FREE Internal Medicine Rheumatologic and Immunologic Conditions Questions and Answers

Question 1

A 35-year-old woman presents with a 6-month history of migratory polyarthritis affecting her small joints, morning stiffness lasting over an hour, and persistent fatigue.
On examination, she has symmetrical swelling and tenderness of the MCP and PIP joints, and mild ulnar deviation.
Laboratory tests show elevated ESR and CRP.
Which of the following autoantibodies is most specific for her suspected diagnosis?

Accepted Answer

Anti-cyclic citrullinated peptide (anti-CCP) antibody

Answer

Anti-nuclear antibody (ANA)

Answer

Rheumatoid factor (RF)

Answer

Anti-double stranded DNA (anti-dsDNA) antibody

Question 2

A 58-year-old man with a history of hypertension and diabetes presents with acute onset, severe pain and swelling in his right great toe. He denies any trauma. On examination, the joint is exquisitely tender, erythematous, and warm. Arthrocentesis of the affected joint reveals negatively birefringent, needle-shaped crystals. What is the most appropriate long-term management to prevent recurrent episodes?

Accepted Answer

Allopurinol

Answer

Daily colchicine

Answer

Oral corticosteroids

Answer

Indomethacin as needed

Question 3

Which of the following conditions is most strongly associated with the presence of anti-Ro/SSA and anti-La/SSB antibodies?

Accepted Answer

Sjögren's Syndrome

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Systemic Sclerosis (Scleroderma)

Answer

Polymyositis/Dermatomyositis

Question 4

A 45-year-old woman presents with a 3-month history of progressive muscle weakness, particularly in her shoulders and hips, making it difficult to comb her hair and climb stairs. She also notes a reddish-purple rash on her eyelids (heliotrope rash) and erythematous, scaly plaques over her knuckles (Gottron's papules). Laboratory tests show elevated creatine kinase (CK). Which of the following is the most likely diagnosis?

Accepted Answer

Dermatomyositis

Answer

Polymyalgia Rheumatica

Answer

Fibromyalgia

Answer

Systemic Lupus Erythematosus

Question 5

A 28-year-old woman presents with a several-month history of arthralgias, fatigue, and a photosensitive malar rash. She also reports recent hair loss and oral ulcers. Laboratory tests reveal positive ANA, anti-dsDNA, and low complement C3 and C4 levels. Which of the following is the most appropriate initial pharmacological treatment for her joint pain and rash, assuming no immediate life-threatening organ involvement?

Accepted Answer

Hydroxychloroquine

Answer

Cyclophosphamide

Answer

Rituximab

Answer

Methotrexate

Question 6

Which of the following is a key distinguishing feature between reactive arthritis and other forms of seronegative spondyloarthropathies?

Accepted Answer

Preceding genitourinary or gastrointestinal infection

Answer

Sacroiliitis on imaging

Answer

Presence of HLA-B27

Answer

Asymmetric oligoarthritis, typically of lower extremities