1. Which of the following cells are involved in the pathogenesis of rheumatoid arthritis? 1.B cell 2.T cell 3.Macrophage 4.All of above

2. Which of the followings is not anti-TNF? 1.Rituximab 2.Etanercept 3.Adalimumab 4.Golimumab

3. DAS-28 is used to assess the disease activity of which disease? 1.systemic lupus erythematosus 2.rheumatoid arthritis 3.ankylosing spondylitis 4.osteoporosis

4. The following side effects are increased with anti-TNF therapy except 1.Infection 2.Tuberculosis 3.Hepatits B 4.Lymphoma

5. The TB incidence rate in Taiwan is around 1.10-24 /100,000 population 2.24-49/ 100,000 population 3.50-100/100,000 population 4.100-299/100,000 population

6. Which is the correct statement regarding screen tests TST (tuberculin skin test) and IGRA (interferon-r release assay) for latent TB infection ? 1.TST is of better sensitivity than IGRA 2.IGRA is of better sensitivity than TST 3.TST is of better specificity than IGRA 4.IGRA is of better specificity than TST

7. Which of the following treatment carries the highest risk of HBV reactivation 1.Methotrexate 2.Steroid 3.Anti-TNF plus steroid 4.Rituximab plus steroid

8. Which of the following antiviral drugs carry the higher risk of emergence of HBV mutant variant? 1. Lamivudine 2. Adefovir 3. Entecavir 4. Telbivudine

10. Which of the following cells are involved in the pathogenesis of rheumatoid arthritis? 1.B cell 2.T cell 3.Macrophage 4.All of above

11. Choy EH, Panayi GS. N Engl J Med 2001;344:907-916 Cytokine signalling pathways involved in RA 11 RF Plasma cell B cell Synovium Osteoclast OPGL Fibroblast IL-4 IL-6 IL-10 IL-4 IL-10 IFN  IL-12 ThO IFN  CD69 CD11 CD4 + T cell CD11 CD69 TNF IL-1 IL-6 Macrophage Th2 Production of metalloproteinases and other effector molecules Migration of polymorphonuclear cells Erosion of bone and cartilage Chondrocyte Etanercept Infliximab Adalimumab Golimumab Certolizumab Rituximab Tocilizumab Abatacept

12. Which of the followings is not anti-TNF? 1.Rituximab 2.Etanercept 3.Adalimumab 4.Golimumab

13. Woodrick, R. S. & Ruderman, E. M. Nat. Rev. Rheumatol. 7, 639–652 (2011)

14. DAS-28 is used to assess the disease activity of which disease? 1.systemic lupus erythematosus 2.rheumatoid arthritis 3.ankylosing spondylitis 4.osteoporosis

15. Measures of disease activity of rheumatoid arthritis DAS-28, SDAI, CDAI 1. Remission ( 緩解 ) 2. Low disease activity ( 低度疾病活動度 ) 3. Moderate disease activity ( 中度疾病活動度 ) 4. High disease activity ( 重度疾病活動度 )

16. The following side effects are increased with anti-TNF therapy except 1.Infection 2.Tuberculosis 3.Hepatits B 4.Lymphoma

17. The TB incidence rate in Taiwan is around 1.10-24 /100,000 population 2.24-49/ 100,000 population 3.50-100/100,000 population 4.100-299/100,000 population

18. Taiwan 66.7 Hong Kong 77 China 102 Phillipines 296 臺灣仍是結核病中度流行區 結核病例報告率為西元 2004 年之每十萬人 74 例至 2007 每十萬人 85 例 ; 在 2010 年則降為每十萬人 57 例 Malaysia 106 S. Korea 87 N. Korea 178 Singapore 41 Japan 31 Australia 5.7 Guam 60 Thailand 142 Indonesia 285 USA 4.6Canada 5.5 UK 12S. Africa 536 Vietnam 178 Every 100,000 people Data From WHO: World TB Report 2005

19. Which is the correct statement regarding screen tests TST (tuberculin skin test) and IGRA (interferon-r release assay) for latent TB infection ? 1.TST is of better sensitivity than IGRA 2.IGRA is of better sensitivity than TST 3.TST is of better specificity than IGRA 4.IGRA is of better specificity than TST

20. A recent meta-analysis: QFT assay has high specificity (96%), whereas TST has low specificity in BCG-vaccinated people (Ann Intern Med 2008;149:177-84 ) TST QFT SpecificitySensitivity

21. Which of the following treatment carries the highest risk of HBV reactivation 1.Methotrexate 2.Steroid 3.Anti-TNF plus steroid 4.Rituximab plus steroid

22. Hepatitis flares in HBsAg (-) NHL patients Hui CK et al: Gastroenterology 2006; 131: 59-68 A retrospective study of 244 HBsAg (-) lymphoma patients 8 patients developed hepatitis (median follow- up 12.4 months) 3 fulminant hepatitis 6/49  12%

23. Which of the following antiviral drugs carry the higher risk of emergence of HBV mutant variant? 1. Lamivudine 2. Adefovir 3. Entecavir 4. Telbivudine

24. 24 Cumulative Incidence of HBV Resistance J Hepatol 2009; 50: 227–42. lamivudine adefovir entecavir telbivudine tenofovir