ABIM Rheumatology 3

Question 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?

Accepted Answer

Anti-centromere

Answer

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

Question 2

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

Accepted Answer

Pulmonary arterial hypertension

Answer

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

Question 3

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

Accepted Answer

Behçet's disease

Answer

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.

Question 4

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

Accepted Answer

c-ANCA directed against proteinase 3 (PR3)

Answer

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

Question 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?

Accepted Answer

Methotrexate

Answer

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.

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Rheumatology 3