FCPS IMM Rheumatology MCQs: High-Yield Practice Questions & Prep

Sample FCPS IMM Medicine rheumatology MCQs on RA, SLE, gout, spondyloarthropathy, systemic sclerosis and metabolic bone disease, with explanations.

Rheumatology questions in IMM test autoantibody-to-disease matching, crystal arthropathy, spondyloarthropathy and metabolic bone disease. They are among the most learnable questions in the paper because the associations repeat. Here is a practice set.

Sample Rheumatology MCQs

1. A 50-year-old man is awakened in the middle of the night with acute pain and tenderness of the right knee. He has a low-grade fever. His knee is hot, tender and swollen. Analysis of fluid from right knee shows: leukocytes 70,000/mm3 with 75% neutrophils, crystal analysis shows negative birefringent, Gram stain negative. The most likely diagnosis is:

A) Acute gout ✅
B) Pseudogout
C) RA
D) Septic arthritis

Why: Needle-shaped, negatively birefringent crystals in an acutely inflamed joint are monosodium urate crystals, diagnostic of gout.

2. A patient presents with muscle weakness; you suspect polymyositis. Which investigation will you perform?

A) CPK
B) EMG
C) LDH
D) Muscle biopsy ✅

Why: Muscle biopsy is the most accurate investigation for polymyositis and shows endomysial inflammatory infiltrates with CD8 T cells and muscle fibre necrosis. CK and EMG support the diagnosis but are not specific.

3. A mother of 5 children complains of pain in both shoulders. What should be done next?

A) Muscle biopsy
B) ALP
C) Ca
D) Vitamin D levels ✅
E) Ca/PO4

Why: Multiparous women with poor sun exposure and bone pain are at risk of osteomalacia, so vitamin D levels are checked.

4. A rheumatoid arthritis patient on steroid develops sudden diffuse pain in abdomen with vomiting along with shoulder tip pain. Test to perform?

A) USG
B) CXR ✅
C) USG KUB
D) Endoscopy

Why: Sudden abdominal pain with shoulder-tip pain in a steroid-treated patient suggests perforated peptic ulcer, shown as free air under the diaphragm on an erect chest X-ray.

5. A 23-year-old female presented with malar rash, cutaneous vasculitis and arthritis. Cause?

A) Severe combined immunodeficiency
B) T-helper cell deficiency
C) IgA deficiency
D) Complement deficiency ✅

Why: Inherited deficiency of early classical complement components (C1q, C2, C4) strongly predisposes to SLE by impairing immune-complex clearance.

6. A young male patient presented with high-grade fever with rigors and chills, pustules on extensor surface. Tender knee joint with synovial fluid exam reveals 55,000 leukocytes. Diagnosis?

A) Streptococcal arthritis
B) Reiter syndrome
C) Gonococcal arthritis ✅
D) Tuberculosis arthritis

Why: Fever, pustular skin lesions over extensor surfaces and a purulent monoarthritis in a young adult suggest disseminated gonococcal infection.

7. Patient of ankylosing spondylitis, investigation to confirm?

A) Spirometry
B) X-ray sacroiliac joint ✅
C) CT lumbar
D) HLA-B27

Why: Plain X-ray of the sacroiliac joints showing sacroiliitis is the most useful investigation to establish ankylosing spondylitis; HLA-B27 supports but does not confirm it.

8. A 60-year-old female presents with blanching of fingers on cold exposure since childhood. Now there is increasing oedema of hands and fingertip infarcts and heart burn. What is your diagnosis?

A) Primary Raynaud disease
B) Scleroderma ✅
C) Dermatomyositis
D) Sarcoidosis

Why: Raynaud phenomenon with digital ulcers/infarcts, skin thickening and reflux oesophagitis is systemic sclerosis.

How to Approach Rheumatology for IMM

Build a one-page table of autoantibodies against diseases, and revisit it weekly.
Know the treatment of an acute gout attack separately from long-term urate lowering.
For bone disease, remember which of calcium, phosphate, ALP and PTH move in osteoporosis, osteomalacia and Paget disease.

Browse every Rheumatology question on its own: Rheumatology MCQs.

Keep Practising

These questions come from HighYield's FCPS IMM Medicine QBank, which holds over 2,400 clinical-vignette MCQs with an explanation for every answer. The first 20 questions are free in Tutor mode, so you can judge the explanation quality before unlocking the full bank.