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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 55-year-old man with gout whose serum urate is well controlled at 0.26 mmol/L on allopurinol develops an acute flare 2 months after his dose was increased. What is the most likely explanation?

    Answer: Mobilisation of urate crystals during changes in serum urate

    During initiation or dose adjustment of urate-lowering therapy, fluctuations in serum urate cause dissolution and mobilisation of existing crystal deposits, triggering acute flares despite adequate control.

  2. Joint aspirate from a swollen knee reveals rhomboid-shaped crystals that are weakly positively birefringent under compensated polarised light. How does this differ from the crystals found in gout?

    Answer: Gout crystals are strongly negatively birefringent and needle-shaped

    Calcium pyrophosphate crystals (pseudogout) are weakly positively birefringent and rhomboid-shaped, whereas monosodium urate crystals (gout) are strongly negatively birefringent and needle-shaped.

  3. A 10-year-old ANA-positive girl is diagnosed with oligoarticular juvenile idiopathic arthritis. Which potentially sight-threatening complication is classically asymptomatic and requires scheduled ophthalmological screening?

    Answer: Anterior uveitis (iridocyclitis)

    Anterior uveitis in oligoarticular JIA is often asymptomatic (no red eye, no pain) and can lead to irreversible blindness if undetected; regular slit-lamp examinations every 3–6 months are mandatory.

  4. A 28-year-old man of Turkish origin presents with recurrent painful oral ulcers, genital ulcers, inflammatory uveitis, and erythema nodosum. A pathergy test shows a pustule forming 48 hours after a needle prick. What is the most likely diagnosis?

    Answer: Behçet's disease

    Behçet's disease is a systemic vasculitis characterised by the triad of oral ulcers, genital ulcers, and uveitis, with a positive pathergy test; it is more prevalent along the ancient Silk Road including Turkey and the Middle East.

  5. A 33-year-old woman presents with puffy oedematous fingers, proximal muscle weakness, and pleuritis. Serology shows a very high-titre anti-U1 RNP antibody with no other specific autoantibodies detected. What is the most likely diagnosis?

    Answer: Mixed connective tissue disease

    Mixed connective tissue disease is defined by overlapping features of SLE, systemic sclerosis, and inflammatory myositis in the context of high-titre anti-U1 RNP antibodies as the sole specific autoantibody.

  6. A patient taking hydralazine for hypertension develops arthralgia, pleuritis, and a positive ANA. Anti-histone antibodies are positive but anti-dsDNA and complement levels are normal. What is the most likely diagnosis?

    Answer: Drug-induced lupus erythematosus

    Drug-induced lupus caused by hydralazine (also procainamide, isoniazid) is characterised by anti-histone antibodies, positive ANA, absence of anti-dsDNA, and normal complement; it resolves on drug withdrawal.

  7. A 67-year-old postmenopausal woman has a femoral neck T-score of –2.7 on DEXA scan with no previous fragility fractures. She takes no current medications. What is the most appropriate pharmacological treatment?

    Answer: Alendronic acid 70mg weekly plus calcium and vitamin D

    A bisphosphonate (alendronic acid) combined with calcium and vitamin D is first-line treatment for osteoporosis; teriparatide and denosumab are reserved for very high-risk patients or those who fail bisphosphonate therapy.