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10.

A patient with known peptic ulcer disease presents with sudden


abdominal pain to the emergency department. She is thought to have
peritonitis but refuses an abdominal examination due to the discomfort
caused by previous examinations. Which of the following maneuvers
will provide reasonably specific evidence of peritonitis without manual
palpation of the abdomen?
A. Bowel sounds are absent on auscultation.
B. Forced cough elicits abdominal pain.
C. Hyperactive bowel sounds are heard on auscultation.
D. Pain is elicited with gentle pressure at the costovertebralangle.
E. Rectal examination reveals heme-positive stools

11. A 45-year-old male says that for the last year he occasionally has
regurgitated particles from food eaten several days earlier. His wife
complains that his breath has been foul-smelling. He has had occasional
dysphagia for solid foods. The most likely diagnosis is
A. gastric outlet obstruction
B. scleroderma
C. achalasia
D. Zenker’s diverticulum
E. diabetic gastroparesis

12. Chronic active hepatitis is most reliably distinguishedfrom chronic


persistent hepatitis by the presence of
A. extrahepatic manifestations
B. hepatitis B surface antigen in the serum
C. antibody to hepatitis B core antigen in the serum
D. a significant titer of anti-smooth-muscle antibody
E. characteristic liver histology

13. All the following are causes of bloody diarrhea except


A. Campylobacter
B. Cryptosporidia
C. Escherichia coli
1
D. Entamoeba
E. Shigella

14. What is the most common cause of dysphagia?


A. Achalasia
B. Esophageal spasm
C. A lower esophageal ring (Schatzki ring)
D. Nonspecific motor disorders
E. An esophageal stricture

15. What is malignant dysphagia usually related to?


A. A squamous cell carcinoma related to Barret’s esophagus
B. An adenocarcinoma related to Barret’s esophagus
C. A squamous cell carcinoma unrelated to Barret’s esophagus
D. An adenocarcinoma unrelated to Barret’s esophagus
E. None of the above

16. What is the drug of choice in the treatment of achalasia?


A. A nitroglycerin derivative
B. A calcium channel blocker
C. A benzodiazepine
D. An antacid
E. Any of the above

17. Achalasia is characterized by which of the following?


A. Transient relaxation of the lower esophageal sphincter
B. Decreased resting pressure of the lower esophageal sphincter
C. Abnormal production of H in the stomach leading to acid-induced
damage in the lower and middle esophagus.
D. Loss of peristalsis and relaxation of the lower esophageal sphincter
E. None of the above

2
18. Esophageal spasm is best characterized by which of the following:
A. A loss of peristalsis and relaxation of the lower esophageal sphincter
B. Increased resting pressure of the lower esophageal sphincter
C. An increased percentage of simultaneous waves with some
discoordinated peristalsis
D. Transient contraction of the lower esophageal sphincter
E. None of the above

19. Which of the following may be indicated in the management of the


acute phase of ulcerative colitis?
A. Steroid enema
B. Oral corticosteroids
C. Parenteral corticosteroids
D. A and B
E. All of the above

20. Which of the following statements regarding the use of


sulfasalazine for the treatment of ulcerative colitis is false?
A. Sulfasalazine is structurally related to both aspirin and sulfa drugs
B. Sulfasalazine is effective in maintaining remission is this condition as
well as in the acute treatment of mild disease
C. Sulfasalazine may impair folic acid metabolism
D. All of the above are false
E. None of the above statements is false

21. Which of the following is a (are) complication(s) of the disease


described? (Ulcerative colitis)
A. Toxic megacolon
B. Colonic cancer
C. Colonic strictures
D. Iritis
E. All of the above

3
22. Which of the following investigations is the most sensitive test for
confirming the diagnosis of Crohn’s diseases?
A. Sigmoidoscopy
B. Colonoscopy
C. Barium enema
D. Computed tomography (CT) scan of the abdomen
E. Magnetic resonance imaging (MRI) scan of the abdomen

23. Which of the following drugs is the most appropriate initial therapy
in the acute phase of Crohn’s disease?
A. Prednisone
B. Sulfasalazine
C. Metronidazole
D. 6-mercaptopurine
E. Azathioprine

24. Sulfasalazine is effective in which of the following subtypes of


Crohn’s disease?
A. Crohn’s colitis
B. Crohn’sileocolitis
C. Crohn’s disease of the small bowel
D. A and B
E. All of the above

25. Which of the following is (are) associated with Crohn’s disease?


A. Skip lesions on x-ray
B. Thumbprinting on x-ray
C. Ineffective surgical treatment
D. None of the above
E. A, B, and C

26. Which of the following statements regarding complications of


Crohn’s disease is false?
4
A. Rectal fissures, rectocutaneous fistulas, and perirectal abscesses are
common complications of this condition
B. Arthritis is sometimes seen as a complication of Crohn’s disease
C. Erythema nodosum and pyodermagangrenosum are sometimes
found with this condition
D. Patients with this condition are not at increased risk of colorectal
cancer
E. None of the above statements is false.
27. What is the pathophysiology of celiac sprue?
A. An immunologic disorder of the small bowel mucosa
B. A disaccharide deficiency of the small intestinal mucosa
C. A deficiency of pancreatic exocrine
D. Secondary contamination of the small intestine by coliform bacteria
E. None of the above

28. Which of the following drugs show(s) effectiveness against H.Pylori?


A. Bismuth subsalicylate ( it also kills hpylori by inhibiting iron leading
to LPS defect in bacteria)
B. Metronidazole
C. Amoxicillin
D. B and C
E. All of the above

29. What is the mode of action of omeprazole?


A. An H1 receptor antagonist
B. An H2 receptor antagonist
C. A proton pump inhibitor
D. A cytoprotective agent
E. An anticholinergic agent

30. Which of the following drugs is classified as an H2 receptor


antagonist?
A. Cimetidine
5
B Ranitidine
C. Famotidine
D. A and B
E. All of the above

31. Which of the following statements regarding the role of drugs in the
development of peptic ulcer is (are) true?
A. The incidence of this condition in patients taking indomethacin or
other NSAIDs is increased
B. The use of dexamethasone is a risk factor for this condition
C. Aspiring may precipitate this condition
D. Some NSAIDs seem more likely to precipitate peptic ulcer than
others
E. All of the above are true

32. Which of the following statements regarding cimetidine is (are)


true?
A. Cimetidine is an H2 receptor antagonist
B. Cimetidine and antacids are no more effective than cimetidine alone
in the treatment of peptic ulcer
C. Exacerbation of peptic ulcer is common
D. Cimetidine may interfere with warfarin metabolism
E. All of the above are true

33. Which of the following statements regarding the diagnosis and


treatment of gastric ulcers is (are) true?
A. The pain of gastric ulcers in contrast with duodenal ulcers is
sometimes aggravated rather than relieved by food
B. Anorexia, nausea, and vomiting are more common in patients with a
gastric ulcer than in those with a duodenal ulcer

6
C. Endoscopy should follow the identification of a gastric ulcer on a
gastrointestinal series
D. The healing rate and the time to heal for gastric ulcers are generally
longer than for duodenal ulcers
E. All of the above

34. The ascites associated with cirrhosis should generally be treated by


which of the following?
A. Sodium restriction
B. Water restriction
C. Spironolactone
D. A and C
E. A, B, and C

35. Which of the following tests is the most sensitive in confirming the
diagnosis of hepatitis A?
A. Anti-hepatitis A virus (HAV)-immunoglobulin G (IgG)
B. Anti-HAV-immunoglobulin M (IgM)
C. HAV core antigen
D. Anti-hepatitis B core antigen (HBcAg)
E. Anti-hepatitis C virus (HCV)

36. Initial screening for hepatitis B should include which of the


following?
A. Anti-hepatitis B surface antigen (HBsAg) and anti-HBc
B. Hepatitis B early antigen (HBeAg) and anti-HBe
C. HBsAg and anti-HBs
D. HBsAg and anti-HBc
E. anti-HBe and anti-HBc

7
37. Which of the following laboratory tests is (are) usually abnormal in
a patient with acute viral hepatitis?
A. serum AST
B. serum bilirubin
C. serum ALT
D. serum alkaline phosphatase
E. All of the above

38. Clinical manifestations of cirrhosis include which of the following?


A. Fatigue
B. Jaundice
C. Splenomegaly
D. Hypoalbuminemia
E. All of the above

39. Indications for the use of hepatitis B vaccine include which of the
following?
A. Heath care personnel
B. Hemodialysis patients
C. All children
D. A and B only
E. All of the above

40. Which of the following types of viral hepatitis is (are) associated


with the development of chronic active hepatitis?
A. hepatitis B
B. hepatitis C
C. hepatitis A
D. A and B only
E. All of the above

41. The pathophysiology of alcoholic cirrhosis includes which of the


following?
8
A. macronodular and micronodular fibrosis
B. Nodular regeneration
C. Increased portal vein pressure
D. Increase in hepatic size followed by a decrease
E. All of the above

42. Which of the following has (have) been suggested as treatment for
complications of cirrhosis of the liver?
A. Prednisone
B. Propranolol
C. Colchicine
D. Propylthiouracil
E. All of the above

43. Which of the following is (are) a complication of alcoholic cirrhosis?


A. Hypersplenism
B. Hepatic encephalopathy
C. Congestive gastropathy
D. Spontaneous bacterial peritonitis
E. All of the above

44. Treatment of the ascites accompanying cirrhosis may include which


of the following?
A. Spironolactone
B. Hydrochlorothiazide
C. Furosemide
D. All of the above
E. A and B only

45. Which of the following statements regarding irritable bowel disease


is false?
A. The typical location of the abdominal pain is the lower abdomen
B. Defecation frequently relieves the pain
9
C. There is often a perception of incomplete emptying of the rectum
D. Bowel action is often irregular
E. Very severe abdominal tenderness is a hallmark of the disease

46. What is the most likely cause of the irritable bowel disease?
A. A mass lesion in the area of the sigmoid colon
B. A low-grade chronic inflammation of the entire small and large bowel
C. An autoimmune phenomenon
D. A decreased ability to digest certain foods
E. None of the above

47. Which of the following would be most unlikely in a patient with


irritable bowel disease?
A. Alternating diarrhea and constipation
B. Increased pain at times of stress
C. Pain on awakening from sleep
D. Abdominal bloating
E. Increased passage of flatus

48. Which of the following investigations is not indicated in irritable


bowel disease?
A. A complete blood count
B. An erythrocyte sedimentation rate (ESR)
C. Electrolytes
D. Abdominal ultrasound
E. Thyroid function studies

49. Which of the following may have to be considered in the differential


diagnosis of irritable bowel disease?
A. Colonic adenocarcinoma
B. Fecal impaction

10
C. Celiac disease
D. Endometriosis
E. All of the above

50. Which of the following conditions (symptoms) is not associated with


irritable bowel disease?
A. Gastroesophageal reflux disease
B. Cholelithiasis
C. Noncardiac chest pain
D. Depression
E. Fatigue

51. Which of the following statements concerning irritable bowel


disease is (are) true?
A. This condition is the most common reason for referral from physician
toa gastroenterologist
B. This condition is slightly more common in men
C. The symptoms associated with this condition are more common in
young adults than in older adults
D. This condition has been associated with a specific biochemical
abnormality in some patients
E. All of the above statements are true

52. Which of the following is the most important component of the


management of irritable bowel disease?
A. Single-agent pharmacologic therapy
B. Multiple-agent pharmacologic therapy
C. A therapeutic physician-patient relationship
D. A focused diet
E. A diet elimination trial: eliminating one food at a time until the
responsible food is found
11
53. Which of the following medications should not be used in the
treatment of irritable bowel disease?
A. Psyllium
B. Loperamide
C. Cholestyramine
D. Codeine phosphate
E. Desipramine

54. A 43 year old female comes to your office with a 3-hour history of
right upper quadrant pain. The pain is described as spasmodic and
sharp. It radiates through to the back. The patient describes several
episodes of this pain within the past 6 months. Nausea and vomiting
accompany most of these episodes. Fever and chills are usually absent.
The pain usually comes on after meal. On examination there are no
abdominal masses or tenderness. The chest is clear and the
cardiovascular system is normal. The patient’s blood pressure is 140/70
mm Hg. The patient has no drug allergies and is on no medications at
the present time. What is the most likely diagnosis in this patient?
A. Acute cholecystitis
B. Biliary colic
C. Acute pancreatitis
D. Ileocecal appendicitis
E. Crohn’s disease

55. Which of the following investigations is more informative NS cost-


effective to diagnose gallstones?
A.A white blood cell count
B. An oral cholecystogram
C. An abdominal ultrasound
D. An electrocardiogram
12
E. CT of abdomen

56. Regarding the use oral dissolution therapy in gallstone disease,


which of the following statements is (are) true?
A. Oral dissolution therapy is an excellent option for most patients
B. Few if any gallstones that are dissolved with oral dissolution reoccur
C. The preferred agent for oral dissolution therapy is ursodiol
D. Oral dissolution therapy should not be combined with extracorporeal
shock wave lithotripsy (ESWL)
E. Oral dissolution therapy works best in patients with large gallstones

57. Which of the following statements regarding the treatment of


asymptomatic gallstones is most accurate?
A. Asymptomatic gallstones should be treated with cholecystectomy
B. Asymptomatic gallstones should not be treated
C. Whether or not asymptomatic gallstones should be treated depends
on the presence or absence of comorbid conditions
D. Asymptomatic gallstones should or should not be treated;
E. Asymptomatic gallstone treatment has radically changed since the
introduction of laparascopic cholecystectomy

58. What is the most common complication during laparoscopic


cholecystectomy?
A. Excessive bleeding
B. Small bowel perforation
C. Injury to the biliary tract system
D. Inability to remove the gallbladder through the laparoscope
E. Liver laceraition

59. Which of the following statement(s) is (are) true of laparoscopic


cholecystectomy?

13
A. Laparoscopic cholecystectomy provides a safe and effective
treatment for most patients with symptomatic gallstones; it is the
treatment of choice
B. Laparoscopic cholecystectomy provides distinct advantages over
open cholecystectomy
C. Laparoscopic cholecystectomy can be performed at a treatment cost
equal to or slightly less than that for open cholecystectomy
D. During laparoscopic cholecystectomy when the anatomy is obscured
because of excessive bleeding or other problems, the operation should
be converted promptly to open cholecystectomy
E. All of the above statements are true

60. What is (are) the essential diagnostic feature(s) of acute


pancreatitis?
A. Abrupt onset of epigastric pain with radiation to the back
B. Nausea and vomiting
C. Elevated serum amylase
D. All of the above
E. None of the above

61. Which of the following statements about acute pancreatitis is (are)


true?
A. Many cases of this disease are associated with a pathologic condition
of the biliary tract
B. strong evidence suggests a link between this disease and alcohol
C. The chronic condition of this disease is more likely to be associated
with alcohol abuse rather than biliary tract disease
D. All of the above statements are true
E. None of the above statements is true

62. Which of the following is (are) complications of acute pancreatitis?


A. Ascites
14
B. Pleural effusion
C. Abscess formation
D. All of the above
E. None of the above

RHEUMATOLOGY

1. A 73-year-old woman with a medical history of obesityand diabetes


mellitus presents to your clinic complaining of right knee pain that has
been progressive and is worse with walking or standing. She has taken
over the-counter nonsteroidalanti-inflammatory drugs without relief.
She wants to know what is wrong with her knee and what may have
caused it. X-rays are performed and reveal cartilage loss and
osteophyte formation. Which of the following represents the most
potent risk factor for the development of osteoarthritis?
A. Age
B. Gender
C. Genetic susceptibility
D. Obesity
E. Previous joint injury

2. A patient presents with 3 weeks of pain in the lower back. All the
following are risk factors for serious causes of spine pathology except
A. age more than 50 years
B. urinary incontinence
C. duration of pain more than 2 weeks
D. bed rest without relief
E. history of intravenous drug use

3. Which of the following joints are typically spared in osteoarthritis


(OA)?
A. Ankle
15
B. Cervical spine
C. Distal interphalangeal joint
D. Hip
E. Knee

4. What is the most common extraarticular manifestation of ankylosing


spondylitis?
A. Anterior uveitis
B. Aortic regurgitation
C. Cataracts
D. Inflammatory bowel disease
E. Third-degree heart block

5. A 43-year-old man presents to your clinic complaining of bilateral


knee pain. He states that the pain worsens with walking and is not
present at rest. He has been experiencing knee pain for many months
and has had no relief from over-the-counter analgesics. He has a history
of hypertension and obesity. Which of the following represents the best
initial treatment strategy for this patient?
A. Avoidance of walking for several weeks
B. Light daily walking exercises
C. Low-dose, long-acting narcotics
D. Oral steroid pulse
E. Weight loss

6. All the following organisms have been implicated in reactive arthritis


except
A. Chlamydia trachomatis
B. Neisseria gonorrhoeae
C. Salmonella enteritidis
D. Shigelladysenteriae ( all others are given in medscape,, shigella
flexneri is there but not this)
E. Yersinia enterocolitica

16
7. A 60-year-old male complains of pain in both knees coming on
graduallyover the past 2 years. The pain is relieved by rest and
worsened by movement. There is bony enlargement of the knees with
mild warmth and small effusions. Crepitation is noted on motion of the
knee joint bilaterally. There are no other findings except for bony
enlargement at the distal interphalangealjoint. The patient is 167 cm
tall and weighs 95 kg. Which of the following is the best way to prevent
disease progression?
a. Weight reduction
b. Calcium supplementation
c. Total knee replacement
d. Long-term nonsteroidal anti-inflammatory drug (NSAID)
administration
e. Oral prednisone

8. A 45-year-old woman has pain in her fingers on exposure to cold,


arthralgias, and difficulty swallowing solid food. Of the following tests,
which, if positive, would be most supportive of a definitive diagnosis?
a. Rheumatoid factor
b. Antinucleolar antibody
c. ECG
d. BUN and creatinine
e. Reproduction of symptoms and findings by immersion of hands in
cold water

9. A 43-year-old man with diabetes and cardiomegaly has had an attack


of pseudogout. He should be evaluated for which of the following?
a. Renal disease
b. Hemochromatosis
c. Peptic ulcer disease
d. Lyme disease
e. Inflammatory bowel disease

17
10. A 75-year-old male complains of headache. On one occasion he
transientlylost vision in his right eye. He also complains of aching in the
shoulders and neck. There are no focal neurologic findings. Carotid
pulses are normal without bruits. Laboratory data show a mild anemia.
Erythrocyte sedimation rate is 85. Which of the following is the best
approach to management?
a. Begin glucocorticoid therapy and arrange for temporal artery biopsy
b. Schedule biopsy and begin corticosteroids based on biopsy results
and clinical
course
c. Schedule carotid angiography
d. Follow ESR and consider further studies if it remains elevated
e. Start aspirin and defer any invasive studies unless further symptoms
develop

11. What is the most characteristic symptom of rheumatoid arthritis?


A. Early morning joint stiffness
B. Progressive joint pain
C. Predilection for the small joints
D. Joint swelling
E. Normal cartilage despite joint pain

12. What is the most characteristic sign of rheumatoid arthritis?


A. Joint swelling
B. Bilateral (symmetrical) joint involvement
C. Erythema surrounding the affected joints
D. Joint bogginess
E. Involvement of theglenohumeral joint in all cases

13. On what is the pathophysiology of rheumatoid arthritis is based?


A. Bone destruction
B. Bone spur formation

18
C. Bone sclerosis
D. Symmetrical joint involvement
E. Synovial inflammation

14. In the course of the pathophysiology of rheumatoid arthritis, which


of the following is most characteristic of the disease?
A. Synovial proliferation with cartilage erosion stimulated by cytokines
B. Cartilage destruction stimulated by the proliferation of proteoglycans
C. Cartilage destruction stimulated by the enzymatic action of
proteoglycans
D. Loss of the synovial membrane
E. None of the above; the pathophysiology of the disease is not known
with any certainty

15. The disease described affects one particular part of the spine. What
is the affected part, and what are the affected vertebrae?
A. Cervical: C6-C7
B. Cervical: C1-C2
C. Thoracic: T7-T9
D. Lumbar: L1-L3
E. LumbarL L4-L5

16. Which anemia usually accompanies rheumatoid arthritis?


A. Microcytic: hypochromic
B. Microcytic: normochromic
C. Normocytic: normochromic
D. Macrocytic: hyperchromic
E. Normocytic: hypochromic

17. Which of the following is a (are) systemic complication(s) of


rheumatoid arthritis?
A. Vasculitis
B. Pericarditis
19
C. Pleural effusion
D. Diffuse interstitial fibrosis of the lungs
E. All of the above

18. Felty’s syndrome is a complication of rheumatoid arthritis. Which of


the following is (are) component of Felty’s syndrome?
A. Splenomegaly
B. Neutropenia
C. Positive rheumatoid factor
D. A and B
E. All of the above

19. For rheumatoid arthritis, which of the following is a (are) proven


therapeutic agent(s)?
A. Auranofin
B. Hydroxychloroquine
C. Methotrexate
D. D-penicillamine
E. All of the above

20. What is the drug of choice for the suppression of inflammation in a


patient with rheumatoid arthritis?
A. Auranofin
B. Methotrexate
C. Oral prednisone (if nsaid doenst work)
D. Naproxen (first doc…)
E. D-penicillamine

21. Which of the following is not a classical radiologic feature of


rheumatoid arthritis?
A. Loss of juxtaarticular bone mass
B. Narrowing of the joint space
C. Bony erosions
20
D. Subarticular sclerosis
E. All of the above are radiologic manifestations

22. Which of the following statements regarding the symptomatology


of osteoarthritis is false?
A. Pain is the chief symptom of osteoarthritis and is usually deep and
aching in character
B. Stiffness of the involved joints is common but of relatively brief
duration
C. The pain of osteoarthritis is characteristically dull and aching
D. The major physical finding in osteoarthritis is bony crepitus
E. The presence of osteophytes is sufficient for the diagnosis of
osteoarthritis

23. Which of the following statements concerning osteoarthritis is


false?
A. This condition is the most common form of joint disease
B. 80% of the population have radiographic features of this condition in
weight-bearing joints before age 65 years
C. This condition has both primary and secondary forms
D. Narrowing of the joint space is unusual
E. Pathologically, the articular cartilage is first roughened and then
finally worn away

24. A 65-year-old female with moderately severe osteoarthritis of her


left hip comes to your office requesting an exercise prescription. She
wishes to “get into shape”. Which of the following would you
recommend to this patient at this time?
A. Exercise is not good for osteoarthritis; rest is much more appropriate
B. A graded exercise program consisting of brisk walking and gradually
increasing the distance to 3 to 4 km/day will probably not cause pain
and will be good for her

21
C. A passive isotonic exercise program is preferable to an active
isometric exercise program
D. Any exercise program will probably hasten her need for total hip
replacement
E. Swimming is the best exercise prescription you can give her; it
promotes cardiovascular fitness and at the same time keeps pressure
off the weight-bearing joints.

25. Which of the following radiographic features is (are) usually seen in


osteoarthritis?
A. Narrowing of the joint spaces
B. Bony sclerosis
C. Osteophyte formation
D. Subchondral cyst formation
E. All of the above

26. Which of the following is a (are) useful treatment modality(ies) in


the treatment of osteoarthritis?
A. Weight loss in obese patients
B. Canes, crutches, and walkers
C. The application of heat to involved joints
D. NSAIDs
E. All of the above

27. Which of the following statements concerning the incidence of


osteoarthritis is (are) true?
A. One third of adults age 25-75 years have radiographic evidence of
osteoarthritis
B. Cartilaginous fraying is common
C. Mild synovitis may develop in response to crystals or cartilaginous
debris
D. The most common sites for this disease are in the small joints of the
hand, the foot, and the knees and/or hips
22
E. All of the above are true

28. What is (are) the major goal(s) of therapy in the disease just
described?
A. Minimize pain
B. Prevent disability
C. Delay progression
D. A and B only
E. All of the above

29. Which of the following statements regarding the use if NSAIDs in


the treatment of osteoarthritis and as given to an elderly patient is
true?
A. NSAIDs are generally very safe for the treatment of the condition
described in elderly patients
B. NSAID toxicity in elderly patients is uncommon
C. NSAID toxicity in elderly patients is unlikely to be associated with
renal insufficiency
D. The most common NSAID toxicity in elderly patients is
gastrointestinal
E. None of the above is true

30. What is the drug of choice for the treatment of primary


osteoarthritis?
A. Acetaminophen (first line) other nsaids are 2nd line
B. Naproxen sodium
C. Diclofenac
D. Indomethacin
E. Any of the above

31. Which of the following statements regarding gout is false?


A. The disease is more common in males than in females
B. Fever is unusual
23
C. More than 50% of the initial attacks of this condition are confined to
the first metatarsophalangeal joint
D. Peripheral leukocytosis can occur
E. Involvement is usually asymmetric

32. What is the most common metabolic abnormality found in patients


with gout?
A. Increased production of uric acid
B. Decreased renal excretion of uric acid
C. Increased production of uric acid metabolites
D. Decreased renal excretion of uric acid metabolites
E. None of the above

33. What is the pharmacologic agent of choice for the initial


management gout?
A. Indomethacin ( newer 1st line, older is colchcine)
B. Colchicine
C. Acetaminophen
D. Aspirin
E. Phenylbuazone

34. The determination of the agent of choice for the prophylaxis of gout
attacks is made by which of the following?
A. A serum blood level ( urate level in blood)
B. A joint fluid aspiration
C. A 24 hour urine determination of uric acid
D. A joint x-ray
E. None of the above

35. Which of the following drugs increase(s) the excretion of uric acid?
A. Sulfinpyrazone
B. Probenecid

24
C. Allopurinol
D. A and B only
E. All of the above

36. In patients started on prophylactic therapy, which of the following


statements regarding the use of prophylactic agents is (are) true?
A. The patient who is begun on a prophylactic agent should also be
started on colchicine
B. Colchicine should be added and maintained for 3 to 6 months
C. Indomethacin can replace colchicine
D. None of the above statements are true
E. All of the above statements are true

37. Which of the following drugs would be most likely to provide


significant relief in the case of acute gout attack?
A. Oral prednisone
B. Oral dexamethasone
C. Intravenous hydrocortisone
D. Intravenous methylprednisolone
E. Intraarticular methylprednisolone acetate

38. Which of the following classes of drugs is most likely to precipitate


attack of gout?
A. Thiazide diuretics
B. Calcium channel blockers
C. ACE-inhibitors
D. beta-blockers
E. Alpha-blockers

39. A27-year-old woman presents with a red rash over her cheeks, and
pain and swelling in both knees as well as several small joints in her
hands. She notes that the rash is worse with sun

25
exposure. Medical evaluation reveals oral ulceration, positive ANA, and
3+ proteinuria.
Which of the following is the most likely mechanism for the renal
damage in this condition?
(A) vasculitis
(B) microemboli
(C) antibasement membrane antibodies
(D) deposition of circulating immune complexes
(E) primary tubular atrophy

40. A 50-year-old man develops fatigue and painful swelling of both


hands. He is also very stiff in the morning and requires longer time to
get ready for work. Physical examination reveals erythema, swelling,
and tenderness on palpation of the proximal interphalangealjoints and
MCP joints. Plain x-rays of the hand are taken. Which of the following x-
ray findings is characteristic of this condition?
(A) lossof articular cartilage and bone erosion
(B) normal
(C) osteolytic changes
(D) osteosclerotic changes
(E) osteolytic and osteosclerotic changes together

41. A 69-year-old man develops clubbing of his fingers. Which of the


following is most likely
associated with this condition?
(A) RF
(B) aortic stenosis
(C) periosteal inflammation
(D) crystal-induced arthritis
(E) diffuse osteoarthritis

42. A 67-year-old man has a long history of symmetrical small joint


arthritis with deformities.He now develops shortness of breath on
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exertion with a dry cough, but no sputum or chest discomfort. His heart
sounds have a loud P2, and the lungs have fine bibasilar crackles. Which
of the following is the most likely diagnosis of the pulmonary condition
associated with his arthritis?
(A) pleuritis
(B) cavitating lesions
(C) intrapulmonary nodules
(D) interstitial fibrosis
(E) diffuse pneumonitis

43. A 45-year-old man has had intermittent swelling and pain in the
superior part of his auricles for several years. Mild arthritis usually
accompanies these episodes. Last year he also had redness, pain, and
swelling over the bridge of his nose. Which of the following is the most
likely diagnosis?
(A) psoriatic arthritis
(B) Behçet’s syndrome
(C) Wegener’s granulomatosis
(D) relapsing polychondritis
(E) rheumatoid arthritis

44. Which of the following features is a characteristic of Ehlers-Danlos


syndrome?
(A) thickening of the skin
(B) mental retardation
(C) an increased incidence of skin carcinoma
(D) thrombocytopenia
(E) habitual dislocation of joints

45. Which of the following statements concerning the articular


manifestations of RA is correct?
(A) wrists are rarely involved
(B) involvement of hands is characteristically asymmetric
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(C) fever up to 38°C is common with joint involvement
(D) ulnar deviation at the wrist is common
(E) absence of morning stiffness makes RA an unlikely cause of articular
symptoms

46. Which of the following is the most common location for


osteoarthritis?
(A) hip
(B) base of thumb
(C) knee
(D) spine
(E) Distal interphalangealand joints of hand

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