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Musculoskeletal Medicine & Rheumatology Flashcards

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

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  1. A 55-year-old woman presents with pain and stiffness in both hands worse in the morning lasting over 1 hour. X-ray shows erosions and joint space narrowing at the MCP and PIP joints. What is the most likely diagnosis?

    Answer: Rheumatoid arthritis

    Rheumatoid arthritis typically presents with symmetrical small joint involvement, prolonged morning stiffness (>1 hour), and erosive changes on X-ray at MCP and PIP joints.

  2. A 28-year-old man presents with low back pain and stiffness worse in the morning and improving with exercise. HLA-B27 is positive and MRI shows bilateral sacroiliitis. What is the most likely diagnosis?

    Answer: Ankylosing spondylitis

    Ankylosing spondylitis presents in young males with inflammatory back pain, HLA-B27 positivity, and sacroiliitis on imaging, with characteristic improvement with exercise.

  3. Which investigation is most SPECIFIC for diagnosing rheumatoid arthritis?

    Answer: Anti-CCP antibodies

    Anti-CCP (anti-cyclic citrullinated peptide) antibodies have >95% specificity for rheumatoid arthritis, making them more diagnostically specific than rheumatoid factor.

  4. A 68-year-old man presents with sudden onset severe pain, erythema, and swelling of the first metatarsophalangeal joint. Serum uric acid is elevated at 560 µmol/L. What is the most likely diagnosis?

    Answer: Gout

    Gout classically presents with acute monoarthritis of the first MTP joint (podagra) with hyperuricaemia, often triggered by alcohol, dehydration, or diuretics.

  5. A patient with SLE develops a butterfly facial rash, joint pains, and proteinuria with red cell casts on urine microscopy. Which antibody best correlates with disease activity and renal involvement in SLE?

    Answer: Anti-dsDNA

    Anti-dsDNA antibody titres correlate with SLE disease activity, particularly lupus nephritis, and rising titres predict disease flares.

  6. According to UK guidelines, what is the first-line treatment for an acute attack of gout?

    Answer: Colchicine or NSAIDs

    NSAIDs (e.g. naproxen) or colchicine are first-line for acute gout; allopurinol and febuxostat are urate-lowering agents used for prophylaxis, not acute attacks.

  7. A 42-year-old woman presents with dry eyes, dry mouth, difficulty swallowing, and symmetrical arthralgia. Blood tests show positive Anti-Ro and Anti-La antibodies. What is the most likely diagnosis?

    Answer: Sjögren's syndrome

    Sjögren's syndrome presents with sicca symptoms (dry eyes and mouth) caused by exocrine gland lymphocytic infiltration and is characterised by Anti-Ro (SSA) and Anti-La (SSB) antibodies.