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Rheumatology Flashcards

7 cards from real ABIM practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 45-year-old woman has Raynaud's phenomenon, dysphagia, skin thickening limited to her fingers and face, and telangiectasias. Which antibody is most associated with limited cutaneous systemic sclerosis?

    Answer: Anti-centromere

    Anti-centromere antibodies are highly associated with limited cutaneous systemic sclerosis (CREST syndrome), while anti-Scl-70 is associated with diffuse cutaneous disease.

  2. In patients with limited cutaneous systemic sclerosis, which complication is the leading cause of morbidity and mortality?

    Answer: Pulmonary arterial hypertension

    Pulmonary arterial hypertension is the leading cause of death in limited cutaneous systemic sclerosis, while interstitial lung disease predominates in diffuse cutaneous disease.

  3. A 25-year-old man presents with recurrent painful oral ulcers, genital ulcers, and uveitis. What is the most likely diagnosis?

    Answer: Behçet's disease

    Behçet's disease is characterized by the triad of recurrent oral ulcers, genital ulcers, and uveitis, with higher prevalence along the ancient Silk Road regions.

  4. Which ANCA pattern and target antigen is most specific for granulomatosis with polyangiitis (formerly Wegener's granulomatosis)?

    Answer: c-ANCA directed against proteinase 3 (PR3)

    c-ANCA directed against proteinase 3 (PR3) is the characteristic and highly specific antibody in granulomatosis with polyangiitis.

  5. A 60-year-old woman has symmetric polyarthritis involving MCPs and PIPs, morning stiffness greater than 1 hour, and radiographs showing periarticular osteopenia and joint space narrowing. Which DMARD is the cornerstone of treatment?

    Answer: Methotrexate

    Methotrexate is the anchor DMARD for rheumatoid arthritis, used as first-line therapy due to its proven efficacy, tolerability, and role as the foundation of combination regimens.

  6. Synovial fluid from a patient with acute monoarthritis of the knee shows positively birefringent rhomboid-shaped crystals. Which metabolic disorder is most characteristically associated with this finding?

    Answer: Hyperparathyroidism

    Calcium pyrophosphate deposition disease (pseudogout), characterized by positively birefringent rhomboid crystals, is associated with hyperparathyroidism, hemochromatosis, and hypomagnesemia.

  7. A 70-year-old man presents with a 2-day history of fever and severe knee pain. Synovial fluid analysis shows WBC 95,000/mm³ with 95% PMNs. What is the most appropriate immediate next step?

    Answer: Start IV antibiotics empirically

    A synovial WBC >50,000/mm³ with predominantly PMNs is highly suggestive of septic arthritis, requiring immediate empiric antibiotics and joint drainage to prevent rapid joint destruction.