PLAB 1 Musculoskeletal Medicine & Rheumatology 2

Question 1

A 58-year-old woman presents with proximal limb weakness, difficulty rising from a chair, and a heliotrope (violaceous) rash around her eyelids. Serum CK is markedly elevated. What is the most likely diagnosis?

Accepted Answer

Dermatomyositis

Answer

Dermatomyositis presents with proximal inflammatory myopathy, markedly elevated CK, and pathognomonic skin findings including the heliotrope rash and Gottron's papules.

Question 2

A 72-year-old woman presents with 3 months of bilateral shoulder and pelvic girdle aching and stiffness worse in the mornings, ESR 85 mm/hr, and CRP 45 mg/L. She responds dramatically to 15 mg prednisolone. What is the most likely diagnosis?

Accepted Answer

Polymyalgia rheumatica

Answer

Polymyalgia rheumatica presents in patients >50 years with bilateral girdle pain and stiffness, markedly elevated inflammatory markers, and a dramatic response to low-dose corticosteroids.

Question 3

Which important complication must all patients with polymyalgia rheumatica be warned about and screened for?

Accepted Answer

Giant cell arteritis

Answer

Giant cell arteritis occurs in 15–20% of PMR patients and can cause irreversible ischaemic visual loss; patients must be warned to report new headache, jaw claudication, or visual symptoms urgently.

Question 4

A 26-year-old man develops asymmetrical oligoarthritis, urethritis, and conjunctivitis 3 weeks after a confirmed Chlamydia trachomatis infection. What is this condition?

Accepted Answer

Reactive arthritis

Answer

Reactive arthritis (formerly Reiter's syndrome) is a sterile inflammatory arthritis triggered by genitourinary or gastrointestinal infection, classically causing the triad of arthritis, urethritis, and conjunctivitis.

Question 5

A patient with rheumatoid arthritis on long-term methotrexate develops painful mouth ulcers and a macrocytic anaemia. Which supplement should be co-prescribed with methotrexate to prevent these side effects?

Accepted Answer

Folic acid

Answer

Folic acid is routinely co-prescribed with methotrexate to reduce folate-deficiency side effects such as mucositis and macrocytic anaemia caused by methotrexate's folate antagonism.

PLAB 1 Practice Test

PLAB 1 Practice Test

PLAB 1 Musculoskeletal Medicine & Rheumatology 2