ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 1 of 98
In a patient with new-onset inflammatory polyarthritis and a positive rheumatoid factor, which additional
serologic finding most strongly predicts erosive progression and extra-articular manifestations, thereby guiding
A. Anti-cyclic citrullinated peptide (anti-CCP) antibodies
B. Antinuclear antibodies (ANA) at 1:160
C. Anti-Ro/SSA antibodies
D. Anti-histone antibodies
PREVIOUS CONTINUE
In a patient with new-onset inflammatory polyarthritis and a positive rheumatoid factor,
which additional serologic finding most strongly predicts erosive progression and
extra-articular manifestations, thereby guiding early escalation to biologic therapy?
(Correct) A. Anti-cyclic citrullinated peptide (anti-CCP) antibodies
B. Antinuclear antibodies (ANA) at 1:160
C. Anti-Ro/SSA antibodies
D. Anti-histone antibodies
Correct Answer: A
Anti-CCP antibodies are highly specific for rheumatoid arthritis and confer a 2- to 3-fold increased risk of
radiographic erosions and extra-articular disease compared with RF alone. ANA is nonspecific; anti-Ro is linked
to Sjögren's and neonatal lupus; anti-histone is associated with drug-induced lupus.
Page 1 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
, ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 2 of 98
Which mechanism best explains the increased risk of tuberculosis reactivation associated with tumor necrosis
factor-alpha (TNF-) inhibitors compared to other biologic classes?
A. TNF- is critical for granuloma formation and maintenance; its blockade impairs containment of latent
B. TNF- inhibitors directly inhibit macrophage phagolysosome fusion, reducing mycobacterial killing.
C. TNF- blockade depletes CD4+ T cells, leading to profound cellular immunodeficiency.
D. TNF- inhibitors upregulate transforming growth factor-beta, which promotes mycobacterial replication.
PREVIOUS CONTINUE
Which mechanism best explains the increased risk of tuberculosis reactivation associated
with tumor necrosis factor-alpha (TNF-) inhibitors compared to other biologic classes?
(Correct) A. TNF- is critical for granuloma formation and maintenance; its blockade impairs
containment of latent mycobacterial infection.
B. TNF- inhibitors directly inhibit macrophage phagolysosome fusion, reducing
mycobacterial killing.
C. TNF- blockade depletes CD4+ T cells, leading to profound cellular immunodeficiency.
D. TNF- inhibitors upregulate transforming growth factor-beta, which promotes mycobacterial
replication.
Correct Answer: A
TNF- is essential for the formation and structural integrity of granulomas that wall off latent tuberculosis; its
inhibition can lead to granuloma disintegration and reactivation. The other options misattribute mechanisms not
central to TNF-'s role in TB containment.
Page 2 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
, ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 3 of 98
A patient with systemic lupus erythematosus (SLE) presents with new-onset seizures and psychosis. MRI
shows no acute infarct. Which autoantibody is most specifically associated with this neuropsychiatric
A. Anti-ribosomal P protein
B. Anti-Smith (Sm)
C. Anti-double-stranded DNA (dsDNA)
D. Anti-U1 ribonucleoprotein (RNP)
PREVIOUS CONTINUE
A patient with systemic lupus erythematosus (SLE) presents with new-onset seizures and
psychosis. MRI shows no acute infarct. Which autoantibody is most specifically
associated with this neuropsychiatric presentation?
(Correct) A. Anti-ribosomal P protein
B. Anti-Smith (Sm)
C. Anti-double-stranded DNA (dsDNA)
D. Anti-U1 ribonucleoprotein (RNP)
Correct Answer: A
Anti-ribosomal P antibodies are strongly associated with lupus psychosis and seizures, independent of other
organ involvement. Anti-Sm is specific for SLE but not neuropsychiatric lupus; anti-dsDNA correlates with
nephritis; anti-U1 RNP is linked to MCTD.
Page 3 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
, ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 4 of 98
Which finding on synovial fluid analysis is most characteristic of calcium pyrophosphate dihydrate (CPPD)
crystal deposition disease?
A. Positively birefringent rhomboid-shaped crystals under polarized light
B. Negatively birefringent needle-shaped crystals
C. Positively birefringent needle-shaped crystals
D. Negatively birefringent rhomboid-shaped crystals
PREVIOUS CONTINUE
Which finding on synovial fluid analysis is most characteristic of calcium pyrophosphate
dihydrate (CPPD) crystal deposition disease?
(Correct) A. Positively birefringent rhomboid-shaped crystals under polarized light
B. Negatively birefringent needle-shaped crystals
C. Positively birefringent needle-shaped crystals
D. Negatively birefringent rhomboid-shaped crystals
Correct Answer: A
CPPD crystals are rhomboid-shaped and exhibit positive birefringence, whereas monosodium urate crystals are
needle-shaped and negatively birefringent. The other options mix these characteristics incorrectly.
Page 4 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 1 of 98
In a patient with new-onset inflammatory polyarthritis and a positive rheumatoid factor, which additional
serologic finding most strongly predicts erosive progression and extra-articular manifestations, thereby guiding
A. Anti-cyclic citrullinated peptide (anti-CCP) antibodies
B. Antinuclear antibodies (ANA) at 1:160
C. Anti-Ro/SSA antibodies
D. Anti-histone antibodies
PREVIOUS CONTINUE
In a patient with new-onset inflammatory polyarthritis and a positive rheumatoid factor,
which additional serologic finding most strongly predicts erosive progression and
extra-articular manifestations, thereby guiding early escalation to biologic therapy?
(Correct) A. Anti-cyclic citrullinated peptide (anti-CCP) antibodies
B. Antinuclear antibodies (ANA) at 1:160
C. Anti-Ro/SSA antibodies
D. Anti-histone antibodies
Correct Answer: A
Anti-CCP antibodies are highly specific for rheumatoid arthritis and confer a 2- to 3-fold increased risk of
radiographic erosions and extra-articular disease compared with RF alone. ANA is nonspecific; anti-Ro is linked
to Sjögren's and neonatal lupus; anti-histone is associated with drug-induced lupus.
Page 1 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
, ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 2 of 98
Which mechanism best explains the increased risk of tuberculosis reactivation associated with tumor necrosis
factor-alpha (TNF-) inhibitors compared to other biologic classes?
A. TNF- is critical for granuloma formation and maintenance; its blockade impairs containment of latent
B. TNF- inhibitors directly inhibit macrophage phagolysosome fusion, reducing mycobacterial killing.
C. TNF- blockade depletes CD4+ T cells, leading to profound cellular immunodeficiency.
D. TNF- inhibitors upregulate transforming growth factor-beta, which promotes mycobacterial replication.
PREVIOUS CONTINUE
Which mechanism best explains the increased risk of tuberculosis reactivation associated
with tumor necrosis factor-alpha (TNF-) inhibitors compared to other biologic classes?
(Correct) A. TNF- is critical for granuloma formation and maintenance; its blockade impairs
containment of latent mycobacterial infection.
B. TNF- inhibitors directly inhibit macrophage phagolysosome fusion, reducing
mycobacterial killing.
C. TNF- blockade depletes CD4+ T cells, leading to profound cellular immunodeficiency.
D. TNF- inhibitors upregulate transforming growth factor-beta, which promotes mycobacterial
replication.
Correct Answer: A
TNF- is essential for the formation and structural integrity of granulomas that wall off latent tuberculosis; its
inhibition can lead to granuloma disintegration and reactivation. The other options misattribute mechanisms not
central to TNF-'s role in TB containment.
Page 2 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
, ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 3 of 98
A patient with systemic lupus erythematosus (SLE) presents with new-onset seizures and psychosis. MRI
shows no acute infarct. Which autoantibody is most specifically associated with this neuropsychiatric
A. Anti-ribosomal P protein
B. Anti-Smith (Sm)
C. Anti-double-stranded DNA (dsDNA)
D. Anti-U1 ribonucleoprotein (RNP)
PREVIOUS CONTINUE
A patient with systemic lupus erythematosus (SLE) presents with new-onset seizures and
psychosis. MRI shows no acute infarct. Which autoantibody is most specifically
associated with this neuropsychiatric presentation?
(Correct) A. Anti-ribosomal P protein
B. Anti-Smith (Sm)
C. Anti-double-stranded DNA (dsDNA)
D. Anti-U1 ribonucleoprotein (RNP)
Correct Answer: A
Anti-ribosomal P antibodies are strongly associated with lupus psychosis and seizures, independent of other
organ involvement. Anti-Sm is specific for SLE but not neuropsychiatric lupus; anti-dsDNA correlates with
nephritis; anti-U1 RNP is linked to MCTD.
Page 3 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
, ABIM RHEUMATOLOGY EXAM 2025/2026 WITH
100% ACCURATE SOLUTIONS
2026 Exam · 98 Questions · With Rationales
ati. ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS
Question: 4 of 98
Which finding on synovial fluid analysis is most characteristic of calcium pyrophosphate dihydrate (CPPD)
crystal deposition disease?
A. Positively birefringent rhomboid-shaped crystals under polarized light
B. Negatively birefringent needle-shaped crystals
C. Positively birefringent needle-shaped crystals
D. Negatively birefringent rhomboid-shaped crystals
PREVIOUS CONTINUE
Which finding on synovial fluid analysis is most characteristic of calcium pyrophosphate
dihydrate (CPPD) crystal deposition disease?
(Correct) A. Positively birefringent rhomboid-shaped crystals under polarized light
B. Negatively birefringent needle-shaped crystals
C. Positively birefringent needle-shaped crystals
D. Negatively birefringent rhomboid-shaped crystals
Correct Answer: A
CPPD crystals are rhomboid-shaped and exhibit positive birefringence, whereas monosodium urate crystals are
needle-shaped and negatively birefringent. The other options mix these characteristics incorrectly.
Page 4 | ABIM RHEUMATOLOGY EXAM 2025/2026 WITH 100% ACCURATE SOLUTIONS 2026
