Joint Disorder MCQs

1. MCQs OnInterviewing, PhysicalExamination, and Investigations of
patients with musculoskeletaldisorders. Jointinflammation syndrome.
Degenerative jointdisorders syndrome.
1). Сomplaints of the patient with the Joint inflammation syndrome:
1. Joint pains are most marked in the early morning and after inactivity
2. chest pain
3. headache, poor concentration
4. Joint pain particularly at night
5. Loss of hair
2).Сomplaints of the patient with the Degenerative joint disorders syndrome:
1. chest pain
2. Joint pains are most marked in the early morning and after inactivity
3. deformity of joints
4. localized redness of the overlying skin
5. localized swelling
1. Sweats and chills
2. localized swelling
3. Audible crepitation
4. Tremor
5. Calcium deposition
4). Which following changed blood analyses should be used for confirmation of the Joint
inflammation syndrome ?
1. Hb increased level
2. Decreased Indirect bilirubin
3. leukocytosis, increased ESR
4. LE cells
5. proteinuria
5).Сlinical signs of the Joint inflammation syndrome all(everything), except:
1. Joint pain
2. Fever

3. Sweats and chills
5. Ceratodermy
6).Lab. tests characteristic of the Joint inflammation syndrome all(everything), except:
1. The total blood count (leukocytosis )
2. C-reactive protein (CRP) > 6 mg/L
3. Serum proteins (а-2-globulin>10,5%; а-globulin>19%)
4. The total blood count ( increased ESR)
5. The total blood count ( decreased ESR)
7). Radiological signs characteristic of the Joint inflammation syndrome all(everything), except
1. Soft tissue swelling
2. joint-space narrowing
3. proliferation of new bone (marginal osteaphytes)
4. subluxation
5. joint erosion
8).Сlinical signs of the Degenerative joint disorders syndrome:
1. Joint pains are mainly related to movement
2. Regional periarticular pain
4. localized swelling (bursitis, tenosynovitis)
5. Localized increasing warmth
9).Radiological signs of the degenerative joint disorders syndrome:
1. Soft tissue swelling
2. joint-space narrowing
3. focal joint-space narrowing, subchondral sclerosis
4. decreased bone density
5. bony ankylosis
10).Сlinical signs of the Joint inflammation syndrome:
1. Joint pain
2. Redness of the overlying skin, swelling due to the synovitis, effusion
3. The classic butterfly (malar) facial rash

4. Loss of hair
5. Ceratodermy
11). Lab. tests characteristic of the Joint inflammation syndrome all(everything), except:
1.The total blood count (leukocytosis )
2.C-reactive protein (CRP) > 6 mg/L
3.Serum proteins (а-2-globulin>10,5%; а-globulin>19%)
4.The total blood count ( increased ESR)
5. increased cholesterol in the blood
12). Lab. tests characteristic of the degenerative joint disorders syndrome :
2. The total blood count (increased ESR)
4.The total blood count ( decreased ESR)
5.Total blood count and ESR- normal results
5. Increased blood glucose
5. increased cholesterol in the blood
15). Radiological signs characteristic of the degenerative joint disorders syndrome:
1.marginal osteaphytes
2.subchondral sclerosis
3.osteoporosis
4.all answers are correct

5.focal joint-space narrowing
1. bone swelling or deformity of joints
2. deviation of the fingers
3. limitation of the function of joints
4. audible crepitation
5. all answers are correct
17). Patient, 36 years women, is suffering from Rheumatoid arthritis during more than 15 years,
in urine it is found outprotein more than 3,5g/d. Is this due to:
1. A chronic pyelonephritis
2. Chronic glomerulonephritis
3. Interstitial nephritis
4. Polycystic kidney disease
5 .Amyloidosis
18). Choose the most positive, proved a combination of signs for Rheumatoid arthritis
diagnosis:
1. "Migratory” arthralgias, involving in pathological process mainly large joints
2. Persistent arthralgias, joints blockage, osteophytes
3. Acute monoarthritis of the first metatarsophalangeal joint
4. Symmetry of joints damage, morning stiffness, ankylosis formation
19). 56 y. female complains of pain and swelling in the hands, knee joints. Physical examination has
revealed exudative - proliferative changes in the named above joints, ulnar deviation, nodules on the
back ofthe elbow joints. Which X- raychanges will be found on the hands X-ray film?
1.Osteoporosis
2.Osteoporosis + intrajoint space narrowing

3.Osteoporosis + intrajoint space narrowing + massive erosions
4.Ankylosis
5.Osteophytes
20).65 y/old obese woman(BMI index = 35) complains of pain in the knee joints, mostly after the
overload, in the first half of the night, sometimes is occurred "blockage"in the knee. Which X-ray
findings are available?
1.Osteoporosis
2.Erosions
3.Ankylosis
4.Osteophytes + intrajoint mouse
5.Osteoporosis+massive erosions
Case study
1). 65 y/old obese woman (BMI index = 35) complains of pain in the knee joints, mostly after
the overload, in the first half of the night, sometimes is occurred "blockage" in the knee. Which
X-ray findings are available?
2). 15 y/old school girl complains of fever, migrant pain in the knee, elbow, shoulder.Swelling
in the joints disappeared in 10 days. Anamnesis taking is revealed, that she was ill 3 weeks ago
with faryngitis with tonsils and neck lymph nodes enlargement. Which syndrome is more
probable?
3). 53 y/ old female with enlargement of bone tissues in the distal interfalangeal joints of both
hands was referred to the blood tests. Which blood analyses should be checked in this case?
4). 57 y/old obese woman (BMI index = 40) complains of pain in the knee joints, mostly after
the overload, in the first half of the night, sometimes is occurred "blockage" in the knee. Which
syndrome will be more available?

5). 56 y/old female complains of pain and swelling in the hands, knee joints. Physical
examination has revealed exudative - proliferative changes in the named above joints, ulnar
deviation, nodules on the back of the elbow joints. Which X- ray changes will be found on the
hands X-ray film?
6). 42 y/old woman complains of pain and swelling in the hands, knee joints. Physical
examination has revealed exudative - proliferative changes in the named above joints, ulnar
deviation, nodules on the back of the elbow joints. Which syndrome will be more available?
7). Patient, 58 y/old male, in the family physician office complains of the extremely acute pain in
the knee joint with bright redness, sharp joint pain, which worsen after rest, and are relived by
movements and after inactivity. Which syndrome will be more available?
8).The patient was 42 years old, 3 months ago after flu noted the appearance of moderate pain
and swelling II and III pyastnofalangovyh joints, II, III, IV of the proximal interphalangeal joints
of both hands, wrist joints, morning stiffness for 6 hours, general weakness, increase in body
temperature to 37.3 ° C. Which syndrome is more probable?
9).Patient G., 41 years old, admitted to the hospital with complaints of pain in the small joints of
the hands and feet, knee, ankle joints, morning stiffness in the joints for 3 hours, general
weakness. Which syndrome is more probable?
10).A 32-year-old woman presents with joint pain. She describes diffuse pain throughout her
hands,knees, and neck and states that “she aches all over.” She indicates that pain is always
present but is worse after activity. She has morning stiffness lasting approximately 1 hour. These
symptoms have been present for approximately 3 months.Results of physical examination are
normal. A joint examination reveals normal findings, with the exception of numerous symmetric
tender points. Which syndrome will be more available?

2. MCQs On Inflammatory periarticular lesions syndrome. Skeletalmuscle
inflammation syndrome.
1).Dense oedema, induration in the Systemic sclerosis occurred mostly due to
1. Chondrocytes activation
2. Proteoglycans loss
3. Collagen overproduction, especially nonmaturated
4. Calcium deposition
5. Protein and carbohydrates metabolism disturbancies
2). Сlinical signs of the Skeletal muscle inflammation syndrome:
4. Immobile face, ptosis
5. Fever
3).Which following changed blood analyses should be used for confirmation of the Systemic
connective tissue inflammation syndrome ?
2. Anemia, leucopenia, trombocytopenia
3. Increased serum proteins
4. Decreased Indirect bilirubin
5. Trombocytosis
4). Lab. tests characteristic of the Skeletal muscle inflammation syndrome all(everything),
except:
1. The total blood count (leukocytosis )
2. C-reactive protein (CRP) > 6 mg/L
3. Serum proteins (а-2-globulin>10,5%; а-globulin>19%)
4. Serum muscle enzymes (AST>0.78 m K/L; creatine phosphokinase>0.25 mmol/L;
MM>96%)
5. The total blood count ( decreased ESR)
5).Radiological signs characteristic of the Skeletal muscle inflammation syndrome:
1. Calcified deposits in the involved muscles
2. osteoporosis

3. new bone formation, calcification of ligaments
4. Calcified deposits in skin or muscles
5. joint erosion
6).Сlinical signs of the Skeletal muscle inflammation syndrome, everything , except, :
1. Swelling of the muscles
2. Muscle atrophy
4. Dispnoe due to dysfunction of both intercostals and diaphragm
5. Fever
7). What represents tophus?
1. Osteophytes
2. Urate crystals depositions in the tissues
3. Inflammatory granulemas
4. Hypodermic consolidation
5. Calcinosis
8).53 y old female with enlargement of bone tissues in the distal interfalangeal joints of both hands
was referred to the blood tests. Which blood analyses should be checked in this case?
1. LE test
2. Rheumatoid factor
3. a2 - globulin
4. Antinuclear factor
5. ESR
9). If the diagnosis of the Systemic sclerosis is defined with lung damage, which radiologic
findings more common?
1. Infiltration

2. Nodules
3. Bilateral basal sclerosis
4. Diaphragm high level
5. Diaphragm low level
10). Which laboratory test mil be positive in the Gout case?
1. Uric acid crystals
2. LE-test
3. Antinuclear factor
4. Antistreptococcal antibody
5. BUN and creatinin
11). 15 y.old school girl complains of fever, migrant pain in the knee, elbow, shoulder.Swelling in
the joints disappeared in 10 days. Anamnesis taking is revealed, that she was ill 3 weeks ago with
faryngitis with tonsils and neck lymph nodes enlargement. Which diagnosis is more probable?
1.Systemic lupus erythematosis
2.Rheumatic fever
3. Gonococcal arthritis
4. Osteoarthritis
5. Systemicsclerosis
Case study
1). Patient, 49-year-oldmale,inthe familyphysician office complains of the extremely acute pain in
the 1-st metatarsophalangeal jointwith bright redness. He has no previous history of the arthritis. Last
days his diet was enriched with fat food and alcohol. Which syndrome will be more available?

2).A 52-year-old man presents with a painful right great toe. Pain awoke him from sleep, and
he noticed his was red and swollen. He has no history of this condition and denies any recent
trauma to this toe. His history is pertinent for hypertension for which he recently began taking a
diuretic. He does not smoke but admits to binge drinking. On physical examination, he reveals
mild distress secondary to pain. He has a reddened face and 1-cm chalky white papules on the
helix of his ears. His right first metatarsophalangeal joint is erythematous, swollen, tender, and
hot. He cannot flex his toe because of pain. The erythema extends to his ankle, and the ankle
joint is tender and warm but does not reveal an effusion. Which syndrome will be more
available?
3). Patient, 40-year-old male pain worse on use, relived by rest. Pain non-progressive and
reproduced by just or a few movements. Apart from the pain, he is feels normal. Localized
periarticular swelling, localized redness of the overlying skin, localized increasing warmth.
Which syndrome will be more available?
4). A 28-year-old woman presents with complaints swelling of the muscles,dispnoe,
breathlessness, limitation of the function of joints, morning stiffness. Symptoms first occurred
about 1 year ago. She was not treated. Physical examination : height is 173cm ,weight is
51kg. Immobile face, ptosis.
Limited to one plane active movement . Selective stress pain in direction of use of muscle. Lab
Tests: Total blood count - anaemia, leukocytosis, increased ESR, C-reactive protein 11 mg/L.
AST - 1.78 mK/L; creatine phosphokinase-0.56 mmol/L.
5). 42 y/old woman complains of pain in the knee joints (Usage pain – worse on use, relived by
rest). Pain non-progressive and reproduced by just or a few movements. Apart from the pain, the
patient feels normal. Localized periarticular swelling. Localized periarticular tenderness away
from the joint line. Which syndrome will be more available?
6). 21 y/ old , woman: inspection of involved periarticular structure at rest: localized redness of
the overlying skin, localized swelling, localized increasing warmth, localized periarticular
tenderness away from the knee joint line.Which syndrome should be established?

3. MCQs On Systemic connective tissue inflammation syndrome.
1).Complaints of the Systemic connective tissue inflammation syndrome all(everything),
except: :
1. dysphagia, stomach-ache, nausea, vomiting
2. chest pain
3. headache, poor concentration
4. Rest pain
5. tremor and sweating
2).Lab. tests characteristic of the Systemic connective tissue inflammation syndrome
all(everything), except:
1. The total blood count (leucopenia or leukocytosis)
2. LE cells
3. persistent proteinuria > 0,5 g/day
4. The total blood count (thrombocytopenia)
5. decrease in blood glucose levels
3).What are the three main diseases of concern to the syndrome Systemic connective tissue
inflammation syndrome :
1. Systemic lupus erythematosus
2. Scleroderma
3. Diabetes mellitus
4. Gout
5. Dermatomyositis
4).Сlinical signs of the Systemic connective tissue inflammation syndrome:
3. Photosensitivity
4. The classic butterfly (malar) facial rash
5. Deformity of joint
5).Сlinical signs of the Systemic connective tissue inflammation syndrome:
1.Joint pains are mainly related to movement

2.Joint pain particularly at night
3.loss of weight
4.The classic butterfly (malar) facial rash
5.Deformity of joint
6). Сomplaints of the patient with the Inflammatory periarticular lesions syndrome (IPLS)
1.chest pain
2. tremor
3.usage pain – worse on use, relived by rest
4. audible crepitation
5. loss of hair
7). Lab. tests characteristic of the degenerative joint disorders syndrome :
2. The total blood count (increased ESR)
4.The total blood count ( decreased ESR)
8). Lab. tests characteristic of the Systemic connective tissue inflammation syndrome all
(everything), except:
1.The total blood count (leucopenia or leukocytosis)
3.LE cells
4.persistent proteinuria > 0,5 g/day
5.The total blood count (thrombocytopenia)
9). The periarticular structures include all (everything), except:
1. the tendons
2. the ligaments
3. the bursas, fascias
4. the aponevrosis
5. the muscles
10). Сlinical signs of the Systemic connective tissue inflammation syndrome :

1.all answers are correct
2.oral ulcers
3.pathological bone fracture
4.loss of hair
5.skin rush as a result of unusual reaction to sunlight
11).What from listed below statements concerning Systemic Lupus Erhythematosus (SLE) is
more correct?
1. Kidneys damage are rarely occured
2. Antinuclear antibodies revealing are highly specific and sensitive characteristic laboratory
criteria
3. Effective methods of treatment are absent
4. The arthritis presence excludes the Systemic Lupus Erhythematosus (SLE) diagnosis
5. Megaloblastic type haemopoiesis is determined by the sternal puncture
12).35y.oldfemale is suffering from numbness and whitening ofthe fingertips due to exposure to cold,
skin hypo- and hyper pigmentation, difficulties to swallow solid food without fluid, which diagnosis
more probable?
1. Rheumatic fever
2. Osteoarthritis
3. Dermatomyositis
4.Systemic lupus erythematosis
5. Systemic sclerosis
13).21 y- o, black womanafter the long time exposure to the sun complains of the erythema appearance
on the nose, cheeks, painand swelling in the joints, pain in the chest, high temperature, weight loss.
Radiologically diaphragm high level, effusion in the pleura! cavity, pericardium has beenrevealed.
Which diagnosis should be established?
1. Rheumatic fever
2. Tuberculosis

3. Sarcoidosis
4. Systemic lupus erythematosis
5. Systemic sclerosis
14)."CREST" syndrome includes all, except
1. Calcinosis
2. Rheunauld phenomenon
3. Erythema
4. Sclerodactyly
5. Telangioectasia
15).Whichfollowing changed blood analyses should be used for confirmation of the diagnosis
Systemic lupus erythematosis ?
2. Аnemia, leucopenia, trombocytopenia
3. leukocytosis
4.DecreasedIndirect bilirubin
5. Trombocytosis
Case study
1). 21 y/ old , woman after the long time exposure to the sun complains of the erythema
appearance on the nose, cheeks, pain and swelling in the joints, pain in the chest, high
temperature, weight loss. Radiologically diaphragm high level, effusion in the pleura! cavity,
pericardium has been revealed. Which syndrome should be established?
2). 32 y/ old female with butterfly facial rash is raised and painful or pruritic and occurs in
photosensitive distribution that spares the nasolabial folds.Which blood analyses should be
checked in this case?

3). 35y.old female is suffering from numbness and whitening of the fingertips due to exposure to cold,
skin hypo- and hyper pigmentation, difficulties to swallow solid food without fluid. Which syndrome
will be more available?
4). Disease characterized by the association of immunological abnormalities with pathological
changes affecting a number of organ systems. The main clinical features include fever, rashes
and arthritis, as well as renal, pulmonary, cardiac and neurological involvement, the renal
changes being very important in assessing the prognosis. Skin involvement may include
cutaneous erythema. Which syndrome will be more available?
5).A 34-year-old woman who is a school teacher presents with symptoms of ankle, knee, and
wrist pain for 4 weeks. She describes the onset of a maculopapular rash on her chest a few days
before her joint symptoms. Which one of the following organisms is most likely responsible for
this presentation?
6). A 24-year-old woman. At her first visit to unit, the patient reported symptoms compatible
with Raynaud's phenomenon. A physical examination detected bruising on the patient's arms and
legs, but no other abnormalities. Repeat blood tests confirmed the presence of thrombocytopenia;
all other test results—including those for gamma globulins and complement levels—fell within
normal ranges. On autoantibody screening, the patient tested positive for ANA. An
echocardiogram, chest X-ray and abdominal scan showed no abnormalities. Nailfold digital
capillaroscopy showed minor capillary changes not specific for scleroderma. Which syndrome
will be more available?

Synovial Fluid
Volume.The amount of fluidcontainedinjointsisusuallysmall.The knee jointnormallycontainsupto
4 mL of fluid. The volume of the aspirate isusuallyrecordedatbedside,butsome laboratoriesmay
include volumeintheirreportsaswell.
■ Colorand clarity.Normal synovial fluidiscolorlessandclear.Otherappearancesmayindicate various
disease states.Yellow/clearsynovial fluidsare typical innoninflammatoryeffusions,whereas
yellow/cloudyfluidsusuallyinvolve aninflammatoryprocesses.A white/cloudysynovial fluidmay
containcrystals;and synovial fluidthatisred,brown,or xanthochromicindicateshemorrhage intothe
joint.Inaddition,synovial fluidmaycontainvarioustypesof inclusions.Freefloatingaggregatesof tissue
appearas rice bodies.Rice bodiesare seeninrheumatoidarthritis(RA)andresultfromdegenerated
synoviumenrichedwithfibrin.

■ Viscosity.Synovial fluidisveryviscousdue toitshigh concentrationof polymerizedhyaluronate.A
stringtestcan be usedto evaluate the level of synovial fluid viscosity.Afterremovingthe needle orcap
fromthe syringe,synovial fluidisexpressedintoatesttube one dropat a time.Normal synovialfluid
will forma “string”approximately5cm longbefore breaking.In addition,the fluidmayclingtothe side
of the testtube ratherthan runningdownto the bottom.Synovial fluidswithpoorviscositywill form
shorterstingsrequire thatsynovial fluidspecimensbe placedinspecimen containersappropriate forthe
testsordered.A heparinized tube ispreferabletoethylenediaminetetraaceticacid(EDTA) orother
anticoagulantsforcellscounts; sterilecontainers formicrobiologytesting;andplaintubesare normally
usedforchemistryandimmunologytestingof synovialfluid.
Synovial fluidspecimensshouldbe handledlike STATspecimensanddeliveredimmediatelytothe
laboratoryfortestingto avoidalterationof chemical constituents,celllysis,andproblemsin
microorganismdetectionandidentification.If aglucose testisto be performed,the patientshouldbe
fastingforat least6 hourspriorto collectionof jointfluid.A 6-hourfastis necessarytoestablishan
equilibriumbetweenplasmaandjointglucose levels.(3cm) or run out of the syringe anddownthe side
of the testtube like water.
■ Clotting.Clottingof synovial fluidcanresultwhenfibrinogenispresent.Fibrinogenmayhave entered
intothe synovial capsule duringdamage tothe synovial membrane orasa resultof a traumatictap.
Clotsinspecimensinterferewithperformance of cell counts.Depositingpartof the specimenintoa
tube containingheparinmayhelpavoidclottingof synovial fluid.
■ Mucin clot. The mucinclottest,alsoknownasRope’stest, isan estimationof the integrityof the
hyaluronicacid–proteincomplex(mucin).Normal synovialfluidformsatightropyclot uponthe addition
of aceticacid.The procedure formucinclotvariesamonglaboratoriesasevidencedbydifferingfluidto
acid ratiosappearinginvarioustexts.Clinical laboratoryprofessionalsshoulduse the procedure
adoptedbytheirlaboratories.A goodmucinclotindicatesgoodintegrityof the hyaluronate.A poor
mucinclot,one that breaksup easily,isassociatedwithdestructionordilutionof hyaluronate.
CHEMICAL EXAMINATION
■ Protein.Synovial fluidcontainsall proteinsfoundin
■ Glucose.Synovial fluidglucose levelsshouldbe interpretedusingserumglucoselevels.A fasting
specimen shouldbe usedoratleastone 6–8 hours postprandially.Normally,synovial fluidglucoselevels
are lessthan10 mg/dL lowerthanserumlevels.Jointdisordersthatare classifiedasinfectious
demonstrate large decreasesinsynovialfluidglucoseandcanbe as much as 20–100 mg/dL lessthan
serumlevels.Othergroupsof jointdisordersdemonstratealessof a decrease insynovial fluidglucose,
0–20 mg/dL.
■ Uric acid. Synovial fluiduricacidnormallyrangesfrom 6to 8 mg/dL.The presence of uricacidin
synovial fluidishelpful indiagnosisgout.Usually,crystal identificationisusedforthisdetermination,

but synovial fluiduricacidlevelsmaybe performedinlaboratoriesthatdonota have lightpolarizing
microscope.
■ Lactic acid. Lactic acid israrely measuredinsynovial fluidbutcanbe helpful indiagnosingseptic
arthritis.Normally,synovialfluidlactate islessthan25 mg/dL butcan be as highas 1000 mg/dL inseptic
arthritis.
■ Lactate dehydrogenase.Lactate dehydrogenase (LD) can be elevatedinsynovial fluid,while serum
levelsremainnormal.Synovial fluidLDlevelsare usuallyincreasedinRA,infectiousarthritis,andgout.
The neutrophils thatare increasedduringthe acute phase of these disorderscontribute tothis
increasedLDlevel.
■ Rheumatoid factor. Rheumatoidfactor(RF)is anantibodytoimmunoglobulins.RFispresentinthe
serumof most patientswithRA,whereasjustmore thanhalf of these patientswill demonstrateRFin
synovial fluid.However,if RFisonlybeingproducedbyjointtissue,synovial fluidRFmaybe positive
while the serumRFisnegative.
Total leucocyte count in joint diseases
False-positive RFcanresultfromotherchronicinflammatorydiseases.
Disease Category TLC cells/cumm
1 Osteoarthritis 150 – 1200
2 Rheumatoidarthritis 3500 – 18,500
3 Septicarthritis 50,000– 62,000
4 TB arthritis 8000 – 12,000
5 Gout 4500 -
6 Traumatic arthritis 2000 – 4550

Joint Disorder MCQs

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