Q 1 . A 72-year-old man develops severe pain and swelling in both knees,
shortly after undergoing an abdominal hernia repair surgery. Physical
examination shows warmth and swelling of both knees with large effusions.
Arthrocentesis of the right knee reveals the presence of intracellular
and extracellular weakly positive birefringent crystals in the
synovial fluid. Gram stain is negative. Which of the following is the
most likely diagnosis?
A. Gout
B. Septic arthritis
C. Calcium oxalate deposition disease
D. Reactive arthritis
E. Pseudogout
Answer E
Q 2 . A 65-year-old man with a history of chronic hypertension, diabetes
mellitus, and degenerative joint disease presents with acute onset of
severe pain of the metatarsophalangeal (MTP) joint and swelling of the
left first toe. Physical examination shows exquisite tenderness of the
joint, with swelling, warmth, and erythema. The patient has no history
of trauma or other significant medical problems. Synovial fluid
analysis and aspiration is most likely to show which of the following?
A. Hemorrhagic fluid
B. Needle-shaped, negatively birefringent crystals
C. Gram-negative organisms
D. Noninflammatory fluid
E. Rhomboidal, positively birefringent crystals
Answer B
Q 3 A 17-year-old sexually active adolescent male presents with a 5-day
history of fever, chills, and persistent left ankle pain and swelling. On
physical examination, maculopapular and pustular skin lesions are
noted on the trunk and extremities. He denies any symptoms of genitourinary
tract infection. Synovial fluid analysis is most likely to show
which of the following?
A. WBCs 75,000/mm 3 with 95% polymorphonuclear leukocytes
B. RBCs 100,000/mm 3 , WBCs 1000/mm3
C. WBCs 48,000/mm 3 with 80% lymphocytes
D. WBCs 500/mm 3 with 25% polymorphonuclear leukocytes
Answer A
Q 4 . A 22-year-old man presents with complaints of low back pain for 3 to
4 months and stiffness of the lumbar area, which worsen with inactivity.
He reports difficulty in getting out of bed in the morning and may
have to roll out sideways, trying not to flex or rotate the spine to minimize
pain. A lumbosacral (LS) spine X-ray film would most likely
show which of the following?
A. Degenerative joint disease with spur formation
B. Sacroiliitis with increased sclerosis around the sacroiliac joints
C. Vertebral body destruction with wedge fractures
D. Osteoporosis with compression fractures of L3-L5
E. Diffuse osteonecrosis of the LS spine
Answer B
Q 5 . A 36-year-old woman was seen by her physician due to pain in her
hands, wrists, and knees. She is diagnosed with rheumatoid arthritis.
Which of the following treatments will reduce joint inflammation and
slow progression of the disease?
A. NSAIDs
B. Joint aspiration
C. Methotrexate
D. Systemic corticosteroids
Answer C
