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AMC MCQ · Rheumatology

AMC Rheumatology MCQ Practice — 100+ Questions for IMGs

RA, gout, SLE, vasculitis and PMR — AMC MCQ rheumatology MCQs aligned with Australian guidelines.

125 questions in the full bank · 5 free samples below · Spaced repetition + AI explanations on the free tier.

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Why Rheumatology matters in AMC MCQ

Rheumatology contributes 5–8 questions to AMC MCQ, covering rheumatoid arthritis, seronegative spondyloarthropathies, crystal arthropathies (gout, pseudogout), systemic lupus erythematosus, vasculitis (GCA, ANCA-associated), polymyalgia rheumatica, and osteoporosis (overlapping with endocrinology).

Mostly Medicine’s rheumatology bank is mapped to the Australian Rheumatology Association (ARA) guidelines, Therapeutic Guidelines: Rheumatology, and PBS criteria for biologic DMARDs. You’ll see items on the 2010 ACR/EULAR criteria for RA, methotrexate dosing and folic acid supplementation, anti-TNF screening (latent TB, hepatitis B), gout flare management (NSAIDs, colchicine, prednisolone) and urate-lowering therapy initiation, and the temporal artery biopsy timing for suspected GCA.

AMC rheumatology vignettes typically mix joint distribution patterns (small vs large, symmetric vs asymmetric, axial vs peripheral) with serology (RF, CCP, ANA, ANCA) and imaging clues, then ask for the most likely diagnosis or first-line therapy. Practising 125+ Australian-aligned rheumatology MCQs is the fastest path to confidence. Sign up free to unlock the full bank.

5 free Rheumatology sample MCQs

Below are five sample questions taken straight from the Mostly Medicine rheumatology bank. The correct answer is highlighted, with the worked explanation tucked inside a collapsed panel so you can self-test first.

Question 1Rheumatoid Arthritis · easy

A 40-year-old woman presents with 3 months of symmetrical small joint arthritis (MCP, PIP, wrists), morning stiffness >1 hour, and fatigue. RF and anti-CCP are positive. Hands X-ray shows periarticular osteopaenia. What is the first-line DMARD?

  1. A.Hydroxychloroquine alone
  2. B.Methotrexate (MTX) 15–25 mg/weekCorrect
  3. C.Adalimumab (anti-TNF) immediately
  4. D.Prednisolone 10 mg/day long-term
  5. E.Leflunomide + sulfasalazine combination
Show explanation

RA first-line DMARD: methotrexate (MTX) is the anchor drug. Start 10–15 mg/week, escalate to 25 mg. Add folic acid 5 mg once/week (not same day as MTX) to reduce side effects. Monitor: FBC, LFTs, creatinine every 1–3 months. If MTX insufficient after 3 months at target dose: add hydroxychloroquine or leflunomide. Anti-TNF if inadequate response to ≥2 conventional DMARDs.

Question 2Gout · easy

A 55-year-old man presents with acute red, hot, swollen first MTP joint. Uric acid is 560 µmol/L. He is on hydrochlorothiazide for hypertension. What is the first-line treatment for acute gout?

  1. A.Start allopurinol immediately to lower urate
  2. B.NSAIDs (indomethacin or naproxen) or colchicine or prednisoloneCorrect
  3. C.Rest and ice only
  4. D.Probenecid to increase uric acid excretion
  5. E.IV corticosteroids only
Show explanation

Acute gout: anti-inflammatory treatment within 24 hours. NSAIDs (indomethacin, naproxen), colchicine (0.5 mg TDS for 3 days), or prednisolone (30–40 mg × 3–5 days) are equally effective. Choose based on comorbidities: eGFR<30→ avoid NSAIDs/colchicine; peptic ulcer→avoid NSAIDs; DM→ caution steroids. Do NOT start allopurinol during acute attack (can prolong/exacerbate). Review thiazide (switches to amlodipine better for BP with gout).

Question 3Gout · medium

A 60-year-old man has had 4 gout flares in 2 years. Uric acid is persistently >0.50 mmol/L. He has CKD Stage 2. What is the urate-lowering target and preferred ULT agent?

  1. A.Target urate <0.60 mmol/L — allopurinol
  2. B.Target urate <0.36 mmol/L — allopurinol or febuxostatCorrect
  3. C.Target urate <0.30 mmol/L — febuxostat preferred
  4. D.No treatment — 4 flares is not enough for ULT
  5. E.Target urate <0.42 mmol/L — probenecid
Show explanation

Urate-lowering therapy (ULT) indications: ≥2 flares/year, tophi, chronic gouty arthritis, uric acid nephrolithiasis, severe hyperuricaemia. Target urate <0.36 mmol/L (<6 mg/dL) — below monosodium urate saturation point. Allopurinol is first-line: start 50–100 mg/day, escalate slowly (HLA-B*5801 screening in Asians — risk of SJS). Febuxostat (non-purine XO inhibitor) if allopurinol intolerant. Cover with prophylactic colchicine 0.5 mg daily for 6 months when starting ULT.

Question 4SLE · medium

A 25-year-old woman presents with malar rash, photosensitivity, oral ulcers, arthritis in multiple joints, and proteinuria 2.5 g/day. ANA is positive at 1:640. Anti-dsDNA is elevated. C3 and C4 are low. What is the diagnosis and what does anti-dsDNA indicate?

  1. A.Drug-induced lupus — anti-histone antibodies positive
  2. B.SLE with renal involvement — anti-dsDNA correlates with disease activityCorrect
  3. C.Sjögren's syndrome — anti-Ro/La positive
  4. D.Mixed connective tissue disease — anti-U1RNP positive
  5. E.Systemic vasculitis — ANCA positive
Show explanation

SLE: ≥4 SLICC criteria. Anti-dsDNA: specific for SLE (95%), correlates with disease activity and lupus nephritis. Low complement (C3/C4) indicates active immune complex deposition. Proteinuria 2.5 g/day = probable lupus nephritis (class III/IV). Renal biopsy required to classify. Treatment: hydroxychloroquine (all SLE patients), immunosuppression (mycophenolate, azathioprine) for nephritis, belimumab for refractory SLE.

Question 5Ankylosing Spondylitis · medium

A 28-year-old man presents with 2 years of inflammatory back pain (worse in morning, improves with exercise, not rest), buttock pain alternating sides, and iritis. HLA-B27 is positive. MRI sacroiliac joints show bone marrow oedema. What is the diagnosis and first-line treatment?

  1. A.Mechanical back pain — physiotherapy
  2. B.Ankylosing spondylitis (axial SpA) — NSAIDs first-lineCorrect
  3. C.AS — anti-TNF immediately
  4. D.AS — sulfasalazine
  5. E.Psoriatic arthritis — methotrexate
Show explanation

Axial spondyloarthritis: inflammatory back pain + HLA-B27 + sacroiliitis on MRI. First-line: NSAIDs (continuous dosing, not PRN) + physiotherapy (exercise is crucial — prevents ankylosis). If ≥2 NSAIDs failed after 4 weeks each → anti-TNF (adalimumab, etanercept, infliximab) or IL-17 inhibitor (secukinumab). Sulfasalazine for peripheral joint disease only. DMARDs not effective for axial disease.

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Rheumatology FAQ

How is rheumatoid arthritis diagnosed?

Use the 2010 ACR/EULAR classification criteria: joint distribution, serology (RF, anti-CCP), acute-phase reactants (ESR, CRP), and symptom duration. Score ≥6/10 confirms RA.

What gout management is tested?

Acute flare: NSAID, colchicine 1.2 mg then 0.6 mg one hour later, or prednisolone. Urate-lowering therapy: allopurinol from low dose (50–100 mg) titrated to target urate <0.36 mmol/L, with prophylactic colchicine for the first 6 months.

How is GCA managed?

High-dose prednisolone (40–60 mg/day) immediately on suspicion — do not delay for biopsy. Aspirin 100 mg daily reduces ischaemic complications. Tocilizumab is PBS-listed for relapsing or refractory disease.

Are autoantibodies heavily tested?

Yes. Know ANA (sensitive but not specific for SLE), anti-dsDNA (specific for SLE), anti-Smith (specific), anti-Ro/La (Sjögren’s, neonatal lupus), anti-Jo1 (myositis), anti-Scl70 (diffuse scleroderma), and ANCA patterns (c-ANCA for GPA, p-ANCA for MPA/EGPA).

How many rheumatology MCQs are free?

Five sample rheumatology MCQs with explanations on this page. The full 125+ bank unlocks with a free Mostly Medicine account.