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Rheumatology Flashcards

7 cards from real MRCP PART 1 practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Rheumatology flashcards as text

  1. A 45-year-old woman presents with 6 weeks of symmetrical swelling of the MCPs and PIPs, 2-hour morning stiffness, elevated CRP, positive RF, and positive anti-CCP. What is the most appropriate first-line DMARD?

    Answer: Methotrexate

    Methotrexate is the anchor DMARD for rheumatoid arthritis and is recommended as first-line therapy by both NICE and EULAR guidelines.

  2. A patient with SLE develops proteinuria 3.5g/24h, haematuria, and cellular casts. Renal biopsy shows endocapillary hypercellularity affecting more than 50% of glomeruli. According to ISN/RPS classification, which class of lupus nephritis is this?

    Answer: Class IV

    Class IV (diffuse proliferative) lupus nephritis involves more than 50% of glomeruli and is the most severe form, requiring aggressive immunosuppression with cyclophosphamide or mycophenolate.

  3. A 65-year-old man taking hydrochlorothiazide presents with acute severe pain in the right first metatarsophalangeal joint. Joint aspirate reveals needle-shaped crystals that are strongly negatively birefringent under polarised light. What is the deposited substance?

    Answer: Monosodium urate

    Monosodium urate crystals are negatively birefringent and needle-shaped, causing gout; thiazide diuretics reduce renal urate excretion, raising serum urate levels.

  4. A 28-year-old man presents with 4 months of insidious lower back pain and stiffness lasting more than 1 hour each morning, relieved by exercise but not rest. X-ray shows bilateral sacroiliac joint erosions. HLA-B27 is positive. What is the most likely diagnosis?

    Answer: Ankylosing spondylitis

    Ankylosing spondylitis is characterised by bilateral sacroiliitis, inflammatory back pain that improves with exercise (not rest), and strong association with HLA-B27 in young men.

  5. A 52-year-old woman presents with a 2-year history of dry eyes, dry mouth, and arthralgia. Schirmer's test confirms reduced lacrimation. Which antibody is most characteristically associated with primary Sjögren's syndrome?

    Answer: Anti-Ro (SSA)

    Anti-Ro (SSA) antibodies are present in approximately 70% of patients with primary Sjögren's syndrome and are the hallmark serological finding.

  6. A 40-year-old man with known psoriasis develops diffuse swelling of the entire right index finger, giving it a sausage-like appearance. What is the correct term for this finding?

    Answer: Dactylitis

    Dactylitis (sausage digit) results from simultaneous inflammation of all compartments of a digit including tendons and joints, and is a hallmark feature of psoriatic arthritis.

  7. A 58-year-old woman with active rheumatoid arthritis is about to start methotrexate. Which baseline investigation is most critical before initiating this drug?

    Answer: Liver function tests and full blood count

    Methotrexate is hepatotoxic and myelosuppressive; baseline liver function tests and full blood count are mandatory before starting therapy, with regular monitoring every 4–12 weeks thereafter.