MRCP Part 1 Rheumatology 2

Question 1

A 74-year-old woman presents with 6 weeks of bilateral shoulder and hip girdle aching, 90-minute morning stiffness, ESR 92 mm/hr, and CRP 58 mg/L. There are no features of giant cell arteritis. What is the first-line treatment?

Accepted Answer

Prednisolone 15mg daily

Answer

Polymyalgia rheumatica is treated with prednisolone 15mg daily initially, with gradual dose reduction guided by symptoms and inflammatory markers; NSAIDs alone are insufficient.

Question 2

A 32-year-old man develops asymmetric oligoarthritis, urethritis, and conjunctivitis 3 weeks after an episode of Campylobacter gastroenteritis. HLA-B27 is positive. What is the most likely diagnosis?

Accepted Answer

Reactive arthritis

Answer

Reactive arthritis is a seronegative spondyloarthropathy triggered by genitourinary or gastrointestinal infection, presenting with the classic triad of arthritis, urethritis, and conjunctivitis.

Question 3

A 48-year-old woman with long-standing Raynaud's phenomenon develops skin thickening confined to the hands and face, telangiectasia, and anti-centromere antibodies. Which long-term complication carries the greatest mortality risk in her condition?

Accepted Answer

Pulmonary arterial hypertension

Answer

Limited cutaneous systemic sclerosis with anti-centromere antibodies confers a high risk of pulmonary arterial hypertension, which is a leading cause of death in this subtype.

Question 4

Which antibody is most closely associated with diffuse cutaneous systemic sclerosis and predicts an increased risk of pulmonary fibrosis?

Accepted Answer

Anti-Scl-70 (anti-topoisomerase I)

Answer

Anti-Scl-70 (anti-topoisomerase I) antibodies are associated with diffuse cutaneous SSc and predict a substantially higher risk of interstitial lung disease.

Question 5

A 47-year-old woman presents with 3 months of proximal muscle weakness, CK 3,800 U/L, heliotrope discolouration of the eyelids, and Gottron's papules over the knuckles. Which investigation is most important to arrange urgently?

Accepted Answer

CT thorax, abdomen and pelvis

Answer

Adult-onset dermatomyositis has a strong association with underlying malignancy; CT TAP is mandatory to screen for occult cancer at diagnosis.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Rheumatology 2