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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 62-year-old man presents with acute knee pain and swelling. Joint aspiration reveals positively birefringent rhomboid-shaped crystals under polarised light microscopy. What is the diagnosis?

    Answer: Pseudogout (calcium pyrophosphate deposition)

    Pseudogout is caused by calcium pyrophosphate dihydrate (CPPD) crystals, which appear positively birefringent and rhomboid-shaped under polarised light, unlike the negatively birefringent needle-shaped urate crystals of gout.

  2. A patient with a known diagnosis of rheumatoid arthritis is to be started on an anti-TNF biologic agent. Which pre-treatment screening is MOST important before initiating therapy?

    Answer: Tuberculosis screening (IGRA or Mantoux)

    TB screening with an interferon-gamma release assay (IGRA) or Mantoux test is mandatory before starting anti-TNF therapy, as these agents can reactivate latent tuberculosis causing life-threatening disease.

  3. What is the mechanism of action of allopurinol in the management of gout?

    Answer: Inhibits xanthine oxidase, reducing uric acid production

    Allopurinol inhibits xanthine oxidase, the enzyme that converts hypoxanthine and xanthine to uric acid, thereby reducing urate production and serum uric acid levels.

  4. A 38-year-old woman with SLE and confirmed antiphospholipid syndrome has had two consecutive first-trimester miscarriages. What is the recommended management during her next pregnancy?

    Answer: Low-dose aspirin plus low molecular weight heparin (LMWH)

    Women with antiphospholipid syndrome and recurrent pregnancy loss require low-dose aspirin and LMWH throughout pregnancy; warfarin is teratogenic in the first trimester and avoided.

  5. A 65-year-old woman with a history of RA and chronic kidney disease develops a severe skin rash after starting allopurinol. What interaction must be warned about when prescribing allopurinol alongside azathioprine?

    Answer: Allopurinol inhibits azathioprine metabolism, causing potentially fatal toxicity

    Allopurinol inhibits xanthine oxidase, which also metabolises azathioprine; co-administration causes azathioprine accumulation leading to severe bone marrow suppression and potentially fatal toxicity.

  6. Which DMARD requires regular monitoring of full blood count, liver function tests, and renal function every 2–3 months due to risks of hepatotoxicity and bone marrow suppression?

    Answer: Methotrexate

    Methotrexate requires regular FBC, LFTs, and renal function monitoring due to risks of hepatotoxicity, pulmonary toxicity, and bone marrow suppression; folic acid must be co-prescribed.

  7. A 30-year-old woman is newly diagnosed with SLE. Which medication is recommended as background therapy for virtually ALL SLE patients unless contraindicated, as it reduces flares and organ damage?

    Answer: Hydroxychloroquine

    Hydroxychloroquine is recommended for all SLE patients as it reduces disease flares, prevents organ damage, lowers cardiovascular risk, and is safe in pregnancy.