ABIM Rheumatology

Question 1

Which antibody is most specific for rheumatoid arthritis?

Accepted Answer

Anti-cyclic citrullinated peptide (anti-CCP)

Answer

Anti-cyclic citrullinated peptide (anti-CCP) antibody has approximately 95% specificity for rheumatoid arthritis, making it more specific than rheumatoid factor.

Question 2

Which antibody is most specific for systemic lupus erythematosus (SLE)?

Accepted Answer

Anti-Smith (anti-Sm)

Answer

Anti-Smith (anti-Sm) antibodies are the most specific antibody for SLE (~99% specific), though they have lower sensitivity than anti-dsDNA.

Question 3

A 55-year-old man presents with sudden-onset severe pain and swelling of his right great toe with a serum uric acid of 9.2 mg/dL. What is the most appropriate first-line treatment for this acute attack?

Accepted Answer

Colchicine

Answer

Colchicine (along with NSAIDs or corticosteroids) is first-line for acute gout; urate-lowering agents like allopurinol should never be initiated during an acute attack.

Question 4

Which synovial fluid finding is most characteristic of gout?

Accepted Answer

Negatively birefringent needle-shaped crystals

Answer

Gout is characterized by monosodium urate crystals that are needle-shaped and negatively birefringent under polarized light microscopy.

Question 5

A 50-year-old woman presents with dry eyes, dry mouth, anti-Ro/SSA antibodies, and anti-La/SSB antibodies. Which condition is most likely?

Accepted Answer

Primary Sjögren's syndrome

Answer

Anti-Ro/SSA and anti-La/SSB antibodies are characteristically associated with primary Sjögren's syndrome, which presents with sicca symptoms (dry eyes and dry mouth).

ABIM - American Board of Internal Medicine Practice Test

ABIM - American Board of Internal Medicine Practice Test

ABIM Rheumatology