Rheumatology and Immunology — MCQs

A 50-year-old woman with SLE presents with headache and fatigue. Her past manifestations of SLE have included arthralgias, hemolytic anemia, malar rash, and mouth ulcers. She has high titres of antibodies to dsDNA. She is currently taking prednisone, 5 mg daily, and hydroxychloroquine, 200 mg daily. On examination, her BP is 190/110 mmHg with a HR of 98 bpm. Urinalysis shows 25 RBCs per HPF with 2+ proteinuria. No RBC casts are identified. Her BUN is 90 mg/dL, and creatinine is 2.8 mg/dL (baseline 0.8 mg/dL). She has no prior renal disease related to SLE and is not taking NSAIDs. She denies recent illness, decreased oral intake, or diarrhea. What is the most appropriate next step in the management of this patient?

What is the most common complication of Giant cell arteritis?

A 25-year-old woman presents with a 2-week history of febrile illness and chest pain. She has an erythematous, macular facial rash and tender joints, particularly in her left wrist and elbow. A CBC shows mild anemia and thrombocytopenia. Corticosteroids are prescribed for the patient. This medication induces the synthesis of an inhibitor of which of the following enzymes in inflammatory cells?

Which radiological feature helps differentiate rheumatoid arthritis from SLE?

A previously healthy and active 72-year-old woman presents with stiffness and pain in her neck and shoulders. The symptoms are much worse in the morning and improve throughout the day. The pain affects the soft tissues and is not localized to the shoulder or hip joints. She denies headache or jaw claudication. Physical examination reveals normal muscle strength and range of motion of the shoulder and hip joints, with no inflammatory synovitis, muscle tenderness, or skin rash. Laboratory studies show an elevated ESR of 92 mm/h and a mild normocytic anemia. What is the best next step in management?

Bilateral symmetrical sacroiliitis is a hallmark of which condition?

Oligoarthritis with ascending joint involvement is seen in which of the following conditions?

What is the drug of choice in scleroderma-induced hypertensive crisis?

In psoriatic arthritis with liver fibrosis, which of the following medications cannot be used for treatment?

A 48-year-old man presents with 3 weeks of fever, fatigue, and shortness of breath. He has a history of nasal allergies and asthma, which have been poorly controlled in the past month. Two days prior to presentation, he developed weakness in his left foot and it now drags when he walks. On examination, his blood pressure is 165/90 mm Hg, pulse 100/min, respirations 20/min, and lungs have bilateral expiratory wheezes. There is left foot drop, and the rest of the neurologic examination is normal. Laboratory evaluation reveals ESR of 90 mm/h, WBC of 14,000/mL with 10% eosinophils, and 1+ proteinuria. A CXR shows bilateral pulmonary infiltrates. For the above patient with a vasculitis syndrome, what is the most likely diagnosis?