MRCP Part 1 Rheumatology

Question 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?

Accepted Answer

Methotrexate

Answer

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

Question 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?

Accepted Answer

Class IV

Answer

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.

Question 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?

Accepted Answer

Monosodium urate

Answer

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

Question 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?

Accepted Answer

Ankylosing spondylitis

Answer

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.

Question 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?

Accepted Answer

Anti-Ro (SSA)

Answer

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

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Rheumatology