ABIM Rheumatology 2 — Questions and Answers
Question 1: A 65-year-old woman presents with bilateral aching in her shoulders and hips, an ESR of 85 mm/hr, markedly elevated CRP, but no true synovitis on examination. What is the most likely diagnosis?
- Fibromyalgia
- Polymyalgia rheumatica (Correct answer)
- Rheumatoid arthritis
- Giant cell arteritis
Correct answer: Polymyalgia rheumatica
Polymyalgia rheumatica typically presents in patients over 50 with bilateral proximal girdle pain, markedly elevated inflammatory markers, and no true synovitis.
Question 2: A patient with polymyalgia rheumatica develops new-onset unilateral temporal headache, scalp tenderness, and jaw claudication. What is the most feared complication if giant cell arteritis is not promptly treated?
- Stroke
- Irreversible blindness (Correct answer)
- Sensorineural deafness
- Renal failure
Correct answer: Irreversible blindness
Giant cell arteritis can cause ischemic optic neuropathy via involvement of the ophthalmic arteries, leading to irreversible blindness if high-dose corticosteroids are not started immediately.
Question 3: Which antibody is characteristically associated with drug-induced lupus?
- Anti-dsDNA
- Anti-Smith
- Anti-histone (Correct answer)
- Anti-Ro/SSA
Correct answer: Anti-histone
Drug-induced lupus is characteristically associated with anti-histone antibodies; common culprits include hydralazine, procainamide, isoniazid, and minocycline.
Question 4: A 40-year-old woman presents with proximal muscle weakness, heliotrope rash over the eyelids, and Gottron papules on her knuckles. Which laboratory finding most supports the diagnosis of dermatomyositis?
- Elevated creatine kinase (CK) (Correct answer)
- Elevated alkaline phosphatase
- Elevated serum uric acid
- Positive anti-Smith antibody
Correct answer: Elevated creatine kinase (CK)
Elevated creatine kinase (CK) is characteristic of inflammatory myopathies like dermatomyositis, reflecting ongoing muscle cell injury.
Question 5: A patient with SLE, lupus anticoagulant, and anticardiolipin antibodies has a history of two miscarriages. What is the recommended anticoagulation strategy during her next pregnancy?
- No anticoagulation needed
- Low-dose aspirin alone
- Low molecular weight heparin (LMWH) plus low-dose aspirin (Correct answer)
- Warfarin throughout pregnancy
Correct answer: Low molecular weight heparin (LMWH) plus low-dose aspirin
In antiphospholipid syndrome with obstetric complications, low-dose aspirin plus LMWH throughout pregnancy is standard of care; warfarin is teratogenic in the first trimester.
Question 6: What is the primary mechanism of action of colchicine in the treatment of acute gout?
- Inhibition of xanthine oxidase to reduce uric acid synthesis
- Promotion of renal uric acid excretion
- Inhibition of neutrophil microtubule polymerization (Correct answer)
- Blocking of IL-1β signaling
Correct answer: Inhibition of neutrophil microtubule polymerization
Colchicine works by inhibiting microtubule polymerization in neutrophils, thereby impairing their migration and activation at sites of urate crystal deposition.
Question 7: A 30-year-old man develops arthritis, urethritis, and conjunctivitis 2-4 weeks after a Salmonella gastroenteritis. What is the most likely diagnosis?
- Disseminated gonococcal arthritis
- Reactive arthritis (Correct answer)
- Septic arthritis
- Ankylosing spondylitis
Correct answer: Reactive arthritis
Reactive arthritis presents with the classic triad of arthritis, urethritis, and conjunctivitis following a genitourinary or gastrointestinal infection.
ABIM Rheumatology 2
A 65-year-old woman presents with bilateral aching in her shoulders and hips, an ESR of 85 mm/hr, markedly elevated CRP, but no true synovitis on examination.
What is the most likely diagnosis?