Page 1 of 80
RHEUMATOLOGY SPOT FINAL EXAM
PREP 2025|ORIGINAL
450+Qs&As|100% VERIFIED &
GRADED A+
1. A 45-year-old woman presents with symmetric polyarthritis
of the hands and wrists, morning stiffness lasting 2 hours,
fatigue, and rheumatoid factor positive. Which is the most
appropriate initial treatment?
A) Naproxen alone
B) Prednisone alone
C) Methotrexate plus folic acid
D) Hydroxychloroquine alone
Answer: C – Methotrexate is first-line disease-modifying
antirheumatic drug (DMARD) for rheumatoid arthritis.
,Page 2 of 80
Rationale: Early initiation of methotrexate reduces joint damage
and improves outcomes. Hydroxychloroquine is less effective for
moderate-severe disease. NSAIDs are symptomatic only.
2. Which of the following extra-articular manifestations of
rheumatoid arthritis is associated with the highest mortality?
A) Rheumatoid nodules
B) Interstitial lung disease
C) Sjögren’s syndrome
D) Carpal tunnel syndrome
Answer: B – Interstitial lung disease (RA-ILD) is a major cause of
mortality in RA.
Rationale: RA-ILD is often progressive and can lead to
respiratory failure. Other manifestations are significant but less
lethal.
,Page 3 of 80
3. A patient with rheumatoid arthritis has a positive anti-CCP
antibody. Which statement is TRUE?
A) It is less specific than rheumatoid factor.
B) It predicts a more aggressive disease course and erosive
damage.
C) It is only found in RA.
D) It disappears with treatment.
Answer: B – Anti-CCP positivity is associated with worse
prognosis and radiographic progression.
Rationale: Anti-CCP has higher specificity than RF and often
appears before disease onset.
4. A 28-year-old man presents with inflammatory back pain,
morning stiffness, and alternating buttock pain. Which
imaging finding confirms ankylosing spondylitis?
A) Sacroiliac joint erosions with sclerosis on X-ray
, Page 4 of 80
B) Disc space narrowing on lumbar spine X-ray
C) Osteophytes on cervical spine
D) Enthesophytes at the Achilles tendon
Answer: A – Bilateral sacroiliitis (grade ≥2 or unilateral grade
≥3) is characteristic of ankylosing spondylitis.
Rationale: MRI can detect early inflammation before X-ray
changes.
5. A 32-year-old woman with oligoarthritis, uveitis, and
HLA-B27 positive develops painless balanitis circinata and
pustules on the soles. The most likely diagnosis is:
A) Psoriatic arthritis
B) Reactive arthritis (Reiter’s syndrome)
C) Ankylosing spondylitis
D) Enteropathic arthritis
RHEUMATOLOGY SPOT FINAL EXAM
PREP 2025|ORIGINAL
450+Qs&As|100% VERIFIED &
GRADED A+
1. A 45-year-old woman presents with symmetric polyarthritis
of the hands and wrists, morning stiffness lasting 2 hours,
fatigue, and rheumatoid factor positive. Which is the most
appropriate initial treatment?
A) Naproxen alone
B) Prednisone alone
C) Methotrexate plus folic acid
D) Hydroxychloroquine alone
Answer: C – Methotrexate is first-line disease-modifying
antirheumatic drug (DMARD) for rheumatoid arthritis.
,Page 2 of 80
Rationale: Early initiation of methotrexate reduces joint damage
and improves outcomes. Hydroxychloroquine is less effective for
moderate-severe disease. NSAIDs are symptomatic only.
2. Which of the following extra-articular manifestations of
rheumatoid arthritis is associated with the highest mortality?
A) Rheumatoid nodules
B) Interstitial lung disease
C) Sjögren’s syndrome
D) Carpal tunnel syndrome
Answer: B – Interstitial lung disease (RA-ILD) is a major cause of
mortality in RA.
Rationale: RA-ILD is often progressive and can lead to
respiratory failure. Other manifestations are significant but less
lethal.
,Page 3 of 80
3. A patient with rheumatoid arthritis has a positive anti-CCP
antibody. Which statement is TRUE?
A) It is less specific than rheumatoid factor.
B) It predicts a more aggressive disease course and erosive
damage.
C) It is only found in RA.
D) It disappears with treatment.
Answer: B – Anti-CCP positivity is associated with worse
prognosis and radiographic progression.
Rationale: Anti-CCP has higher specificity than RF and often
appears before disease onset.
4. A 28-year-old man presents with inflammatory back pain,
morning stiffness, and alternating buttock pain. Which
imaging finding confirms ankylosing spondylitis?
A) Sacroiliac joint erosions with sclerosis on X-ray
, Page 4 of 80
B) Disc space narrowing on lumbar spine X-ray
C) Osteophytes on cervical spine
D) Enthesophytes at the Achilles tendon
Answer: A – Bilateral sacroiliitis (grade ≥2 or unilateral grade
≥3) is characteristic of ankylosing spondylitis.
Rationale: MRI can detect early inflammation before X-ray
changes.
5. A 32-year-old woman with oligoarthritis, uveitis, and
HLA-B27 positive develops painless balanitis circinata and
pustules on the soles. The most likely diagnosis is:
A) Psoriatic arthritis
B) Reactive arthritis (Reiter’s syndrome)
C) Ankylosing spondylitis
D) Enteropathic arthritis
