site of hand involved in this disease especially in postmenopausal women?

A. Wrist joint
B. Proximal interphalangeal joints
C. First carpometacarpal joint
D. Fifth carpometacarpal joint

A

C. First carpometacarpal joint

176
Q

Lacrimal and salivary gland enlargement due to lymphoma associated with Sjogren syndrome:

A. HELLP syndrome
B. Sicca syndrome
C. Raynauds phenomenon
D. Mikulicz syndrome

A

D. Mikulicz syndrome

177
Q

Which of the following are the pathognomonic hallmark of gout?

A. Urate crystals
B. Tophi
C. Heberden’s nodes
D. Boutonniere deformities

A

B. Tophi

178
Q

Which joint is most commonly affected in rheumatoid arthritis?

A. DIP
B. MTP
C. PIP
D. All these

A

C. PIP

179
Q

This best describes Rheumatoid arthritis in terms of its diagnostic modality:

A. Clinical signs and symptoms + ANA + rheumatoid factor
B. Clinical signs and symptoms + rheumatoid factor
C. Clinical symptoms and signs + Anti-CCP + rheumatoid factor
D. Clinical signs and symptoms + Anti-CCP

A

C. Clinical symptoms and signs + Anti-CCP + rheumatoid factor

180
Q

Which of the following is helpful in the evaluation of patients with Gouty Arthritis?

A. Gender
B. Acute onset
C. Elderly patient
D. Polyarticular

A

B. Acute onset

181
Q

Autoimmune disease characterized by widespread damage of small blood vessels with perivascular fibrosis of the skin and other organs?

A. RA
B. SLE
C. Scleroderma
D. MCTD

A

C. Scleroderma

182
Q

A person is said to have Systemic Lupus Erythematosus if he/she fulfills at least how many of the eleven criteria given by the American College of Rheumatology?

A. Three
B. Two
C. One
D. Four

A

D. Four

MODULE (9 decks)

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