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Rheumatology Flashcards

7 cards from real MRCP PART 1 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 flashcards as text

  1. A 74-year-old woman presents with 6 weeks of bilateral shoulder and hip girdle aching, 90-minute morning stiffness, ESR 92 mm/hr, and CRP 58 mg/L. There are no features of giant cell arteritis. What is the first-line treatment?

    Answer: Prednisolone 15mg daily

    Polymyalgia rheumatica is treated with prednisolone 15mg daily initially, with gradual dose reduction guided by symptoms and inflammatory markers; NSAIDs alone are insufficient.

  2. A 32-year-old man develops asymmetric oligoarthritis, urethritis, and conjunctivitis 3 weeks after an episode of Campylobacter gastroenteritis. HLA-B27 is positive. What is the most likely diagnosis?

    Answer: Reactive arthritis

    Reactive arthritis is a seronegative spondyloarthropathy triggered by genitourinary or gastrointestinal infection, presenting with the classic triad of arthritis, urethritis, and conjunctivitis.

  3. A 48-year-old woman with long-standing Raynaud's phenomenon develops skin thickening confined to the hands and face, telangiectasia, and anti-centromere antibodies. Which long-term complication carries the greatest mortality risk in her condition?

    Answer: Pulmonary arterial hypertension

    Limited cutaneous systemic sclerosis with anti-centromere antibodies confers a high risk of pulmonary arterial hypertension, which is a leading cause of death in this subtype.

  4. Which antibody is most closely associated with diffuse cutaneous systemic sclerosis and predicts an increased risk of pulmonary fibrosis?

    Answer: Anti-Scl-70 (anti-topoisomerase I)

    Anti-Scl-70 (anti-topoisomerase I) antibodies are associated with diffuse cutaneous SSc and predict a substantially higher risk of interstitial lung disease.

  5. A 47-year-old woman presents with 3 months of proximal muscle weakness, CK 3,800 U/L, heliotrope discolouration of the eyelids, and Gottron's papules over the knuckles. Which investigation is most important to arrange urgently?

    Answer: CT thorax, abdomen and pelvis

    Adult-onset dermatomyositis has a strong association with underlying malignancy; CT TAP is mandatory to screen for occult cancer at diagnosis.

  6. A 35-year-old woman with SLE has suffered three first-trimester miscarriages and one DVT. Lupus anticoagulant and anti-cardiolipin IgG are positive on two occasions 12 weeks apart. What is the most appropriate long-term antithrombotic treatment?

    Answer: Warfarin with target INR 2–3

    Antiphospholipid syndrome with confirmed venous thrombosis requires long-term warfarin targeting an INR of 2–3; direct oral anticoagulants are not recommended in APS due to evidence of higher recurrence rates.

  7. A 68-year-old man presents with acute onset of a hot, erythematous, severely swollen right knee. Joint aspirate shows cloudy fluid with WBC 85,000/mm³ (92% neutrophils) and Gram-positive cocci in clusters on Gram stain. What is the most appropriate immediate management?

    Answer: IV flucloxacillin and urgent joint washout

    Septic arthritis (most likely Staphylococcus aureus) is a medical emergency requiring IV antibiotics and surgical joint washout to prevent irreversible cartilage destruction.