Deck 9: Arthritides

Question 1

The most common inflammatory arthritide is __________.

A) rheumatoid arthritis
B) juvenile idiopathic arthritis
C) systemic lupus erythematosus
D) ankylosing spondylitis

Answer 1

rheumatoid arthritis

Question 2

The osseous erosions of rheumatoid arthritis, occurring at areas where panus has direct contact with bone, are found at the __________.

A) distal tufts of the phalanges
B) intraarticular bare areas
C) metadiaphysis of long bones
D) epiphysis of long bones

Answer 2

intraarticular bare areas

Question 3

What type of rash, associated with polymyositis, presents as a bluish-purplish discoloration on the upper eyelids?

A) Heliotrope
B) Erythematous
C) Gottron
D) Murray valley

Answer 3

Heliotrope

Question 4

The first imaging finding of rheumatoid arthritis is usually __________.

A) fibrous ankylosis
B) swan-neck deformity
C) fusiform periarticular soft tissue swelling
D) bilateral acetabular protrusion

Question 5

Which of the following statements accurately characterizes polymositis?

A) It affects more men than women.
B) It has bilateral, symmetrical muscle involvement.
C) It is a suppurative inflammatory disorder.
D) It involves the cardiac muscle after rheumatic fever.

Question 6

Jaccoud's arthropathy should be mentioned in the differential diagnosis for __________.

A) rheumatoid arthritis
B) ankylosing spondylitis
C) chronic arthritis
D) polymyositis

Question 7

Which of the following arthritides is associated with nonerosive, reversible joint deformities of the hands and feet?

A) Osteoarthritis
B) Jaccoud's arthritis
C) Rheumatoid arthritis
D) Ankylosing spondylitis

Question 8

The most common radiographic abnormality encountered in the cervical spine due to rheumatoid arthritis is __________.

A) hypolordotic curve
B) atlantoaxial subluxation or instability
C) neuroforaminal encroachment
D) tenosynovitis

Question 9

Radiographic features of polymyositis may include all of the following except __________.

A) soft tissue calcification
B) swan-neck deformity of the digits
C) soft tissue swelling
D) periarticular osteoporosis

Question 10

Which of the following arthritides has a metabolic etiology?

A) Gout
B) Systemic lupus erythematosus
C) Ankylosing spondylitis
D) Reiter's syndrome

Question 11

The most useful imaging modality for initial evaluation of arthropathy, partly because it is relatively inexpensive and rapidly obtained, is __________.

A) magnetic resonance imaging
B) plain film radiography
C) computed tomography
D) scintigraphy

Question 12

The classic joint distribution of rheumatoid arthritis in the hands involves the __________.

A) MCP and DIP articulations
B) PIP and DIP articulations
C) MCP and PIP articulations
D) MCP and carpal articulations

Question 13

The progressive thickening of the skin from increased collagen deposits is characteristic of ___________.

A) scleroderma
B) polymyositis
C) Jaccoud's arthropathy
D) systemic lupus erythematosus

Question 14

A patient presenting with a malar "butterfly" rash, arthralgia, and ulcers in the nose and mouth is most likely suffering from __________.

A) rheumatoid arthritis
B) systemic lupus erythematosus
C) psoriatic arthritis
D) Reiter's syndrome

Question 15

Which of the following statements is false regarding rheumatoid arthritis?

A) Men are affected more than women.
B) Joint involvement is typically bilateral and symmetrical.
C) Primary sites include synovial tissues of the hands and feet.
D) The peak incidence occurs between 40 and 70 years of age.

Question 16

Which of the following statements concerning juvenile rheumatoid arthritis is incorrect?

A) Features include periostitis and growth abnormalities.
B) It has a greater predilection for small joint involvement.
C) It is the most common childhood arthritis.
D) It is an inflammatory disease of unknown cause.

Question 17

Which of the following deformities is best described as hyperextension of the proximal interphalangeal joints with hyperflexion of the distal interphalangeal joints?

A) Swan-neck
B) En boutonniere
C) Zigzag
D) Mallet finger

Question 18

Which of the following conditions typically spares the metacarpophalangeal and proximal interphalangeal joints?

A) Systemic lupus erythematosus
B) Polymyositis
C) Reiter's syndrome
D) Rheumatoid arthritis

Question 19

Which of the following arthropathies is seropositive?

A) Ankylosing spondylitis
B) Enteropathic arthritis
C) Psoriatic arthritis
D) Scleroderma

Question 20

Which of the following inflammatory arthritides would reveal antibodies directed against cell nuclei on blood laboratory evaluation?

A) Rheumatoid arthritis
B) Systemic lupus erythematosus
C) Polymyositis
D) Jaccoud's arthropathy

Question 21

Intervertebral disc herniation is more common among __________.

A) 45-year-old to 65-year-old patients
B) 25-year-old to 45-year-old patients
C) Women
D) Nonsmokers

Question 22

Which joints are classically involved first in ankylosing spondylitis?

A) Sacroiliac
B) Acromioclavicular
C) Atlantoaxial
D) Costovertebral

Question 23

What is the most common disc level to exhibit herniation?

A) L5
B) L3
C) C7
D) T6

Question 24

Radiographic features of ankylosing spondylitis include all of the following except __________.

A) central joint erosions
B) Romanus lesions
C) shiny corner sign
D) syndesmophytes

Question 25

The joint most commonly affected by gout is the __________.

A) first MTP
B) second MTP
C) first MCP
D) second MCP

Question 26

Which of the following best differentiates a seropositive from a seronegative arthropathy?

A) Inflammation
B) Bilateral joint involvement
C) An increased ESR
D) Rheumatoid factor

Question 27

Which of the following is a major site of involvement with hydroxyapatite deposition disease?

A) Supraspinatus tendon of the shoulder
B) Quadriceps tendon of the knee
C) Trochanteric bursae of the hip
D) Extensor tendons of the wrist

Question 28

The most common seronegative spondyloarthropathy is __________.

A) psoriatic arthritis
B) ankylosing spondylitis
C) enteropathic arthritis
D) Reiter's syndrome

Question 29

Basic calcium phosphate crystals deposited in the periarticular soft tissues, especially the tendons, describes __________.

A) CPPD
B) HADD
C) pseudogout
D) gout

Question 30

Joint space narrowing, subchondral bone sclerosis, intraarticular loose bodies, subchondral cysts, and joint deformity are common radiographic findings of __________.

A) diffuse idiopathic skeletal hyperostosis
B) ankylosing spondylitis
C) degenerative joint disease
D) spinal stenosis

Question 31

Which of the following arthritides is radiographically marked by ossification of the anterior longitudinal ligament with relative maintenance of intervertebral disc height, absence of posterior joint fusion, and lack of sacroiliac joint involvement?

A) Diffuse idiopathic skeletal hyperostosis
B) Ankylosing spondylitis
C) Psoriatic spondylosis
D) Neuropathic arthropathy

Question 32

What is the term for a free fragment of a herniated disc?

A) Bulge
B) Protrusion
C) Extrusion
D) Sequestration

Question 33

All of the following are common presentations of calcium dehydrate (CPPD) crystal disease except __________.

A) chondrocalcinosis
B) pyrophosphate arthropathy
C) pseudogout
D) telangiectasia

Question 34

Altered bowel and bladder function, impotence, progressive muscle atrophy, and saddle paresthesia are seen with __________.

A) Sjögren syndrome
B) cauda equina syndrome
C) Felty's syndrome
D) Reiter's syndrome

Question 35

Which of the following disorders is associated with monosodium urate crystal deposition in various tissues?

A) CPPD
B) Pseudogout
C) Psoriatic arthritis
D) Gout

Question 36

Vacuum phenomena and Schmorl's nodes are radiographic features of __________.

A) spondylosis
B) degenerative joint disease
C) diffuse idiopathic skeletal hyperostosis
D) spinal stenosis

Question 37

A patient presents with physical examination findings of nail pitting, skin lesions, and soft tissue swelling of an entire digit. Which arthritide is most likely?

A) Enteropathic
B) Psoriatic
C) Reactive
D) Rheumatoid

Question 38

Which of the following explains the correct chronological order of the four stages of gout?

A) Acute arthritic, chronic tophaceous, asymptomatic, intercritical
B) Asymptomatic, intercritical, acute arthritic, chronic tophaceous
C) Acute arthritic, chronic tophaceous, intercritical, asymptomatic
D) Asymptomatic, acute arthritic, intercritical, chronic tophaceous

Question 39

The arthritide associated with disorders of the gut and most commonly related to inflammatory bowel disease (IBD) is __________.

A) Reiter's syndrome
B) ankylosing spondylitis
C) psoriatic arthritis
D) enteropathic arthritis

Question 40

The classic triad associated with Reiter's syndrome includes arthritis, urethritis, and __________.

A) dermatitis
B) conjunctivitis
C) hepatitis
D) balanitis

Question 41

Which of the following types of acquired spinal stenosis would be best evaluated with contrast-enhanced MRI?

A) Ossification of the posterior longitudinal ligament
B) Postsurgical
C) Spondylolisthesis
D) Metabolic

Question 42

A 58-year-old male patient presents with history of intermittent severe pain and redness of the right first metatarsophalangeal joint and elevated blood levels of serum urate. Which sign may be expected on radiographic examination?

A) Pencil in a cup deformity
B) Rat bite erosions
C) Gull wing
D) Overhanging edge

Question 43

Spinal fusion associated with ankylosing spondylitis is often associated with dystrophic calcification in which structure?

A) Ligamentum nuchae
B) Ligamentum flavum
C) Intervertebral disc
D) Interspinous ligament

Question 44

How is hemochromatosis treated?

A) NSAIDs
B) Corticosteroids
C) Phlebotomy
D) Joint aspiration

Question 45

Radiographic findings of hemochromatosis most closely resemble those of __________.

A) hydroxyapatite deposition disease
B) calcium pyrophosphate disease
C) osteoarthritis
D) rheumatoid arthritis

Question 46

The posture most commonly associated with neurogenic claudication can best be described as a combination of ___________.

A) trunk flexion, hip and knee extension
B) trunk, hip, and knee extension
C) trunk, hip, and knee flexion
D) trunk and knee flexion, hip extension

Question 47

In what percent of patients with inflammatory bowel disease would you expect to see sacroiliitis?

A) 3% to 18%
B) 19% to 25%
C) 26% to 40%
D) 41% to 60%

Question 48

Which of the following joints is classically the first to demonstrate erosive changes seen with ankylosing spondylitis?

A) Intervertebral disc
B) Iliofemoral
C) Sacroiliac
D) Metacarpophalangeal

Question 49

Which condition is marked by radiographic findings of severe joint degeneration along with chondrocalcinosis of hyaline and fibrocartilage?

A) Rheumatoid arthritis
B) Pyrophosphate arthropathy
C) Neurotrophic arthropathy
D) Systemic lupus erythematosus

Question 50

What type of signal intensity is expected in the nucleus pulposus of a dessicated intervertebral disc on magnetic resonance imaging examination?

A) High on STIR
B) Low on T2
C) High T1
D) High T2

Question 51

Which of the following causes of spinal stenosis is more common in women?

A) Degenerative spondylolisthesis
B) Idiopathic
C) Endocrine
D) Posttraumatic

Question 52

The most common cause for neuropathic arthropathy in the foot and ankle is __________.

A) syringomyelia
B) congestive heart failure
C) diabetes
D) liver failure

Question 53

Purely productive (nonerosive) enthesopathic hyperostosis involving the pelvis, calcaneus, and patella is associated with which of the following conditions?

A) Psoriatic arthritis
B) Diffuse idiopathic skeletal hyperostosis
C) Neuropathic arthropathy
D) Enteropathic arthropathy

Question 54

Swan-neck, boutonniere, and hitchhiker are some characteristic deformities seen with which inflammatory joint disease?

A) Juvenile idiopathic arthritis
B) Rheumatoid arthritis
C) Systemic lupus erythematosus
D) Reactive arthritis

Question 55

A 22-year-old male patient presents with foot pain. Radiographic examination reveals fluffy periosteal new bone formation at the origin of the plantar fascia and Achilles insertion. Which infectious organism is most likely linked to triggering this reaction?

A) Chlamydia trachomatis
B) Yersinia
C) Salmonella
D) Streptococcus pyogenes

Question 56

A patient presents with nonerosive, reversible joint deformity of the digits of the hands. Which of the following diseases likely preceded this condition?

A) Rheumatic fever
B) Rheumatoid arthritis
C) Chronic diabetes mellitus
D) Alcoholism

Question 57

Which of the following joints is most likely a site of nontraumatic osteoarthritis?

A) Hip
B) Metatarsophalangeal
C) Shoulder
D) Ankle

Question 58

Ossification of only the supraspinous ligament is responsible for which sign observed in ankylosing spondylitis?

A) Trolley tract
B) Train track
C) Railroad track
D) Dagger

Question 59

Which of the following radiographic findings best differentiates hydroxyapatite deposition disease (HADD) from calcium pyrophosphate deposition disease (CPPD)?

A) Bare area erosions
B) Juxtaarticular soft tissue swelling
C) Juxtaarticular osteopenia
D) Periarticular soft tissue calcification

Question 60

Which of the following findings of psoriatic arthropathy is not present in patients with rheumatoid arthritis?

A) Proximal interphalangeal joint involvement
B) Bony erosions
C) Normal bone density
D) Joint effusion

Question 61

Radiographic examination of the shoulder in a 34-year-old female reveals complete resorption of the proximal humerus with a sharp transverse demarcation at the proximal metadiaphysis. Which of the following conditions is the most likely cause?

A) Diabetes
B) Spinal cord trauma
C) Amyotrophic lateral sclerosis
D) Syringohydromyelia