Rheumatology

A 38-year-old male presents with multiple peripheral joint swelling and pain, recurrent for over 4 years, accompanied by morning stiffness that improves with activity. Laboratory tests show RF(+). A diagnosis of rheumatoid arthritis (RA) is considered. Which of the following is INCORRECT about RA joint involvement?

A 20-year-old female presents with pitting edema of the eyelids and both lower extremities, accompanied by oliguria for the past month. Laboratory tests show: serum albumin (Alb) 27g/L, A/G ratio 0.8, creatinine 133μmol/L, urinary protein (++++), 24-hour urinary protein quantification 5g, ANA titer 1:640, and anti-RNP antibodies. Which test is most significant for assessing disease activity?

A 32-year-old woman reports easy hair loss while combing for the past 3 years, recurrent painless oral mucosal ulcers, and 2 years of cold-induced finger pallor progressing to cyanosis followed by normalization. On history, she develops facial erythema after sun exposure. SLE is suspected. Which laboratory finding is most diagnostic?

A 24-year-old woman presents with high fever and arthralgia for half a month, edema for 10 days, blood pressure (BP) 150/90 mmHg. Over the past 7 days, she developed apathy and hypophonia. For the last 3 days, her urine output was 200-400 ml/day, with urinary protein (+++) and urinary red blood cells (RBCs) 15-20/HP. Hemoglobin (Hb) 80 g/L, C3 0.42 g/L, albumin (Alb) 23 g/L, serum creatinine (Scr) 400 μmol/L. Which test is LEAST helpful for diagnosis?

The Schober test is used to assess

A 51-year-old woman presents with xerostomia and dry eyes for 1 year, intermittent bilateral parotid gland swelling, and scattered red rashes on both lower limbs for 1 month, accompanied by generalized arthralgia without obvious joint swelling. Physical examination reveals scattered rice-sized red rashes on both lower limbs that do not blanch on pressure. Lab tests: normal UA, ESR 120mm/h, RF positive 1:640, ANA positive 1:320, elevated α-globulin, IgG, IgM, and IgA. Which of the following tests is most significant for diagnosis?

A 58-year-old woman presents with 1 week of bilateral lower limb edema, oliguria, nausea, vomiting, and blurred vision. BP 190/138 mmHg. Facial expression rigidity, thickened hand skin, ESR 48 mm at the end of the first hour. Urinary protein (++) (3-4 g/d), urine sediment RBC 5-8/HPF, Scr 600 μmol/L. Bilateral enlarged kidneys. The clinical diagnosis is:

A 40-year-old female patient presents with a 5-year history of cold-induced purple-white discoloration and pain in both hands, along with dysphagia for 2 years and generalized swelling sensation. Blood pressure (BP) is 150/100 mmHg for the past week. Physical examination reveals thickened and hardened skin on the hands and abdomen, with reduced facial skin wrinkles. Laboratory tests show proteinuria (++), urinary RBCs 10-20/HP, blood urea nitrogen (BUN) 11 mmol/L, serum creatinine (Scr) 240 μmol/L, antinuclear antibody (ANA) positive, and other antibodies negative. Based on the clinical features, which type of systemic sclerosis (SSc) should be considered?

A 62-year-old female presented with bilateral lower extremity edema, oliguria, nausea and vomiting, and blurred vision for 1 week. Blood pressure was 190/140 mmHg. She had facial expression rigidity and thickened hand skin. ESR was 48 mm at the end of the first hour. Urinary protein was 3 g/day, urine sediment showed RBCs 5-8/HPF, and serum creatinine was 610 μmol/L. Ultrasound revealed enlarged kidneys. The clinical diagnosis is:

A 45-year-old woman complains of morning stiffness in the interphalangeal and metacarpophalangeal joints of both hands. After 4 months, she develops pain and swelling during movement. Treatment with aspirin, other non-steroidal anti-inflammatory drugs (NSAIDs), and gold compounds has been ineffective, with progressive worsening of symptoms including fatigue, decreased appetite, weight loss, irregular fever, movement disorder in both elbow joints, elevated serum gamma globulin, rheumatoid factor (RF) positive (++), erythrocyte sedimentation rate (ESR) 60 mm at the end of the first hour, and elevated C-reactive protein (CRP). The most likely diagnosis is:

A 45-year-old woman complains of morning stiffness in the interphalangeal and metacarpophalangeal joints of both hands, followed by pain and swelling during movement after 4 months. Treatment with aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and gold compounds was ineffective, and her condition gradually worsened with fatigue, decreased appetite, weight loss, irregular fever, movement disorder in both elbow joints, elevated serum gamma globulin, rheumatoid factor (RF) positive (++), erythrocyte sedimentation rate (ESR) 60 mm at the end of the first hour, and elevated C-reactive protein (CRP). The most likely diagnosis is:

A 30-year-old female patient presents with low-grade fever, weight loss, and polyarthralgia over the past 3 months. Physical examination reveals mild pitting edema in both lower limbs. Urinalysis (UA) shows urinary protein (++), and 10-20 red blood cells (RBC)/HP. p-ANCA is positive, while other autoantibodies are negative. Renal biopsy pathology demonstrates necrotizing inflammatory changes in small arteries without immune complex deposition. Renal angiography shows no vascular stenosis. The most likely diagnosis is:

A 60-year-old woman presents with intermittent pain in the distal interphalangeal joints of both hands for 3 years, accompanied by morning stiffness lasting 30 minutes. Physical examination reveals Heberden's nodes on the fingers. The most likely diagnosis is:

Elderly female with rash, limb muscle weakness for 1 month, dysphagia, and chest tightness for half a month. Physical examination reveals violaceous eyelid plaques with periorbital edema, coarse breath sounds in both lungs, fine rales in lower lungs, tenderness in left hand 2nd and 4th PIP joints, muscle strength grade 3 in upper limbs, and grade 2 in lower limbs. Based on analysis, the preliminary diagnosis is:

A 55-year-old woman presents with pain in both finger joints for 2 years, intermittent and progressively worsening. Over the past 6 months, she developed knee joint pain, especially noticeable when climbing stairs. For the past month, she has had significant right knee joint swelling, limited mobility, and difficulty walking. Physical examination reveals distal interphalangeal joint bony hypertrophy with Heberden's nodes, right knee joint swelling with a positive patellar tap test (ballottement test), and obvious left knee crepitus. What is the first-choice diagnostic test for this patient?

A 48-year-old woman has experienced heaviness in both shoulders, weakness when lifting arms, and reduced walking endurance for 2 months. Erythrocyte sedimentation rate (ESR) is 47mm at the 1st hour. The typical clinical manifestation of polymyositis is:

A 38-year-old male presents with a 2-year history of low-grade fever and fatigue. Over the past 6 months, he developed myalgia in limb joints and muscles, difficulty climbing 3 floors, and red rashes on eyelids, nasal bridge, and cheeks. He also reports dysphagia with solid foods. Physical exam reveals periorbital edema and violaceous erythema on eyelids, nasal bridge, cheeks, distal interphalangeal joints, and periungual skin. The best diagnostic test is:

An elderly female presents with rash, limb myasthenia for 1 month, dysphagia, and chest tightness for half a month. Physical examination reveals violaceous patches on the upper eyelids with periorbital edema, coarse breath sounds in both lungs, fine moist rales in the lower lungs, tenderness in the left hand's 2nd and 4th PIP joints, muscle strength grade 3 in upper limbs, and grade 2 in lower limbs. Investigations show weakly positive ANA (1:100), negative ENA profile, elevated CK (4487 U/L), and chest CT scan suggesting pulmonary inflammatory changes. Dermatomyositis (DM) with pulmonary inflammation is suspected. To improve prognosis, what must be excluded concurrently when diagnosing DM?

A 40-year-old woman presents with swelling and pain in both fingers for 3 years, accompanied by Raynaud's phenomenon. Examination reveals claw-like deformity of the fingers and skin thickening and hardening. Laboratory tests show antinuclear antibody (ANA) positive and anti-Scl-70 antibody positive. The most likely diagnosis is:

A 36-year-old woman presents with irregular low-grade fever and arthralgia for over 1 year, edematous fixed erythema on cheeks for 6 months (worsens with sun exposure), xerostomia, difficulty opening mouth, and recent dysphagia. She also reports finger pallor and pain on cold exposure. Laboratory tests: ANA(+), ESR 150mm/h, anti-dsDNA antibody (+), anti-Scl-70 antibody (+). Barium swallow shows poor esophageal motility.

Which antibody is a marker for the diagnosis of systemic lupus erythematosus (SLE)?

A 24-year-old male developed gross hematuria 4 hours after fever onset. Blood pressure (BP) 120/80 mmHg. Urinary protein (++++), urinary red blood cells (RBCs) covering the entire field/HP (90% dysmorphic RBCs). Albumin 40 g/L. Immunoglobulin A (IgA) 4.2 g/L.

A 36-year-old woman presents with hair loss over the past 2 years, recurrent painless oral ulcers, cold-induced finger pallor/pain/purplish discoloration (resolving with warmth), malar rash, and urinary protein (++). Which condition is most likely?

A 42-year-old woman presents with intermittent fever for 1 month (peak 40.1°C, nadir 37.5°C), most pronounced in the afternoon, accompanied by arthralgia in limbs and a rash on the face and anterior chest that disappears when afebrile. Joint pain improves when fever subsides. Lab findings: ESR 82mm/h, WBC 16.0×10⁹/L, elevated serum ferritin, ANA(-). The most likely diagnosis is:

The pathological basis of joint destruction, deformity, and dysfunction in rheumatoid arthritis is

A 38-year-old male presents with recurrent swelling and pain in multiple peripheral joints for over 4 years, accompanied by morning stiffness that improves with activity. Laboratory tests show RF(+). A diagnosis of rheumatoid arthritis is considered. Which of the following statements about rheumatoid arthritis is incorrect?

A 35-year-old woman presents with recurrent pain in the proximal interphalangeal, wrist, elbow, and knee joints with morning stiffness for 3 years. One month ago, she developed fever (39°C), alopecia, and oral ulcers. Examination shows mild swelling of both wrists. Lab results: WBC 2.5×10⁹/L, PLT 74×10⁹/L, urinary protein (++), ESR 80mm/1st hour, elevated CRP, RF 1:64, ANA 1:320. Wrist X-rays are normal. The most likely diagnosis is:

A 34-year-old woman presents with irregular fever for 6 months, accompanied by joint pain, and fixed raised erythema on both cheeks for 3 months. SLE is suspected. Which of the following findings would NOT support the diagnosis of SLE?

A 29-year-old woman presents with joint pain for 1 year and scattered petechiae for 2 months accompanied by menorrhagia. Laboratory tests: erythrocyte sedimentation rate (ESR) 100mm/h, normal ASO, hemoglobin (Hb) 86g/L, platelets (PLT) 51×10⁹/L, antinuclear antibody (ANA) granular pattern positive, proteinuria (+++). Diagnosed with systemic lupus erythematosus (SLE), which of the following statements about prognosis is INCORRECT?

A 30-year-old female with a 12-year history of proteinuria and intermittent hematuria presents with gross hematuria 2 days after a cold. Blood pressure is 146/94 mmHg, urine protein ++++ (5g/d), urine sediment shows full-field dysmorphic RBCs/HP, normal renal function, serum albumin 20g/L, hemoglobin 70g/L, ANA 1:80, C3 0.5g/L. The most likely diagnosis is:

A 20-year-old female presents with persistent fever for 5 days, facial edematous skin lesions, swollen and painful knee and ankle joints, lower extremity edema, and scattered petechiae. Laboratory tests: ESR 100 mm/h, hemoglobin 80 g/L, reticulocytes 10%, Coombs test (+), platelets 40×10⁹/L, urinalysis: protein (++), RBC 5-10/HP. The most likely diagnosis is:

A 19-year-old female presents with remittent fever for 7 days and symmetric edematous erythema on both cheeks for 2 days, with erythema on fingertips and periungual areas. Laboratory tests: Hb 90 g/L, WBC 3.4×10⁹/L, urine protein (+++), 0-2 casts/HP, ANA(+), LE cells (+). Diagnosed with SLE. What is the first-line treatment?

A 40-year-old woman with a 5-year history of arthritis, photosensitivity, alopecia, and urinary protein (+). For the past month, she has had pitting edema of both lower limbs, oliguria, BP 168/100 mmHg. Lab findings: urinary protein (++), red blood cells 10-15/HPF, Hb 100g/L, Scr 230 μmol/L, ANA 1:640 (membranous pattern), anti-Smith antibody positive, serum C3 0.5 g/L. The most likely diagnosis is:

A 37-year-old male had swelling and pain in the finger joints of both hands two years ago, which resolved with symptomatic treatment. Although he experienced arthralgia afterward, he could work normally without systematic examination or treatment. Two months ago, he developed fever (~38°C), fatigue, and gradually worsening shortness of breath with minimal cough. Physical examination: spindle-shaped swelling of the proximal interphalangeal joints of both middle fingers, slightly impaired function of both wrists with tenderness, inability to fully extend the right elbow joint, and a 1cm×1cm subcutaneous nodule on the extensor surface. Chest X-ray showed moderate pleural effusion on the right side, small pleural effusion on the left side, and increased pulmonary markings. ESR was 56mm/hr, CRP was elevated, and RF was high-titer positive. What is the most likely cause of bilateral pleural effusion in this patient?

A 45-year-old male presents with symmetric small joint swelling and pain accompanied by morning stiffness for 3 years. Over the past 3 months, symptoms worsened with prolonged morning stiffness, dry cough, shortness of breath, and dyspnea on exertion (no paroxysmal nocturnal dyspnea). Examination reveals swollen/tender wrist and MCP joints, reduced grip strength, painless subcutaneous nodules on elbows, and bilateral Velcro rales in lower lung fields. The most likely diagnosis is:

A 32-year-old woman reports easy hair loss during combing over the past 3 years, recurrent painless oral mucosal ulcers, and episodes of finger pallor, pain, and subsequent cyanosis upon cold exposure in winter for the past 2 years, which later resolve. During history-taking, the doctor notes that the patient develops facial skin erythema after sun exposure in summer, raising suspicion of SLE. Which additional laboratory finding would confirm the diagnosis?

A 24-year-old female presents with high fever and arthralgia for half a month, edema for 10 days, and blood pressure (BP) of 150/90 mmHg. Over the past 7 days, she has developed apathy and hypophonia. For the last 3 days, her urine output has been 200–400 mL/day, with urinary protein (+++), urinary red blood cells (RBCs) 15–20/HP. Laboratory tests show hemoglobin (Hb) 80 g/L, C3 0.42 g/L, albumin (Alb) 23 g/L, and serum creatinine (Scr) 400 μmol/L. The most likely diagnosis is:

A 26-year-old female presents with pain in the wrist and ankle joints for 6 months and a facial rash upon exposure to sunlight since summer. Exam: alopecia, irregular, circular skin lesions on the face and neck with slightly raised edges, multiple superficial ulcers in the oral cavity, liver palpable 0.5 cm below the costal margin, spleen just palpable below the costal margin. Laboratory tests: positive LE cells. Based on the revised American Rheumatology criteria, this meets the diagnosis of SLE. What is the first-line treatment for this case?

A 21-year-old female presents with a 6-month history of low-grade fever and 2 weeks of hematuria. Urine sediment shows RBCs covering the entire field/HP, with 80% being dysmorphic RBCs. Urinary protein (++). Rash on the face and limbs. Blood pressure 150/90 mmHg. Laboratory tests reveal: WBC count 3.0×10^9/L, plasma albumin 3.6 g/L, Scr 80 μmol/L, IgG 18.2 g/L, C3 0.58 g/L, ANA 1:640. The clinical diagnosis is systemic lupus erythematosus (SLE). Which test is most helpful for confirming lupus nephritis?

A 30-year-old female developed fever and arthralgia after catching a cold, lasting 2 months. She was hospitalized with generalized edema and oliguria for 1 week. X-ray examination revealed pericardial and pleural effusion. Laboratory tests showed: urinary protein (+++), plasma albumin 24g/L, hemoglobin 83g/L, reticulocyte count 0.20 (20%), platelets 60×10⁹/L, anti-dsDNA antibody (+), and erythrocyte sedimentation rate 110mm/1h. What is the first-line treatment for this patient?

A 20-year-old female presents with dizziness, fatigue, facial edema, polyarthralgia, hair loss, and oral ulcers for 5 months. Previously diagnosed with 'nephritis' but treatment was ineffective. Anemia worsened after whole blood transfusion. ESR 120mm/h, WBC 4.5×10⁹/L, RBC 2.5×10¹²/L, Hb 50g/L, platelets 5.5×10⁹/L, reticulocytes 10%. Urinalysis: RBC 5-8/HP, urinary protein (++++), hyaline casts (+), granular casts (+). The most likely diagnosis is:

A 37-year-old male had swelling and pain in the finger joints of both hands 2 years ago, which resolved with symptomatic treatment. Although arthralgia persisted, he continued working without systematic evaluation or treatment. Two months ago, he developed fever (~38°C), fatigue, and progressive shortness of breath with minimal cough. Examination revealed spindle-shaped swelling of the proximal interphalangeal joints of both middle fingers, slightly impaired function and tenderness in both wrists, inability to fully extend the right elbow joint, and a 1cm×1cm subcutaneous nodule on its extensor surface. Chest X-ray showed moderate pleural effusion on the right side, small pleural effusion on the left side, and increased pulmonary markings. ESR was 56mm/1st hour, CRP elevated, and rheumatoid factor (RF) strongly positive. Which finding most suggests the diagnosis?

A 54-year-old male with a 5-year history of rheumatoid arthritis (RA) reports worsening arthralgia in the finger joints of both hands over the past 2 months, with morning stiffness lasting about 1 hour. He has never received formal systematic treatment. Examination reveals synovial thickening in the 1st and 2nd MCP joints of both hands, swelling and marked tenderness in the 2nd to 4th proximal interphalangeal (PIP) joints of the right hand, and swelling with tenderness in the 2nd and 3rd PIP joints of the left hand. X-ray shows disappearance and fusion of the bone spaces in both wrists, with marked narrowing of the metacarpophalangeal and proximal interphalangeal joint spaces. Based on the X-ray findings of both hands, which stage of RA does this patient belong to?

A 45-year-old male patient presents with symmetric small joint swelling and pain accompanied by morning stiffness for 3 years. Over the past 3 months, symptoms have worsened with prolonged morning stiffness, dry cough, shortness of breath, and dyspnea on exertion (no paroxysmal nocturnal dyspnea). Physical examination reveals swollen and tender wrists and metacarpophalangeal joints, reduced grip strength, painless subcutaneous nodules on both elbows, and Velcro rales in the lower lung fields. Which additional tests are needed to confirm the diagnosis?

A 45-year-old woman has had recurrent multiple oral ulcers for 2 years. Two months ago, she developed left knee joint swelling and pain after exertion, along with painful erythema nodosum on both lower limbs. One week ago, she experienced sudden blurred vision in her right eye. Laboratory tests show elevated ESR and negative ANA. The most likely diagnosis is:

A 28-year-old female patient presents with recurrent low-grade fever, oral and vulvar ulcers for 1 year, accompanied by a red nodular rash on both lower limbs and arthralgia for 1 month. No nasal congestion or rhinorrhea. Reports cough, but no abdominal pain or diarrhea. ESR 40 mm/h, antinuclear antibody (ANA), anti-extractable nuclear antigen (anti-ENA), and antineutrophil cytoplasmic antibody (ANCA) all negative. The most likely diagnosis is:

A 27-year-old female presents with recurrent oral ulcers for 1 year, photophobia and tearing for 2 months, accompanied by nodular erythema on limbs. Laboratory tests show ANA(+) and positive pathergy test. The most likely diagnosis is:

To improve the prognosis of polymyositis, which concurrent condition must be ruled out at the time of diagnosis?

A 38-year-old male presents with low-grade fever and fatigue for 2 years, accompanied by myalgia in limb joints and muscles for the past 6 months, difficulty climbing to the 3rd floor, red rash on upper eyelids, and dysphagia with solid foods. Physical examination reveals periorbital edema, and violaceous erythema on eyelids, nasal bridge, cheeks, distal interphalangeal joints, and periungual skin. The most likely diagnosis is:

The characteristic facial rash of dermatomyositis (DM) is

A 40-year-old male patient presents with fatigue for 1 month, subjective muscle pain in both upper limbs with difficulty in lifting for 2 weeks, and diffuse dusky erythematous rash on the neck and anterior chest. The most likely diagnosis is:

Which of the following is the most significant distinguishing feature between osteoarthritis (OA) and rheumatoid arthritis (RA)?

Regarding the pathogenesis of pulmonary edema, which of the following explanations is incorrect?

A 58-year-old female patient presents with progressively worsening xerostomia and fatigue over the past year. Physical examination reveals multiple dental caries, residual black tooth roots, and generalized lymphadenopathy. Laboratory tests show ESR 89mm/h, serum γ-globulin 28.5%, ANA 1:80 positive, and anti-SSA antibody positive. The most likely diagnosis is:

A 55-year-old woman with 5-year history of Raynaud's phenomenon, 2 years of dysphagia after eating, generalized swelling sensation, thickened and hardened skin on hands, and facial skin without wrinkles. Recent BP 160/94 mmHg. Urinary protein ++ (1.5g/d), urine sediment RBCs 10-15/HPF. BUN 1 mmol/L, Scr 240 μmol/L. The primary clinical diagnosis for this case is scleroderma. Which type of scleroderma is this?

A 21-year-old male developed urinary frequency, urgency, and dysuria 2 weeks ago, followed by left ankle and heel pain/swelling 1 week later, and bilateral eye burning with increased discharge 3 days ago. The most likely diagnosis is:

A 21-year-old male presents with intermittent back pain for 1 year, worse at night and upon waking, and unexplained left knee joint swelling and pain for the past week. This patient should be highly suspected of having:

A 26-year-old male presents with persistent low back pain for over 1 year, accompanied by limited mobility and morning stiffness, which improves with activity. He also reports knee joint pain for the past 6 months. Physical examination reveals restricted forward flexion, extension, and lateral bending of the spine. Laboratory tests show negative rheumatoid factor (RF). The most likely diagnosis is:

A 26-year-old male presents with intermittent low back pain for 5 years and left knee joint swelling with arthralgia for 1 year. Physical exam: left knee joint swelling with tenderness, negative patellar tap test, positive bilateral '4' sign, and occiput-to-wall distance of 15cm. The most likely diagnosis is:

A 26-year-old male presents with intermittent low back pain for 5 years and left knee joint swelling/pain for 1 year. Physical exam: left knee joint swelling/tenderness, negative patellar ballottement, positive bilateral '4' sign, occiput-to-wall distance 15cm. The fundamental pathological change in ankylosing spondylitis (AS) is:

A 70-year-old female patient presents with a 3-month history of headache and 1-month history of visual acuity decline. She also reports low-grade fever, fatigue, and generalized flu-like symptoms. No history of hypertension (HTN). Physical exam reveals nodular skin in the temporal region, marked tenderness over the left temporal artery, and weakened pulsation. Head CT shows no abnormalities. The most likely diagnosis is:

A 38-year-old female patient has recurrent oral ulcers for 10 years, alternating episodes of iritis for 3 years, and vulvar ulcers with lower back and lower limb pain for the past 3 months. Physical examination shows scattered ulcers on bilateral buccal mucosa, heart rate 80 bpm with regular rhythm, and left sacroiliac joint tenderness (+). The most likely diagnosis is:

A 38-year-old female patient has recurrent oral ulcers for 7 years, accompanied by migratory swelling and pain in large joints of the limbs. In the past week, she experienced blurred vision in the left eye and intermittent abdominal pain. The most likely diagnosis is:

A 35-year-old female patient presents with proximal muscle pain, fatigue, and eyelid rash for 3 months. Creatine kinase (CK) and CK-MM are significantly elevated. Electromyography suggests myopathic damage, and muscle biopsy shows loss of striations with inflammatory cells between muscle fibers. The most likely diagnosis is:

A 48-year-old woman has experienced heaviness in both shoulders, weakness in lifting arms, and decreased walking endurance for 2 months. Erythrocyte sedimentation rate (ESR) is 47 mm/1st hour. The most convincing laboratory test to differentiate polymyositis from polymyalgia rheumatica is:

A 38-year-old male presents with low-grade fever and fatigue for 2 years, accompanied by myalgia in limb joints and difficulty climbing stairs over the past 6 months. He also developed red rashes on eyelids, nasal bridge, and cheeks, along with dysphagia for solid foods. Physical examination reveals periorbital edema and violaceous erythema on eyelids, nasal bridge, cheeks, distal interphalangeal joints, and periungual skin.

A 65-year-old woman presents with intermittent pain in the small joints of both hands for 2 years, without swelling, accompanied by morning stiffness lasting about 20 minutes. No other joints are involved. Laboratory tests (urinalysis, RBC, ESR) are normal, and rheumatoid factor (RF) is negative. The most likely physical finding in this patient is:

A 58-year-old female presents with progressively worsening xerostomia and fatigue over the past year. Physical exam reveals multiple dental caries, residual black tooth roots, and generalized lymphadenopathy. Laboratory tests show ESR 89mm/h, serum γ-globulin 28.5%, ANA 1:80 positive, and anti-SSA antibody positive. Which of the following tests is LEAST useful for diagnosing this condition?

A 60-year-old woman presents with swelling of both hands and feet for 3 years. Blood pressure (BP) 180/130 mmHg, facial skin without wrinkles, perioral furrows. Urinary protein (++) (1.9g/d), urinary red blood cells (RBCs) 25-30/HPF, hemoglobin (Hb) 100g/L, blood urea nitrogen (BUN) 20.8 mmol/L, antinuclear antibody (ANA) positive. Which immunological marker is most helpful for diagnosis?

A 55-year-old woman presents with Raynaud's phenomenon for 5 years, dysphagia after eating for 2 years, generalized swelling sensation, thick and hard skin on both hands, and facial skin without wrinkles. Blood pressure (BP) is 160/94 mmHg for the past week. Urinary protein ++ (1.5g/d), urine sediment shows red blood cells (RBCs) 10-15 per high power field (HPF). Blood urea nitrogen (BUN) 1 mmol/L, serum creatinine (Scr) 240 μmol/L. The primary diagnostic criterion for systemic sclerosis in this case is:

A 21-year-old male patient has experienced intermittent back pain for 1 year, which is worse at night and in the morning. Over the past week, he developed unexplained swelling and pain in the left knee joint. Which of the following tests should be performed to assist in diagnosis?

Elderly female with rash, limb myasthenia for 1 month, dysphagia, and chest tightness for half a month. Physical examination reveals violaceous eyelid plaques with periorbital edema, coarse breath sounds in both lungs, fine rales/crackles in bilateral lower lungs, tenderness in left hand 2nd and 4th PIP joints, muscle strength grade 3 in upper limbs, and grade 2 in lower limbs. Which of the following is most helpful for definitive diagnosis?

A 26-year-old male presents with persistent low back pain for over 1 year, accompanied by limited mobility and morning stiffness, which improves with activity. He has also experienced knee joint pain for the past 6 months. Physical examination reveals restricted forward bending, backward leaning, and lateral flexion. Laboratory tests show rheumatoid factor (RF) is negative. The most important auxiliary test to confirm the diagnosis is:

A 26-year-old male presents with intermittent lower back pain for 5 years and left knee joint swelling/pain for 1 year. Physical exam: left knee joint swelling/tenderness, negative patellar ballottement, positive bilateral '4' sign, occiput-to-wall distance 15 cm. Which test should be performed for definitive diagnosis?

A 70-year-old female presents with a 3-month history of headache and 1 month of visual acuity decline. She also reports low-grade fever, fatigue, and generalized flu-like symptoms. No history of hypertension (HTN). Physical exam reveals a palpable nodule in the temporal region with marked tenderness and weakened pulsation over the left temporal artery. Head CT shows no abnormalities. The typical pathological finding of this condition is:

A 38-year-old female patient has recurrent oral ulcers for 10 years, alternating episodes of iritis for 3 years, and vulvar ulcers with lower back and lower limb pain for the past 3 months. Physical examination shows scattered ulcers on the buccal mucosa, heart rate 80 bpm with regular rhythm, and left sacroiliac joint tenderness (+). Which of the following tests is most specific for diagnosing this condition?

A 38-year-old female patient has recurrent oral ulcers for 7 years, accompanied by migratory swelling and pain in large joints of the limbs. In the past week, she experienced blurred vision in the left eye and intermittent abdominal pain. Which of the following clinical manifestations is rarely seen in this disease?

A 35-year-old female patient presents with proximal limb muscle pain, fatigue, and eyelid rash for 3 months. CK and CK-MM are significantly elevated. Electromyography suggests myogenic damage, and muscle biopsy shows loss of muscle striations with inflammatory cells between muscle fibers. The first-line treatment for this patient is:

A 65-year-old woman presents with intermittent pain in small joints of both hands for 2 years, without swelling, accompanied by morning stiffness lasting about 20 minutes. No other joints are involved. Urinalysis (UA) and RBC count are normal, erythrocyte sedimentation rate (ESR) is normal, and rheumatoid factor (RF) is negative. Which of the following ancillary tests would be most helpful for diagnosis?

A 60-year-old woman with 3 years of swelling in hands and feet. BP 180/130 mmHg, facial skin without wrinkles, perioral furrows. Urinary protein (++) (1.9g/d), urinary RBCs 25-30/HPF, Hb 100g/L, BUN 20.8 mmol/L, ANA positive. When the patient develops nausea, vomiting, and retinal hemorrhage, the most likely diagnosis is:

A 55-year-old woman with a 5-year history of Raynaud's phenomenon, 2 years of dysphagia after eating, generalized swelling sensation, thickened and hardened skin on both hands, and facial skin without wrinkles. Blood pressure (BP) 160/94 mmHg for the past week. Urinary protein ++ (1.5g/d), urine sediment red blood cells (RBCs) 10-15 per high power field (HPF). Blood urea nitrogen (BUN) 1 mmol/L, serum creatinine (Scr) 240 μmol/L. The clinical diagnosis is most likely systemic sclerosis. After confirmation, the characteristic pulmonary change in this case should be:

A 26-year-old male presents with intermittent low back pain for 5 years and left knee joint swelling/pain for 1 year. Physical exam: left knee joint swelling/tenderness, negative patellar ballottement test, positive bilateral '4' sign, occiput-to-wall distance 15cm. Investigations: HLA-B27 positive, sacroiliac CT shows bony sclerosis, joint space narrowing, irregular articular surfaces with erosions and cystic changes. Scout image shows 'bamboo spine' appearance. The most likely diagnosis is:

A 38-year-old woman presents with recurrent oral ulcers for 7 years, accompanied by migratory swelling and pain in large joints of the limbs. Over the past week, she has experienced blurred vision in the left eye and intermittent abdominal pain. Which of the following statements about this disease is incorrect?

The common clinical manifestation of primary Sjögren's syndrome involving the kidneys is

A 55-year-old woman with a 5-year history of Raynaud's phenomenon, 2 years of dysphagia after eating, generalized swelling sensation, thickened and hardened skin on both hands, and facial skin without wrinkles. Blood pressure (BP) 160/94 mmHg for the past week. Urinary protein ++ (1.5g/d), urine sediment red blood cells (RBCs) 10-15 per high power field (HPF). Blood urea nitrogen (BUN) 1 mmol/L, serum creatinine (Scr) 240 μmol/L. The clinical diagnosis is primarily considered systemic sclerosis. The most severe manifestation of renal involvement in this case is:

In Sjögren's syndrome with significant thrombocytopenia, which treatment should NOT be used temporarily?

Which of the following methods is contraindicated in poisoned patients with renal dysfunction or coma?

The organs most susceptible to damage in carbon monoxide (CO) poisoning are

The most severe damage caused by inhalation of poorly water-soluble irritant gases to the human body is

Immunotoxic effects of xenobiotics

A 70-year-old obese male presents with right knee joint pain for 2 years, worse when going downstairs, and right knee joint swelling for 1 week with significant movement limitation. Pain improves with rest. Physical examination shows negative patellar ballottement test. The most likely diagnosis is:

A 19-year-old male presents with swelling and pain around the left knee and right Achilles tendon for 2 weeks, and right heel pain during walking for 1 month. No history of trauma or exposure to cold dampness. No fever. The signs of swelling and pain around the Achilles tendon suggest

A 30-year-old woman presents with bilateral knee joint swelling and pain for 6 months, and recent fever with facial edema. Physical exam: temperature 38°C, facial edema, oral mucosal ulcers, liver palpable 1 fingerbreadth below the costal margin, spleen palpable 2 fingerbreadths below the costal margin, bilateral knee joint swelling with erythema, swelling, and tenderness, BP 150/90 mmHg (20/12 kPa). Urinalysis shows no proteinuria. ANA(+) and anti-Smith (anti-Sm) antibody (+), diagnosed with systemic lupus erythematosus (SLE). After treatment, her condition improved, and she was discharged. The doctor advised her on post-discharge preventive measures. Which of the following is INCORRECT?

A 21-year-old female presents with a 6-month history of low-grade fever and 2 weeks of hematuria. Urine sediment shows RBCs covering the entire field/HPF, with 80% being dysmorphic. Urinary protein (++). Rash on the face and limbs. Blood pressure (BP) 150/90 mmHg. White blood cell (WBC) count 3.0×10^9/L, plasma albumin (Alb) 3.6 g/L, serum creatinine (Scr) 80 μmol/L, immunoglobulin G (IgG) 18.2 g/L, C3 0.58 g/L, antinuclear antibody (ANA) 1:640. The clinical diagnosis is systemic lupus erythematosus (SLE). Assuming this is Class IV lupus nephritis, what is the treatment principle?

Which immunological test is most diagnostically valuable for systemic lupus erythematosus (SLE)?

A 30-year-old female developed fever and arthralgia after catching a cold for 2 months. She was hospitalized with generalized edema and oliguria for the past week. X-ray examination revealed pericardial and pleural effusion. Laboratory tests showed: urinary protein (+++), plasma albumin 24g/L, Hb 83g/L, reticulocyte count 0.20 (20%), platelets 60×10⁹/L, anti-dsDNA antibody (+), erythrocyte sedimentation rate (ESR) 110mm/1h. One week later, the patient developed melena with occult blood (++++). The preferred treatment is:

A 20-year-old female presents with recurrent high fever, migratory arthralgia, oral ulcers, and hair loss for 1 month. Investigations show RF 1:20(+), anti-SSA antibody (+), anti-dsDNA antibody (+), urinary protein (++), and 5 granular casts/HPF. Which test is most helpful to determine the nature of lupus nephritis?

A 37-year-old male had swelling and pain in the finger joints of both hands 2 years ago, which resolved with symptomatic treatment. Although arthralgia persisted, he continued working without systematic examination or treatment. Two months ago, he developed fever (~38°C), fatigue, and gradually progressing shortness of breath with minimal cough. Examination reveals: spindle-shaped swelling of the proximal interphalangeal joints of both middle fingers, slightly impaired function of both wrists with tenderness, inability to fully extend the right elbow joint, a 1cm×1cm subcutaneous nodule on the extensor surface, chest X-ray shows moderate pleural effusion on the right side and small pleural effusion on the left side with increased pulmonary markings. ESR 56mm/1st hour, elevated CRP, and high-titer positive RF. What is the preferred treatment for this patient?

A 38-year-old male presents with polyarticular peripheral joint swelling and pain, recurrent for over 4 years, accompanied by morning stiffness that improves with activity. Laboratory tests show RF(+). A diagnosis of rheumatoid arthritis is considered. To reduce disease activity and control progression, what is the preferred first-line treatment?

A 32-year-old woman presents with a 3-year history of hair loss during combing and recurrent painless oral ulcers. For the past 2 years, she has experienced finger pallor, pain, and subsequent cyanosis upon cold exposure in winter, which later resolves. During history-taking, the physician notes that the patient develops facial skin erythema after sun exposure in summer, raising suspicion of SLE. Which of the following lab findings indicates active lupus?

A 56-year-old woman presents with dry mouth and eyes for 2 years, polyarthralgia for 6 months (without joint swelling), CXR shows interstitial lung disease and mediastinal widening. ESR 30mm/h, RF 1:160, ANA 1:320. The most likely diagnosis is:

A 26-year-old woman presents with pain in the wrist and ankle joints for 6 months and a facial rash upon exposure to sunlight since summer. Exam: alopecia, irregular, circular skin lesions on the face and neck with slightly raised edges, multiple superficial ulcers in the oral cavity, liver palpable 0.5 cm below the costal margin, spleen just palpable below the costal margin. Lab: positive LE cells. According to revised ACR criteria, she meets the diagnosis of systemic lupus erythematosus (SLE). Which of the following statements about her laboratory tests is INCORRECT?

A 30-year-old woman presents with bilateral knee joint swelling and pain for 6 months, now with fever and facial edema. Physical exam: temperature 38°C, facial edema, oral ulcers, liver palpable 1 fingerbreadth below the costal margin, spleen palpable 2 fingerbreadths below the costal margin, bilateral knee joint swelling with erythema, swelling, and tenderness, BP 150/90 mmHg (20/12 kPa). Urinalysis: proteinuria (-), ANA (+), anti-Smith antibody (+), diagnosed with SLE. One year later, follow-up shows urinary protein (++), red blood cells 10-15/HPF, BUN 10 mmol/L, Cr 180 μmol/L, and renal biopsy reveals mesangial proliferative lupus nephritis. The first-line treatment at this stage is:

A 20-year-old female presents with recurrent high fever, migratory arthralgia, oral ulcers, and hair loss for 1 month. Investigations show RF 1:20(+), anti-SSA antibody (+), anti-dsDNA antibody (+), urinary protein (++), and 5 granular casts/HPF. Renal biopsy reveals diffuse proliferative nephritis. The best first-line drug combination is:

A 26-year-old woman presents with arthralgia in the wrist and ankle joints for 6 months and a facial rash upon exposure to sunlight since summer. Examination in July reveals alopecia, irregular circular skin lesions on the face and neck with slightly raised edges, multiple superficial ulcers in the oral cavity, liver palpable 0.5 cm below the costal margin, and spleen just palpable below the costal margin. Laboratory tests show positive LE cells. According to the revised American Rheumatology criteria, she meets the diagnosis of systemic lupus erythematosus (SLE). Which of the following is correct regarding SLE treatment?

A 20-year-old female presents with dizziness, fatigue, facial edema, polyarthralgia, hair loss, and oral ulcers for 5 months. Previously diagnosed with 'glomerulonephritis' but treatment was ineffective. Anemia worsened after whole blood transfusion. ESR: 120mm/h, WBC: 4.5×10⁹/L, RBC: 2.5×10¹²/L, Hb: 50g/L, PLT: 5.5×10⁹/L, reticulocytes: 10%. Urinalysis: RBC 5-8/HPF, urinary protein (++++), hyaline casts (+), granular casts (+). BP: 113/75 mmHg, 24-hour urine output: 700ml, normal electrolytes. Renal function: BUN 17.5mmol/L, Cr 420μmol/L. Renal biopsy: 10/15 glomeruli show cellular crescents; diffuse mesangial/endothelial proliferation. Immunofluorescence shows widespread immunoglobulin/complement deposits in capillary walls/mesangium. No current infection. Select the best treatment.

Which of the following statements about Sjögren's syndrome is INCORRECT?

A 65-year-old female patient was admitted with purpura on both lower limbs for 1 month, accompanied by low-grade fever, pain in small joints of the hands, knees, and ankles (without swelling), and morning stiffness lasting about 10 minutes. Physical examination revealed multiple dental caries, with no joint deformity, swelling, or tenderness. Laboratory tests showed normal CBC, ANA 1:160 positive, RF 1:320 positive, anti-SSA antibody positive, and all other autoantibodies negative. Protein electrophoresis: γ-globulin 30%. The most likely diagnosis is:

Into how many stages can the skin lesions of systemic sclerosis (SSc) be classified?

Systemic sclerosis (SSc) has an insidious onset, and its most common initial symptom is

The manifestation of severe renal involvement in systemic sclerosis (SSc) is

A 54-year-old woman presents with 2-year history of ulcers and scarring on fingertips, 6 months of dysphagia, and 2 days of shortness of breath. BP 170/112 mmHg. Urinary protein ++ (5g/d), urine sediment shows RBCs 10-30/HPF. Enlarged kidneys. CXR shows bilateral lower lobe pulmonary interstitial fibrosis. The most likely diagnosis is:

A 55-year-old woman with a 5-year history of Raynaud's phenomenon, 2 years of dysphagia after eating, generalized swelling sensation, thick and hard skin on both hands, and facial skin without wrinkles. Blood pressure (BP) 160/94 mmHg for 1 week. Urinary protein (++), 5 g/day; urine sediment red blood cells (RBCs) 10-15 per high power field (HPF). Blood urea nitrogen (BUN) 11 mmol/L, serum creatinine (Scr) 240 μmol/L. The clinical diagnosis is primarily considered scleroderma. Which type of scleroderma is this?

A 70-year-old male with obesity has experienced right knee joint pain for 2 years, exacerbated when descending stairs. Over the past week, he developed right knee joint swelling with significant mobility limitation. Pain improves with rest. Physical examination shows negative patellar ballottement test. Which investigation is most valuable for diagnosis?

A 42-year-old woman presents with 1 month of shortness of breath on climbing stairs and 1 week of inability to lie flat at night. She has thickened skin on both hands. BP 148/92 mmHg, urinary protein (++) (2g/d), urine sediment shows 10-15 RBCs/HPF. Pericardial effusion is present. ANA positive, weakly positive anti-Scl-70, and anti-SSA positive. The clinical diagnosis is:

The fundamental pathological change in ankylosing spondylitis (AS) is

Which of the following is a correct clinical manifestation of ankylosing spondylitis (AS)?

Which genetic marker is most closely associated with the pathogenesis of ankylosing spondylitis (AS)?

An X-ray of joints in ankylosing spondylitis (AS) may show:

A 21-year-old male presents with hip and sacroiliac joint pain for 6 months (relieved by activity), and left knee joint swelling/pain for 1 month. The most likely diagnosis is:

A 28-year-old male presents with abdominal pain and bloody diarrhea for 6 days, and swelling/pain in the left knee joint for 2 days. Examination shows conjunctival congestion in both eyes, left knee joint swelling, and urine WBC count of 4-5/HPF. The most likely diagnosis is:

Seronegative spondyloarthropathy refers to

Ankylosing spondylitis (AS) is most commonly seen in

A 28-year-old male presents with abdominal pain and bloody purulent stools for 8 days, and joint swelling/pain for 3 days. Physical exam: bilateral conjunctival congestion, swelling of the left knee joint (+ patellar tap test), erythematous skin lesions on soles with scattered yellow-brown vesicles, crusts, and ulcers. Urinalysis shows 4-5 WBCs/HPF. The most likely diagnosis is:

A 27-year-old male presents with hip and sacroiliac joint pain for 6 months, which improves with activity. One month ago, he developed left knee joint swelling and pain. The most likely diagnosis is:

A 40-year-old female patient presents with fever, generalized joint pain, and purpuric rash for 1 year. She has a 2-year history of recurrent bronchial asthma and allergic rhinitis. CBC shows: WBC 10.1×10⁹/L (neutrophils 68%, eosinophils 16%), elevated immunoglobulin E (IgE), and p-ANCA positivity. The most likely diagnosis is:

A 45-year-old male presents with nasal congestion, purulent nasal discharge, cough, hemoptysis for 6 months, along with low-grade fever and arthralgia. CXR shows exudative lesions in the middle and lower lung fields. Wegener's granulomatosis is suspected. Which test is most suggestive for diagnosis?

A 18-year-old female patient has experienced dizziness and headache for 1 year, accompanied by lower limb weakness and coldness. She reports easy fatigue, hyperhidrosis, and a 3 kg weight loss over the past year. BP: 170/100 mmHg (upper limbs), 150/90 mmHg (lower limbs). A vascular bruit is heard over the abdomen. The most likely diagnosis is: