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Sample Saudi Board Adult Rheumatology Practice Questions

Try these sample questions to review concepts for the Saudi Board Adult Rheumatology exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 46-year-old female presents with a 4-month history of symmetric swelling, tenderness, and morning stiffness lasting >90 minutes involving the bilateral metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, as well as both wrists. Laboratory studies reveal elevated erythrocyte sedimentation rate (ESR 62 mm/hr), C-reactive protein (CRP 28 mg/L), and high-titer anti-cyclic citrullinated peptide (anti-CCP) antibodies (>250 U/mL; normal <20). Radiographs demonstrate periarticular osteopenia and marginal erosions at the ulnar styloid. According to the 2010 ACR/EULAR classification criteria for Rheumatoid Arthritis (RA), what is the minimum score required to classify a patient as having definite RA?
A.4 out of 10 points
B.6 out of 10 points
C.8 out of 10 points
D.10 out of 10 points
Explanation: The 2010 ACR/EULAR threshold is at least 6 of 10 points in a patient with clinical synovitis not better explained by another disease. Domains are joint involvement, serology, acute-phase reactants, and symptom duration. The exact joint score requires an explicit joint count; classification criteria support research consistency and do not replace clinical diagnosis.
2A 50-year-old female with newly diagnosed moderate-to-severe seropositive rheumatoid arthritis is started on oral methotrexate at 15 mg weekly along with daily folic acid. Which of the following is considered an absolute contraindication to initiating methotrexate therapy?
A.Current pregnancy
B.Controlled mild hypertension on amlodipine
C.History of uncomplicated appendectomy 10 years ago
D.Well-controlled hypothyroidism on levothyroxine
Explanation: Methotrexate can cause fetal harm and is contraindicated for rheumatic disease during pregnancy. Patients who may become pregnant need contraception and a planned medication transition before conception. Guidance for maternal exposure must not be automatically applied to paternal low-dose methotrexate exposure.
3A 52-year-old male with active rheumatoid arthritis refractory to 6 months of triple therapy (methotrexate 25 mg weekly, sulfasalazine 2 g daily, and hydroxychloroquine 400 mg daily) is being evaluated for initiation of a biological DMARD (tumor necrosis factor inhibitor). Before prescribing an anti-TNF agent, which mandatory baseline screening must be performed to prevent catastrophic reactivation?
A.Interferon-gamma release assay (IGRA) or tuberculin skin test (TST), chest radiography, and hepatitis B virus serologies (HBsAg, anti-HBc total, anti-HBs)
B.Colonoscopy with random mucosal biopsies
C.Continuous 24-hour ambulatory Holter electrocardiography
D.Serum protein electrophoresis with immunofixation for multiple myeloma
Explanation: TNF inhibition increases the risk of tuberculosis reactivation, so baseline TB assessment is required before treatment. Hepatitis B serology identifies active or resolved infection that may need prophylaxis or monitoring. A positive result requires an individualized infection-management plan; the timing of biologic initiation depends on the infection, preventive regimen, and specialist advice.
4A 58-year-old female with long-standing rheumatoid arthritis treated with methotrexate develops persistent dry cough and exertional dyspnea over 6 months. High-resolution computed tomography (HRCT) of the chest reveals peripheral, subpleural, basilar-predominant reticulation, traction bronchiectasis, and subpleural honeycombing without ground-glass opacities. What is the classic radiologic pattern of interstitial lung disease described here?
A.Usual Interstitial Pneumonia (UIP) pattern
B.Nonspecific Interstitial Pneumonia (NSIP) pattern
C.Organizing Pneumonia (OP) pattern
D.Lymphocytic Interstitial Pneumonia (LIP) pattern
Explanation: Unlike most other connective tissue diseases (such as systemic sclerosis and myositis, where NSIP is dominant), rheumatoid arthritis-associated interstitial lung disease (RA-ILD) most commonly manifests as a Usual Interstitial Pneumonia (UIP) pattern (~60% of cases). The hallmarks of UIP on HRCT are subpleural basilar-predominant reticular opacities, traction bronchiectasis, and structural honeycombing. RA-UIP carries a worse prognosis and higher mortality than RA-NSIP.
5A 64-year-old male with severe, seropositive, erosive rheumatoid arthritis for 20 years presents with splenomegaly, recurrent bacterial skin infections, and an absolute neutrophil count (ANC) of 450/mcL (normal 1,500-8,000). Bone marrow examination shows myeloid hyperplasia with maturation arrest. What is the diagnosis?
A.Felty syndrome
B.Adult-onset Still disease
C.Hemophagocytic lymphohistiocytosis (HLH)
D.Systemic lupus erythematosus
Explanation: Felty syndrome is a rare, severe extra-articular manifestation of long-standing rheumatoid arthritis defined by the classic triad of: (1) rheumatoid arthritis (usually seropositive and erosive), (2) splenomegaly, and (3) persistent severe neutropenia (ANC <1,000/mcL). Patients have high titers of RF and anti-CCP, frequently express HLA-DR4, and suffer from recurrent pyogenic bacterial infections and lower extremity cutaneous ulcers. Treatment centers on controlling RA disease activity with DMARDs (methotrexate, rituximab) and G-CSF for severe infections.
6A 56-year-old female with long-standing rheumatoid arthritis presents with suboccipital neck pain radiating to the vertex, paresthesias in both hands, hyperreflexia, and a positive Hoffman sign. Cervical spine flexion-extension radiographs show an anterior atlantodental interval (AADI) of 6.5 mm on flexion view (normal <= 3.0 mm). What is the underlying pathology, and what is the primary clinical concern?
A.Atlantoaxial subluxation due to pannus-mediated destruction of the transverse atlantal ligament; risk of high cervical spinal cord compression and fatal medullary impingement
B.Subaxial cervical spondylolisthesis due to facet joint ankylosis
C.Basilar invagination without ligamentous laxity
D.Cervical disc herniation with C6 radiculopathy
Explanation: In rheumatoid arthritis, synovial pannus formation around the odontoid process (dens) and the transverse atlantal ligament causes erosive destruction and laxity of the ligament. An anterior atlantodental interval (AADI) > 3 mm in adults indicates atlantoaxial subluxation; an AADI > 6-8 mm or posterior atlantodental interval (PADI) < 14 mm places the cervical spinal cord at immediate risk of impingement. Neurological symptoms (cervical myelopathy, hyperreflexia, Clonus, Hoffman sign) mandate urgent neurosurgical evaluation for occipitocervical or C1-C2 fusion.
7Which oral JAK inhibitor used for rheumatoid arthritis was studied in ORAL Surveillance, leading the US FDA to strengthen boxed warnings about cardiovascular events, malignancy, thrombosis, and mortality?
A.Tofacitinib; increased risk of major adverse cardiovascular events (MACE), venous thromboembolism (DVT/PE), malignancies (lymphoma and lung cancer), and serious infections
B.Abatacept; increased risk of interstitial nephritis and acute liver failure
C.Tocilizumab; increased risk of pure red cell aplasia and secondary hyperparathyroidism
D.Rituximab; increased risk of central retinal vein occlusion and hypercalcemia
Explanation: Tofacitinib (along with baricitinib and upadacitinib) is an oral JAK inhibitor. In the randomized post-marketing ORAL Surveillance trial comparing tofacitinib to TNF inhibitors in RA patients >=50 years with >=1 cardiovascular risk factor, tofacitinib failed to meet non-inferiority for MACE and malignancies, demonstrating increased incidence of MACE (myocardial infarction, stroke), venous thromboembolism (PE and DVT), malignancies (particularly lymphoma and lung cancer in smokers), and all-cause mortality.
8A 32-year-old female with well-controlled seropositive rheumatoid arthritis presents to her rheumatologist stating that she and her husband wish to conceive. She is currently taking methotrexate 20 mg weekly, hydroxychloroquine 400 mg daily, and low-dose prednisone 5 mg daily. What medication adjustments are strictly indicated before attempting conception?
A.Stop methotrexate 1–3 months before conception under the ACR plan, arrange folate supplementation, and continue appropriate pregnancy-compatible treatment
B.Discontinue all medications immediately including hydroxychloroquine and prednisone, and avoid all DMARDs throughout pregnancy
C.Switch methotrexate to leflunomide without cholestyramine washout
D.Replace methotrexate with mycophenolate mofetil
Explanation: The 2020 ACR reproductive-health guideline recommends stopping maternal methotrexate 1–3 months before conception and using pregnancy-compatible therapy. Hydroxychloroquine can be continued; low-dose prednisone may be used when clinically needed, with the lowest effective dose. Folate supplementation and the transition plan should be individualized rather than equating a menstrual cycle with the entire recommended interval.
9A patient with rheumatoid arthritis is discussing TNF-inhibitor options during pregnancy. Which structural feature explains the minimal active placental transfer of certolizumab pegol?
A.It is a PEGylated Fab fragment lacking an Fc domain, which prevents active FcRn-mediated placental transfer during pregnancy
B.It is a fully human IgG4 antibody that crosses the placenta in the first trimester only
C.It is an oral small-molecule peptide that does not bind human TNF receptors
D.It contains an intact IgM pentameric structure that cannot enter fetal circulation
Explanation: Certolizumab pegol consists of a humanized Fab' antigen-binding fragment linked to two 20-kDa polyethylene glycol (PEG) chains. Crucially, it completely lacks an Fc crystallizable domain. Active transplacental transfer of IgG antibodies in the second and third trimesters is mediated by the neonatal Fc receptor (FcRn) in the syncytiotrophoblast. Because certolizumab lacks an Fc region, there is negligible to no active placental transfer, making it a preferred anti-TNF agent during pregnancy.
10A 60-year-old female with rheumatoid arthritis on leflunomide 20 mg daily develops acute shortness of breath and fever. Her chest CT reveals severe acute pneumonitis. Leflunomide toxicity is suspected. What is the emergency pharmacological protocol used to accelerate leflunomide metabolite (teriflunomide) elimination from the body?
A.Oral cholestyramine 8 g three times daily for 11 days, or activated charcoal 50 g every 12 hours for 11 days
B.High-volume hemodialysis with high-flux membranes for 72 hours
C.Intravenous calcium EDTA chelation therapy
D.Continuous intravenous sodium bicarbonate urinary alkalinization
Explanation: Teriflunomide undergoes enterohepatic recirculation and can persist long after leflunomide is stopped. The current label gives cholestyramine 8 g three times daily for 11 days or activated charcoal 50 g every 12 hours for 11 days as accelerated elimination regimens. When verification of elimination is required, the label specifies concentrations below 0.02 mg/L on two tests at least 14 days apart; this is a safety threshold, not a claim of analytical undetectability.

About the Saudi Board Adult Rheumatology Exam

Independent English-language MCQ study adaptation by OpenExamPrep for the Saudi Fellowship Final Written Examination in Rheumatology, commonly searched as Saudi Board Adult Rheumatology. Practice inflammatory arthritis, connective tissue disease, vasculitis, crystal disease, metabolic bone disease, and related clinical decisions. This is not an official translation, an official-format simulation, or a substitute for OSCE, oral, or supervised clinical practice. OpenExamPrep is not affiliated with or endorsed by SCFHS.

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Written MCQs followed by a separate clinical examination with six 10-minute graded stations: two OSCE and four SOE stations.

Time Limit

Written-paper duration not confirmed in the public specialty sources reviewed; check the admission notice.

Passing Score

70%, with conditional adjustment to a minimum of 65% as specified in the written blueprint

Exam / Certification Fees

Not confirmed in the public specialty sources reviewed; check SCFHS registration.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

6%

Basic and Clinical Sciences

Immunology, musculoskeletal anatomy, and pharmacology.

5%

Crystal-induced Arthropathies

Gout and other crystal-associated joint disease.

5%

Infections and Related Arthritides

Septic, viral, and other infection-associated joint disorders.

5%

Metabolic Bone Disease

Osteoporosis and other metabolic bone disorders.

5%

Osteoarthritis and Related Disorders

Degenerative disease and related bone, tendon, or joint disorders.

12%

Rheumatoid Arthritis

Clinical assessment, complications, and management.

8%

Seronegative Spondyloarthropathies

Axial and peripheral inflammatory disease.

14%

Other Rheumatic and Connective Tissue Disorders

Systemic sclerosis, Sjogren disease, myositis, and overlap disorders.

14%

Lupus Erythematosus

Systemic lupus and related antiphospholipid disease.

8%

Nonarticular and Regional Musculoskeletal Disorders

Regional pain, tendinopathies, entrapment, and nociplastic pain.

6%

Nonrheumatic Systemic Disorders

Systemic disorders with rheumatologic presentations.

12%

Vasculitides

Large-, medium-, and small-vessel disease.

Preparing for the Saudi Board Adult Rheumatology Exam

What You Need to Know

  • Passing score: 70%, with conditional adjustment to a minimum of 65% as specified in the written blueprint
  • Assessment: Written MCQs followed by a separate clinical examination with six 10-minute graded stations: two OSCE and four SOE stations.
  • Time limit: Written-paper duration not confirmed in the public specialty sources reviewed; check the admission notice.
  • Exam / certification fees: Not confirmed in the public specialty sources reviewed; check SCFHS registration. Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Saudi Board Adult Rheumatology: Suggested Study Strategy

1Use the current specialty blueprint rather than the older curriculum table for topic weights.
2Distinguish research classification criteria from clinical diagnosis.
3Review current drug labels and primary guidelines for pregnancy, infection prevention, and immunosuppression.
4Prepare examination, communication, and oral reasoning skills through supervised clinical and station practice.

Frequently Asked Questions

Is the current written examination exactly 120 questions?

No. The 2024–2027 final written blueprint specifies one paper of 80–120 single-best-answer MCQs, with 10% unscored items allowed for pretesting. The older curriculum's 120-item example should not be treated as a fixed current count.

What clinical and training requirements also apply?

SCFHS requires approved training completion and program requirements such as clinical logbook and research work. Passing the written examination precedes the separate six-station final clinical assessment: two OSCE and four SOE stations, each lasting 10 minutes.

What is the passing score?

The written blueprint sets 70%. If fewer than 70% of candidates pass before approval, the score is lowered one mark at a time toward a 70% pass rate or a 65% score, whichever comes first, with an absolute 65% floor.

Is this an official English examination simulation?

No. This is an independent English-language MCQ study adaptation. The reviewed public specialty sources do not explicitly confirm permitted assessment languages, so no official English sitting or translation is claimed. OSCE and structured oral practice require separate preparation.