# AMC MCQ Rheumatology Questions: 10 Free Practice MCQs

> 10 free AMC MCQ rheumatology questions with answers and explanations, from a bank of 12 rheumatology questions. Try them now, no sign up.

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Last updated: 2026-10-31

Rheumatology questions test the joint and the system. The AMC MCQ expects you to separate inflammatory from mechanical pain, recognise septic arthritis and vasculitis, and start treatment for rheumatoid arthritis, gout and polymyalgia rheumatica without delay. Safety monitoring for methotrexate and biologic therapy is part of the answer, as is the eye and lung involvement that changes management.

## Where candidates lose marks

* Missing septic arthritis and treating a hot joint as a flare.
* Starting allopurinol during an acute gout attack without the right cover.
* Forgetting methotrexate monitoring, folic acid and the teratogenic risk.
* Ignoring systemic features such as weight loss, rash or renal impairment in a rheumatological presentation.

**Guideline to follow:** The AMC MCQ follows the Australian Rheumatology Association guidance, the Royal Australian College of General Practitioners musculoskeletal guidance and eTG.

Ten AMC MCQ-style rheumatology questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 12 rheumatology questions and many more across every topic.

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1. 1 / 10  
A 52-year-old man presents with chronic sinusitis, recurrent epistaxis, and a new onset of haemoptysis. Urinalysis reveals 2+ blood and 2+ protein, and blood tests show a serum creatinine of 185 umol/L. Serum antibody testing is positive for c-ANCA (PR3-ANCA).  
Which of the following is the most likely diagnosis?  
Show answer

**Answer: D.** Granulomatosis with Polyangiitis (GPA)

**Why:** Granulomatosis with Polyangiitis (GPA) is a systemic necrotizing vasculitis of small-to-medium vessels. It is characterized by the triad of upper respiratory tract disease, lower respiratory tract involvement, and glomerulonephritis. More than 90% of active patients are positive for anti-neutrophil cytoplasmic antibodies showing a cytoplasmic pattern (c-ANCA) targeting proteinase 3 (PR3-ANCA).

  * **A.** Goodpasture's causes pulmonary-renal syndrome but is characterized by anti-GBM antibodies, not c-ANCA/PR3-ANCA, and does not typically cause upper airway granulomas.
  * **B.** SLE can cause lupus nephritis but is associated with ANA and anti-dsDNA antibodies, not PR3-ANCA.
  * **C.** EGPA is associated with severe asthma, eosinophilia, and p-ANCA (MPO-ANCA), rather than c-ANCA/PR3-ANCA.  
Sources: eTG complete, Rheumatology, Vasculitis; Australian Rheumatology Association (ARA) Guidelines
2. 2 / 10  
A 45-year-old woman is diagnosed with severe Rheumatoid Arthritis. The rheumatologist plans to start her on oral Methotrexate 15mg weekly, along with Folic Acid 5mg weekly.  
Which of the following monitoring regimens and safety advice is most appropriate for this patient?  
Show answer

**Answer: D.** Perform Full Blood Count (FBC) and Liver Function Tests (LFTs) every 2-4 weeks initially, and advise her to report any dry cough or dyspnoea

**Why:** Methotrexate monitoring in Australia requires baseline and regular (every 2-4 weeks initially, then 2-3 monthly) FBC, LFTs, and renal function checks. Patients must be warned about symptoms of methotrexate pneumonitis (dry cough, fever, dyspnoea) and bone marrow suppression (infection, bleeding).

  * **A.** Routine annual pulmonary tests are not standard; active monitoring of FBC/LFTs initially is much more frequent and critical.
  * **B.** Alcohol must be strictly limited due to synergistic hepatotoxicity. LFT monitoring must be much more frequent.
  * **C.** Methotrexate levels are checked for high-dose oncology regimens, not for low-dose weekly rheumatoid arthritis therapy.  
Sources: Australian Rheumatology Association (ARA) Guidelines; AMH
3. 3 / 10  
A 4-year-old girl presents with a 2-month history of a persistent limp. Her parents note that her left knee is swollen and warm, particularly in the morning, but she rarely complains of pain. Physical exam confirms a left knee effusion.  
What is the most likely type of JIA, and what screening is mandatory to prevent permanent visual impairment?  
Show answer

**Answer: C.** Oligoarticular JIA; regular screening slit-lamp examinations to detect asymptomatic uveitis

**Why:** Oligoarticular JIA is defined as arthritis affecting 4 or fewer joints during the first 6 months of disease. A major silent complication is chronic anterior uveitis. Regular slit-lamp examinations by an ophthalmologist are required to detect and treat uveitis early with topical steroids.

  * **A.** Systemic JIA presents with daily spiking fevers, salmon-pink rash, and hepatosplenomegaly, not isolated joint swelling.
  * **B.** Polyarticular JIA affects >=5 joints. While RF is checked once, serial testing is not used for screening.
  * **D.** HLA-B27 is checked once to support diagnosis, not repeatedly.  
Sources: RCH Melbourne Clinical Practice Guideline: Juvenile Idiopathic Arthritis
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5. 4 / 10  
A 64-year-old man with a background of Stage 4 CKD (eGFR 22 mL/min/1.73m2) presents with a highly painful, swollen, erythematous left first metatarsophalangeal (MTP) joint. Joint aspiration confirms gout. He is currently in severe pain.  
Which of the following is the most appropriate first-line therapy for this acute flare?  
Show answer

**Answer: C.** Oral Prednisolone 30mg daily for 5 days

**Why:** For acute gout flares in patients with severe renal impairment (eGFR < 30), conventional first-line agents like NSAIDs are contraindicated, and colchicine requires substantial dose adjustments or avoidance. Corticosteroids (oral or intra-articular) are the preferred choice.

  * **A.** NSAIDs are contraindicated in severe renal impairment (eGFR < 30) due to the risk of acute-on-chronic kidney injury.
  * **B.** Colchicine dose must be strictly reduced in renal impairment to avoid severe toxicity (neuromyopathy); standard dosing is unsafe.
  * **D.** Urate-lowering therapy like allopurinol should not be initiated during an acute flare, as it can prolong or worsen the attack.  
Sources: eTG Rheumatology, Gout; Australian Medicines Handbook (AMH)
6. 5 / 10  
A 54-year-old man presents to the clinic with acute, severe pain, swelling, and erythema in his left first metatarsophalangeal (MTP) joint, which woke him from sleep. He has a history of chronic kidney disease (CKD Stage 3, eGFR 42 mL/min/1.73m2). He is not currently taking any urate-lowering therapy.  
Which of the following is the most appropriate first-line pharmacological treatment for this acute gout flare according to the Therapeutic Guidelines (eTG)?  
Show answer

**Answer: D.** Oral Colchicine 500 micrograms, twice daily (with a maximum of three times daily)

**Why:** First-line treatments for acute gout flares include NSAIDs, colchicine, or oral corticosteroids. In patients with significant chronic kidney disease (CKD), NSAIDs are contraindicated. Colchicine is effective but requires renal dosing (maximum of 1-1.5 mg daily for eGFR 30-50, and avoid if eGFR < 30). Oral prednisolone is another safe first-line option in renal impairment.

  * **A.** Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided or used with extreme caution in patients with moderate-to-severe chronic kidney disease.
  * **B.** Allopurinol is a urate-lowering therapy and must not be initiated during an acute flare, as it can prolong or worsen the attack.
  * **C.** Systemic intravenous corticosteroids are not indicated as first-line therapy for a single-joint gout flare when low-dose colchicine or oral steroids can be used.  
Sources: eTG complete, Rheumatology, Gout Flare; Australian Medicines Handbook (AMH)
7. 6 / 10  
A 62-year-old man with a history of recurrent gouty arthritis (4 flares in the last 12 months) and a baseline serum urate of 0.54 mmol/L (normal < 0.36) is to be commenced on long-term urate-lowering therapy. His renal function is normal.  
What is the recommended approach for initiating urate-lowering therapy in this patient according to the Therapeutic Guidelines (eTG)?  
Show answer

**Answer: C.** Start Allopurinol 100mg daily, titrate the dose every 2-4 weeks to target a serum urate < 0.36 mmol/L, and co-prescribe low-dose Colchicine (500 mcg daily) for the first 3-6 months

**Why:** Long-term gout management requires lowering serum urate to prevent crystal deposition and joint damage. Allopurinol is started at a low dose (100 mg daily, lower if CKD) and titrated to achieve a target urate < 0.36 mmol/L (or < 0.30 mmol/L in tophaceous gout). Slow titration reduces hypersensitivity risk. Concurrent low-dose colchicine (500 mcg daily) is required for 3 to 6 months to prevent flares induced by rapid urate shifts.

  * **A.** Initiating high-dose allopurinol immediately increases the risk of severe drug hypersensitivity and acute gout flares.
  * **B.** NSAIDs are used for acute flares or short-term prophylaxis, but they do not lower urate or prevent long-term joint destruction.
  * **D.** Allopurinol is the preferred first-line urate-lowering therapy in Australia; febuxostat is reserved for patients intolerant of allopurinol.  
Sources: eTG complete, Rheumatology, Gout Management; RACGP Gout Management Guidelines
8. 7 / 10  
A 70-year-old postmenopausal woman attends her GP for a general health review. She has no history of fractures, does not smoke, and has a normal BMI. She is concerned about bone health.  
What is the most appropriate screening recommendation for osteoporosis in this patient according to Australian guidelines?  
Show answer

**Answer: B.** Perform a screening Dual-Energy X-ray Absorptiometry (DXA) scan

**Why:** The RACGP Red Book and Healthy Bones Australia recommend screening bone mineral density using a Dual-Energy X-ray Absorptiometry (DXA) scan for all adults aged 70 years and over. Earlier screening is indicated if there are specific risk factors (e.g. corticosteroid use, early menopause).

  * **A.** While fractures are a major risk factor, screening is recommended for all women over 70, even without prior fractures.
  * **C.** Serum markers are often normal in osteoporosis and are not used as primary screening tests.
  * **D.** CT scans are not the gold standard for osteoporosis screening and expose the patient to unnecessary radiation.  
Sources: RACGP Red Book; Healthy Bones Australia Guidelines
9. 8 / 10  
A 48-year-old woman with active rheumatoid arthritis is prescribed weekly oral Methotrexate. Her rheumatologist explains the necessity of taking concurrent folic acid.  
Which of the following describes the primary cellular mechanism of action of methotrexate at the doses used for rheumatoid arthritis?  
Show answer

**Answer: B.** Competitive inhibition of dihydrofolate reductase, leading to decreased purine synthesis

**Why:** Methotrexate is a folate analogue. At low anti-inflammatory doses used for rheumatoid arthritis, it inhibits dihydrofolate reductase (DHFR), which prevents the conversion of dihydrofolate to active tetrahydrofolate. This disrupts purine nucleotide synthesis and cell division, particularly in rapidly dividing inflammatory cells. Folic acid supplementation is given to reduce mucosal, gastrointestinal, and haematological toxicities without compromising efficacy.

  * **A.** COX-2 inhibition is the mechanism of NSAIDs, not methotrexate, which is a disease-modifying antirheumatic drug (DMARD).
  * **C.** This is the mechanism of biologic agents like etanercept, not the small-molecule folate antagonist methotrexate.
  * **D.** Calcineurin inhibition is the mechanism of action of cyclosporine and tacrolimus.  
Sources: Australian Medicines Handbook (AMH), Methotrexate; Australian Rheumatology Association (ARA) Prescribing Guidelines
10. 9 / 10  
A 48-year-old woman with a history of diffuse cutaneous systemic sclerosis presents to the emergency department with a severe headache, blurred vision, and dyspnea. Her blood pressure is 210/120 mmHg, and her creatinine has risen from a baseline of 75 umol/L to 185 umol/L. Urinalysis shows 1+ protein and trace blood.  
Which of the following is the most appropriate first-line medical management for this patient?  
Show answer

**Answer: D.** Oral Captopril (ACE inhibitor) titrated to blood pressure

**Why:** This patient is presenting with Scleroderma Renal Crisis (SRC), a life-threatening complication of systemic sclerosis characterized by malignant hypertension and rapidly progressive renal failure. The pathophysiology is driven by renal ischemia leading to hyperreninemia. Short-acting oral ACE inhibitors (specifically Captopril) are the treatment of choice and are continued even if renal function temporarily deteriorates.

  * **A.** Beta-blockers are not effective in reversing the angiotensin-II mediated renal vasoconstriction of scleroderma renal crisis.
  * **B.** While nitroprusside lowers blood pressure, it does not target the underlying renin-mediated pathology and can worsen renal perfusion.
  * **C.** High-dose corticosteroids are contraindicated in systemic sclerosis because they can precipitate or worsen scleroderma renal crisis.  
Sources: eTG Rheumatology, Systemic Sclerosis; Australian Rheumatology Association (ARA) Position Statements
11. 10 / 10  
An 8-year-old Aboriginal boy from a remote community presents with a 3-day history of a painful, swollen left knee, which started after his right ankle pain resolved. He has a fever of 38.8°C. Cardiorespiratory examination reveals a new apical systolic murmur. He had a sore throat 3 weeks ago.  
What is the most likely diagnosis, and what is the Jones criteria classification of his findings?  
Show answer

**Answer: B.** Acute Rheumatic Fever (ARF); 2 major criteria (migratory polyarthritis and carditis) plus 1 minor criterion (fever)

**Why:** Acute Rheumatic Fever (ARF) is diagnosed using the Jones criteria. For high-risk populations (including Aboriginal and Torres Strait Islander Australians in endemic areas), the criteria are simplified. Diagnosis requires 2 major, or 1 major and 2 minor criteria, along with evidence of preceding GAS infection.

  * **A.** The migratory nature of the joint pain (ankles then knees) and a new heart murmur point to acute rheumatic fever, not isolated septic arthritis.
  * **C.** JIA is a chronic arthritis (lasting >6 weeks) and does not typically present with new-onset heart murmurs and migratory acute polyarthritis.
  * **D.** The patient has no purpuric rash or abdominal symptoms, making HSP highly unlikely.  
Sources: National Heart Foundation of Australia: Australian guideline for diagnosis of acute rheumatic fever

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