CARDIOLOGY BOARDS ABIM TEST
BANK 2026 COMPREHENSIVE
QUESTIONS AND ACCURATE
SOLUTIONS VERIFIED
◉ ANA frequency in dz. Answer: Drug induced SLE - 100%
SLE - 90%
Polymyositis/dermatomyositis - 40-60%
RA - 40%
MCTD - 95%
Limited scleroderma and diffuse scleroderma - 60-90%
Sjogrens - 70%
Nl population - 30% (1:40), 5% (1:160)
So, need more specific subtype testing if positive
◉ ANA subtypes. Answer: Anti-dsDNA - specific for SLE, can be + if
taking TNF inhibs. Marker for dz activity & potential for renal dz
Anti-Sm - specific for SLE, often seen with U1-RNP
Anti U1-RNP - sensitive, not specific for MCTP (neg rules it out)
Anti-histone - sens, not spec for drug induced SLE (procainamide,
hydralazine, chlorpromazine, quinidine)
Anti-Scl-70 - diffuse scleroderma, increased chance of interstitial lung
dz
Anti-centromere - limited scleroderma; increased Pulm HTN
,Anti-synthetase (Jo-1) - myositis; increased ILD
◉ Anti-SSA, SSB tests. Answer: SSA (Ro) - SLE, neonatal SLE,
Sjogrens, myositis; not in scleroderma; maternal transfer to baby -
neonatal heart block
SSB (La) - SLE, Sjogrens; sometimes found with SSA; can see maternal
transfer to baby
◉ ANCA testing. Answer: Get p & c-ANCA. If positive, check ELISA
for subtypes anti-PR3, anti-MPO
c-ANCA + anti-PR3 - Wegeners
p-ANCA, MPO positive - Churg-Strauss, PAN, pauci-immune
glomerulonephritis, microscopic polyangiitis, anti-glomerular basement
membrane dz
p-ANCA, MPO negative - Crohns, UC, chronic active hepatitis, PBC,
PSC, PAN, chronic arthridities
◉ Compliment tests. Answer: low in active SLE, vasculitis
Can also be low from genetic deficiency, consumed with activation, or
underproduced (HELLP syndrome)
C3 - consumed with any compliment activation
C4 - consumed with only classic pathway activation
CH50 - looks at total hemolytic component of classical pathway
◉ Rheumatoid factor and anti-CCP (citrullinated cyclic peptide).
Answer: RF - pos in 80-85% of RA, not specific
,CCP - appears earlier, greater specificity
◉ HLA's. Answer: HLA-B27 - 7-8% of nl population; 60-80% in
Reiters + reactive spondyloarthropathy; 90% with ank spondy; 60% of
sponylitis pts with psoriasis or IBD are positive; 80% in Yersinia,
Salmonella, Shigella arthropathy
HLA-DR2, DR3 - Sjogrens, polymyositis
HLA-DR4 - severe RA
◉ Joint fluid evaluation. Answer: Normal - 0-200 WBC
Non-inflammatory- 200-2000 WBC - OA, neuropathic joins,
hypertrophic osteoarthropathy, occasionally SLE, scleroderma,
rheumatic fever
Inflammatory - 2K-50K WBC - RA, SLE, SS, crystals, ank spon, IBD-
assc arthritis
Septic - 50K+ - >75% neurophils. Occasionally see this many WBC
with crystals
◉ Crystals in joint. Answer: Gout - yellow, negatively birefringent
CPPD - blue crystals, positively birefringent
To be sure they are causing the inflammation, you should see them
intracellularly
◉ Collagen vascular diseases. Answer: Marfan syndrome - long limbs,
aortic root dilation, ectopia lentis
, Ehler-Danlos - skin elasticity and joint hypermobility; types - classic
(most severe, easily scarred skin and hypermobile joints), Hypermobile
(mainly joint symptoms), vascular (mainly skin issues and rupture of
large vessels)
Osteogenesis imperfecta - procollagen gene defects; osteopenia, brittle
bones, blue sclera, teeth problem, hearing loss
Pseudoxanthoma elasticum - autosomal recessive; affects skin, blood
vessels, eyes. Angioid steaks on fundoscopy; recurrent GI bleeding
◉ Prevalence of RA. Answer: 1% overall, 40-50 yo, female: male 3:1,
10% with genetics
◉ Labs for RA. Answer: RF - 80-85%
anti-CCP - 97%, earlier than RF; assc with erosive RA
HLA-DR4 - aggressive RA
Joint fluid - inflammatory (2K+wbc), decreased viscosity; finf IL-1, IL-6
in joint fluid
◉ Markers for severe course in RA. Answer: high titer RF
positive anti-CCP, HLA-DR4,
Constitutional symptoms
Insidious onset
early XR evidence of erosive dz
extraarticular dz
BANK 2026 COMPREHENSIVE
QUESTIONS AND ACCURATE
SOLUTIONS VERIFIED
◉ ANA frequency in dz. Answer: Drug induced SLE - 100%
SLE - 90%
Polymyositis/dermatomyositis - 40-60%
RA - 40%
MCTD - 95%
Limited scleroderma and diffuse scleroderma - 60-90%
Sjogrens - 70%
Nl population - 30% (1:40), 5% (1:160)
So, need more specific subtype testing if positive
◉ ANA subtypes. Answer: Anti-dsDNA - specific for SLE, can be + if
taking TNF inhibs. Marker for dz activity & potential for renal dz
Anti-Sm - specific for SLE, often seen with U1-RNP
Anti U1-RNP - sensitive, not specific for MCTP (neg rules it out)
Anti-histone - sens, not spec for drug induced SLE (procainamide,
hydralazine, chlorpromazine, quinidine)
Anti-Scl-70 - diffuse scleroderma, increased chance of interstitial lung
dz
Anti-centromere - limited scleroderma; increased Pulm HTN
,Anti-synthetase (Jo-1) - myositis; increased ILD
◉ Anti-SSA, SSB tests. Answer: SSA (Ro) - SLE, neonatal SLE,
Sjogrens, myositis; not in scleroderma; maternal transfer to baby -
neonatal heart block
SSB (La) - SLE, Sjogrens; sometimes found with SSA; can see maternal
transfer to baby
◉ ANCA testing. Answer: Get p & c-ANCA. If positive, check ELISA
for subtypes anti-PR3, anti-MPO
c-ANCA + anti-PR3 - Wegeners
p-ANCA, MPO positive - Churg-Strauss, PAN, pauci-immune
glomerulonephritis, microscopic polyangiitis, anti-glomerular basement
membrane dz
p-ANCA, MPO negative - Crohns, UC, chronic active hepatitis, PBC,
PSC, PAN, chronic arthridities
◉ Compliment tests. Answer: low in active SLE, vasculitis
Can also be low from genetic deficiency, consumed with activation, or
underproduced (HELLP syndrome)
C3 - consumed with any compliment activation
C4 - consumed with only classic pathway activation
CH50 - looks at total hemolytic component of classical pathway
◉ Rheumatoid factor and anti-CCP (citrullinated cyclic peptide).
Answer: RF - pos in 80-85% of RA, not specific
,CCP - appears earlier, greater specificity
◉ HLA's. Answer: HLA-B27 - 7-8% of nl population; 60-80% in
Reiters + reactive spondyloarthropathy; 90% with ank spondy; 60% of
sponylitis pts with psoriasis or IBD are positive; 80% in Yersinia,
Salmonella, Shigella arthropathy
HLA-DR2, DR3 - Sjogrens, polymyositis
HLA-DR4 - severe RA
◉ Joint fluid evaluation. Answer: Normal - 0-200 WBC
Non-inflammatory- 200-2000 WBC - OA, neuropathic joins,
hypertrophic osteoarthropathy, occasionally SLE, scleroderma,
rheumatic fever
Inflammatory - 2K-50K WBC - RA, SLE, SS, crystals, ank spon, IBD-
assc arthritis
Septic - 50K+ - >75% neurophils. Occasionally see this many WBC
with crystals
◉ Crystals in joint. Answer: Gout - yellow, negatively birefringent
CPPD - blue crystals, positively birefringent
To be sure they are causing the inflammation, you should see them
intracellularly
◉ Collagen vascular diseases. Answer: Marfan syndrome - long limbs,
aortic root dilation, ectopia lentis
, Ehler-Danlos - skin elasticity and joint hypermobility; types - classic
(most severe, easily scarred skin and hypermobile joints), Hypermobile
(mainly joint symptoms), vascular (mainly skin issues and rupture of
large vessels)
Osteogenesis imperfecta - procollagen gene defects; osteopenia, brittle
bones, blue sclera, teeth problem, hearing loss
Pseudoxanthoma elasticum - autosomal recessive; affects skin, blood
vessels, eyes. Angioid steaks on fundoscopy; recurrent GI bleeding
◉ Prevalence of RA. Answer: 1% overall, 40-50 yo, female: male 3:1,
10% with genetics
◉ Labs for RA. Answer: RF - 80-85%
anti-CCP - 97%, earlier than RF; assc with erosive RA
HLA-DR4 - aggressive RA
Joint fluid - inflammatory (2K+wbc), decreased viscosity; finf IL-1, IL-6
in joint fluid
◉ Markers for severe course in RA. Answer: high titer RF
positive anti-CCP, HLA-DR4,
Constitutional symptoms
Insidious onset
early XR evidence of erosive dz
extraarticular dz
