Rheumatology and Orthopedics Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Rheumatology and Orthopedics flashcards as text
A 45-year-old woman presents with a butterfly-shaped facial rash, joint pain, and a positive anti-dsDNA antibody. Which complement levels would most likely be found during active disease flare?
Answer: Decreased C3 and C4
In active SLE, complement is consumed by immune complex deposition, leading to decreased C3 and C4 levels.
A 60-year-old man with gout has a serum uric acid of 9.8 mg/dL and has experienced 3 flares in the past year. Which medication is first-line for long-term urate-lowering therapy?
Answer: Allopurinol
Allopurinol is the first-line urate-lowering therapy for gout, targeting a serum uric acid level below 6 mg/dL.
A 35-year-old man with ankylosing spondylitis has failed NSAIDs. Which biologic class is most appropriate as next-line therapy?
Answer: TNF-alpha inhibitors
TNF-alpha inhibitors (e.g., adalimumab, etanercept) are the recommended biologic class for ankylosing spondylitis refractory to NSAIDs.
A 70-year-old woman presents with proximal muscle weakness, difficulty rising from a chair, and heliotrope rash. Which laboratory finding best confirms the diagnosis?
Answer: Elevated CK and positive anti-Jo-1
Dermatomyositis presents with elevated creatine kinase and myositis-specific antibodies such as anti-Jo-1.
A patient with rheumatoid arthritis on methotrexate develops a dry cough and progressive dyspnea. Chest CT shows interstitial infiltrates. What is the most likely diagnosis?
Answer: Methotrexate-induced pneumonitis
Methotrexate-induced pneumonitis is a serious hypersensitivity reaction presenting with cough, dyspnea, and interstitial infiltrates.
A 50-year-old woman with osteoporosis and a T-score of -2.8 has been on oral bisphosphonate therapy for 5 years. Which rare adverse effect should be discussed at this point?
Answer: Atypical femur fracture
Atypical subtrochanteric femur fractures are a recognized rare complication of prolonged bisphosphonate therapy, typically after 5+ years.
A 28-year-old man presents with urethritis, conjunctivitis, and asymmetric oligoarthritis after a recent Chlamydia infection. What is the classic triad associated with this condition?
Answer: Urethritis, conjunctivitis, arthritis
Reactive arthritis (formerly Reiter's syndrome) classically presents with the triad of urethritis, conjunctivitis, and arthritis following genitourinary or GI infection.