ABIM Rheumatology 2

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?

Accepted Answer

Polymyalgia rheumatica

Answer

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?

Accepted Answer

Irreversible blindness

Answer

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?

Accepted Answer

Anti-histone

Answer

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?

Accepted Answer

Elevated creatine kinase (CK)

Answer

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?

Accepted Answer

Low molecular weight heparin (LMWH) plus low-dose aspirin

Answer

In antiphospholipid syndrome with obstetric complications, low-dose aspirin plus LMWH throughout pregnancy is standard of care; warfarin is teratogenic in the first trimester.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Rheumatology 2