FREE Internal Medicine Rheumatology and Orthopedics Questions and Answers

Question 1

A 35-year-old woman presents with a 4-month history of symmetric pain and swelling in her metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, accompanied by morning stiffness lasting over an hour.
Physical examination reveals soft, boggy swelling of the affected joints.
Which of the following sets of laboratory findings would be most specific for diagnosing her condition?

Accepted Answer

Positive anti-cyclic citrullinated peptide (anti-CCP) antibodies and a positive rheumatoid factor (RF).

Answer

Elevated C-reactive protein (CRP) and a positive antinuclear antibody (ANA) test.

Answer

Elevated erythrocyte sedimentation rate (ESR) and hyperuricemia.

Answer

Normal inflammatory markers and a positive human leukocyte antigen B27 (HLA-B27) test.

Question 2

A 55-year-old male with a history of recurrent sinusitis and recent onset of shortness of breath and hemoptysis is found to have nodular opacities on chest X-ray. Urinalysis reveals red blood cell casts. Which of the following autoantibodies is most specifically associated with this patient's likely diagnosis?

Accepted Answer

Anti-neutrophil cytoplasmic antibody, cytoplasmic pattern (c-ANCA) with anti-proteinase 3 (PR3)

Answer

Anti-double-stranded DNA (anti-dsDNA)

Answer

Anti-Scl-70 (anti-topoisomerase I)

Answer

Anti-neutrophil cytoplasmic antibody, perinuclear pattern (p-ANCA) with anti-myeloperoxidase (MPO)

Question 3

A 68-year-old man with stage 4 chronic kidney disease (eGFR 25 mL/min/1.73m²) presents with an exquisitely painful, swollen, and erythematous first metatarsophalangeal joint. Arthrocentesis confirms gout. Which of the following is the most appropriate initial treatment for his acute gout flare?

Accepted Answer

Intra-articular glucocorticoid injection

Answer

High-dose oral naproxen

Answer

Oral colchicine 1.2 mg followed by 0.6 mg in one hour

Answer

Oral allopurinol 300 mg daily

Question 4

A 75-year-old woman presents with a 2-month history of severe stiffness and aching in her shoulders, neck, and pelvic girdle. The stiffness is most pronounced in the morning, making it difficult for her to get out of bed. She also reports malaise and a low-grade fever. Laboratory tests show a markedly elevated ESR of 90 mm/hr. What is the most appropriate initial therapy?

Accepted Answer

Low-dose prednisone (15 mg daily)

Answer

High-dose prednisone (60 mg daily)

Answer

Methotrexate 15 mg weekly

Answer

Naproxen 500 mg twice daily

Question 5

A 28-year-old male presents with a 3-year history of chronic inflammatory back pain and stiffness that improves with exercise but not with rest. A plain radiograph of the pelvis is obtained. Which of the following radiographic findings in the sacroiliac joints would be most characteristic of ankylosing spondylitis?

Accepted Answer

Bilateral symmetric sclerosis and joint space fusion (ankylosis)

Answer

Juxta-articular osteopenia and marginal erosions

Answer

Subchondral cysts and osteophyte formation

Answer

Punched-out erosions with sclerotic borders

Question 6

A 45-year-old man presents to the emergency department with the sudden onset of a severely painful, swollen, and warm right knee, making him unable to bear weight. He has a fever of 38.5°C (101.3°F). What is the most critical next step in the management of this patient?

Accepted Answer

Perform an arthrocentesis of the knee

Answer

Obtain a serum uric acid level

Answer

Order a plain radiograph of the knee

Answer

Initiate empiric intravenous antibiotics