Internal Medicine Exam Rheumatology and Orthopedics 2

Question 1

A 45-year-old woman presents with a butterfly-shaped facial rash, joint pain, and a positive anti-dsDNA antibody. Which complement levels would most likely be found during active disease flare?

Accepted Answer

Decreased C3 and C4

Answer

In active SLE, complement is consumed by immune complex deposition, leading to decreased C3 and C4 levels.

Question 2

A 60-year-old man with gout has a serum uric acid of 9.8 mg/dL and has experienced 3 flares in the past year. Which medication is first-line for long-term urate-lowering therapy?

Accepted Answer

Allopurinol

Answer

Allopurinol is the first-line urate-lowering therapy for gout, targeting a serum uric acid level below 6 mg/dL.

Question 3

A 35-year-old man with ankylosing spondylitis has failed NSAIDs. Which biologic class is most appropriate as next-line therapy?

Accepted Answer

TNF-alpha inhibitors

Answer

TNF-alpha inhibitors (e.g., adalimumab, etanercept) are the recommended biologic class for ankylosing spondylitis refractory to NSAIDs.

Question 4

A 70-year-old woman presents with proximal muscle weakness, difficulty rising from a chair, and heliotrope rash. Which laboratory finding best confirms the diagnosis?

Accepted Answer

Elevated CK and positive anti-Jo-1

Answer

Dermatomyositis presents with elevated creatine kinase and myositis-specific antibodies such as anti-Jo-1.

Question 5

A patient with rheumatoid arthritis on methotrexate develops a dry cough and progressive dyspnea. Chest CT shows interstitial infiltrates. What is the most likely diagnosis?

Accepted Answer

Methotrexate-induced pneumonitis

Answer

Methotrexate-induced pneumonitis is a serious hypersensitivity reaction presenting with cough, dyspnea, and interstitial infiltrates.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Rheumatology and Orthopedics 2