Internal Medicine Exam Common Rheumatologic Disorders 5

Question 1

A 43-year-old woman with RA is on methotrexate 20mg/week. She develops mouth sores, macrocytic anemia, and fatigue. What is the most appropriate management?

Accepted Answer

Add folic acid 1mg daily and continue methotrexate

Answer

Methotrexate toxicity (mucositis, megaloblastic anemia) is reduced by supplemental folic acid 1-5mg daily without significantly impairing its efficacy.

Question 2

A 35-year-old woman presents with livedo reticularis, recurrent spontaneous abortions, thrombocytopenia, and a prolonged PTT that does not correct with mixing study. Which antibody panel is most diagnostic?

Accepted Answer

Lupus anticoagulant, anticardiolipin IgG/IgM, and anti-β2-glycoprotein I

Answer

Antiphospholipid syndrome is diagnosed by the combination of clinical criteria (thrombosis or pregnancy morbidity) and confirmed positive antiphospholipid antibodies on two occasions 12 weeks apart.

Question 3

A 72-year-old woman on long-term prednisone for polymyalgia rheumatica presents with sudden severe back pain. Spine X-ray shows a wedge compression fracture at T12. What is the most important preventive measure that should have been initiated?

Accepted Answer

Calcium and vitamin D supplementation plus bisphosphonate therapy

Answer

Glucocorticoid-induced osteoporosis prevention requires calcium, vitamin D, and a bisphosphonate (or other anti-resorptive) starting with chronic steroid use.

Question 4

A 58-year-old woman with RA presents with a painless effusion in her right knee. Joint aspiration yields 80 mL of clear, straw-colored fluid with WBC 1,200/mm³ and glucose equal to serum. What does this synovial fluid analysis indicate?

Accepted Answer

Noninflammatory (Group I) fluid consistent with RA remission or osteoarthritis overlay

Answer

Noninflammatory synovial fluid (WBC <2,000/mm³, clear, normal glucose) suggests inactive RA or a concurrent non-inflammatory process like OA.

Question 5

A 29-year-old man with IBD-associated arthritis has asymmetric oligoarthritis of large joints that parallels bowel disease activity. Which treatment is most appropriate for both his arthritis and bowel disease?

Accepted Answer

Infliximab

Answer

Infliximab (anti-TNF chimeric antibody) is effective for both IBD and its associated peripheral arthritis, making it the preferred biologic in this setting.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Common Rheumatologic Disorders 5