ITE Rheumatology

Question 1

A 35-year-old woman presents with a 3-month history of symmetric, painful swelling of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, morning stiffness lasting 2 hours, and fatigue.
Labs show RF positive, anti-CCP positive, ESR 68.
Which of the following is the most appropriate initial disease-modifying therapy?

Accepted Answer

Methotrexate

Answer

Prednisone 40 mg daily

Answer

Naproxen 500 mg twice daily

Answer

Hydroxychloroquine monotherapy

Question 2

A 28-year-old woman presents with a malar rash, oral ulcers, pleuritis, and a CBC showing leukopenia (WBC 2,800) and thrombocytopenia (platelets 88,000). ANA is positive at 1:640. Which antibody, if positive, would be MOST specific for her likely diagnosis?

Accepted Answer

Anti-Smith (anti-Sm)

Answer

Anti-Ro/SSA

Answer

Anti-Jo-1

Answer

Anti-Scl-70

Question 3

A 58-year-old man with hypertension and chronic kidney disease presents with sudden onset severe pain and swelling of the right first metatarsophalangeal joint. Synovial fluid analysis shows negatively birefringent, needle-shaped crystals. Serum uric acid is 9.4 mg/dL. He is currently on hydrochlorothiazide. What is the most appropriate acute treatment?

Accepted Answer

Colchicine 1.2 mg followed by 0.6 mg one hour later

Answer

Allopurinol 300 mg daily started immediately

Answer

Indomethacin 50 mg three times daily

Answer

Probenecid 500 mg twice daily

Question 4

A 45-year-old woman with longstanding Raynaud's phenomenon develops progressive skin tightening extending above the elbows, dysphagia, and pulmonary hypertension. Which antibody is MOST closely associated with this presentation?

Accepted Answer

Anti-topoisomerase I (Anti-Scl-70)

Answer

Anti-centromere antibody

Answer

Anti-U1 RNP

Answer

Anti-dsDNA

Question 5

A 32-year-old man presents with low back pain and stiffness for 8 months, worse in the morning and improving with exercise, not rest. He is HLA-B27 positive. Sacroiliac joint MRI shows bone marrow edema. Which of the following is the most appropriate initial therapy?

Accepted Answer

A nonsteroidal anti-inflammatory drug (NSAID) at full therapeutic dose

Answer

Methotrexate 15 mg weekly

Answer

Anti-TNF biologic therapy

Answer

Systemic corticosteroids

Question 6

A 70-year-old woman presents with proximal muscle weakness, difficulty rising from a chair, bilateral shoulder and hip girdle aching, an ESR of 95 mm/hr, and a CRP of 4.2 mg/dL. She has no muscle enzyme elevation and normal EMG. What is the most likely diagnosis?

Accepted Answer

Polymyalgia rheumatica (PMR)

Answer

Polymyositis

Answer

Fibromyalgia

Answer

Hypothyroid myopathy