ABIM RHEUMATOLOGY EXAM QUESTIONS AND ANSWERS FULLY SOLVED
The most appropriate and cost-effective means of assessing the cause of acute monoarthritis - Answers
Aspiration and analysis of the synovial fluid for leukocytes, Gram stain with culture, and crystals.
Ocular manifestations of systemic rheumatologic dx - Answers #Rheumatoid arthritis - episcleritis and
scleritis #Spondyloarthritis and sarcoidosis - uveitis and vasculitis
#Sjögren syndrome - Dry eyes ( kerato-conjunctivitis sicca)
Noninflammatory conditions causing elevations in ESR - Answers Kidney disease, DM, pregnancy, and
obesity
Rheumatoid factor - Answers Immunoglobulin directed against the Fc portion of IgG
Most specific antibodies characteristic of RA - Answers Anti-cyclic citrullinated peptide
Synovial fluid leukocyte counts most often seen in infectious arthritis - Answers > 50,000/µL (50 × 109/L)
Prophylactic therapy for patients on chronic glucocorticoid therapy - Answers Calcium and vitamin D
supplementation
SE of Methrothrexate - Answers -Hepatitis
=Bone marrow suppression (leukopenia, anemia). Patients with liver disease should not receive
methotrexate, and limitation of alcohol intake is strongly advised.
Treatment of ankylosing spondylitis - Answers First line - NSAIDs
2nd line (if above fails) - TNF-α inhibitors
Characteristic radiologic findings of RA - Answers - Periarticular osteopenia and
- Marginal (near the edges of the joint) erosions
*Erosive changes may not be evident early in dx
Most common cardiac manifestation of RA - Answers Pericarditis , often asymptomatic.
Bony enlargement of a DIP joint in OA - Answers Heberden node
Bony enlargement of a PIP joint in OA - Answers Bouchard node.
Radiographic Hallmarks of OA - Answers - Joint-space narrowing (articular cartilage loss)
- Osteophytes formation
- Sclerosis of subchondral bone,
, - Subchondral cysts
- Lack of periarticular osteopenia
Presence of flowing osteophytes involving the anterolateral aspect of the thoracic spine at 4 or more
contiguous vertebrae with preservation of the intervertebral disk space and the absence of apophyseal
joint or sacroiliac inflammatory changes - Answers Diffuse idiopathic skeletal hyperostosis (DISH)
Pharmacological Rx of OA - Answers Acetaminophen - First line
NSAID
SSRI - Duloxetine
Intra-articular glucocorticoid
Intra-articular hyaluronic acid - not effective
Arthroplasty
Mainstay of fibromyalgia treatment - Answers Nonpharmacologic therapy, including regular aerobic
exercise
FDA approved meds for fibromyalgia. - Answers Pregabalin, duloxetine, and milnacipran
The 4 disorders of spondyloarthritis - Answers + Ankylosing spondylitis
+ Psoriatic arthritis,
+ Inflammatory bowel disease (IBD)-associated
arthritis, and
+ Reactive arthritis (formerly known as Reiter syndrome)
Low back pain and stiffness that are prominent in the morning (>1 hour), worse after immobility and are
better with use - Answers Ankylosing spondylitis
Hyperkeratotic rash found on the soles and palms that may be indistinguishable from pustular psoriasis.
- Answers keratoderma blenorrhagicum,
* consistent with reactive arthritis
Treatment of Ankylosing spondylitis - Answers -NSAIDs - first line
-TNFα inhibitor such as adalimumab - refractory
Worst sequelae of Sjögren syndrome - Answers Lymphoma
The most appropriate and cost-effective means of assessing the cause of acute monoarthritis - Answers
Aspiration and analysis of the synovial fluid for leukocytes, Gram stain with culture, and crystals.
Ocular manifestations of systemic rheumatologic dx - Answers #Rheumatoid arthritis - episcleritis and
scleritis #Spondyloarthritis and sarcoidosis - uveitis and vasculitis
#Sjögren syndrome - Dry eyes ( kerato-conjunctivitis sicca)
Noninflammatory conditions causing elevations in ESR - Answers Kidney disease, DM, pregnancy, and
obesity
Rheumatoid factor - Answers Immunoglobulin directed against the Fc portion of IgG
Most specific antibodies characteristic of RA - Answers Anti-cyclic citrullinated peptide
Synovial fluid leukocyte counts most often seen in infectious arthritis - Answers > 50,000/µL (50 × 109/L)
Prophylactic therapy for patients on chronic glucocorticoid therapy - Answers Calcium and vitamin D
supplementation
SE of Methrothrexate - Answers -Hepatitis
=Bone marrow suppression (leukopenia, anemia). Patients with liver disease should not receive
methotrexate, and limitation of alcohol intake is strongly advised.
Treatment of ankylosing spondylitis - Answers First line - NSAIDs
2nd line (if above fails) - TNF-α inhibitors
Characteristic radiologic findings of RA - Answers - Periarticular osteopenia and
- Marginal (near the edges of the joint) erosions
*Erosive changes may not be evident early in dx
Most common cardiac manifestation of RA - Answers Pericarditis , often asymptomatic.
Bony enlargement of a DIP joint in OA - Answers Heberden node
Bony enlargement of a PIP joint in OA - Answers Bouchard node.
Radiographic Hallmarks of OA - Answers - Joint-space narrowing (articular cartilage loss)
- Osteophytes formation
- Sclerosis of subchondral bone,
, - Subchondral cysts
- Lack of periarticular osteopenia
Presence of flowing osteophytes involving the anterolateral aspect of the thoracic spine at 4 or more
contiguous vertebrae with preservation of the intervertebral disk space and the absence of apophyseal
joint or sacroiliac inflammatory changes - Answers Diffuse idiopathic skeletal hyperostosis (DISH)
Pharmacological Rx of OA - Answers Acetaminophen - First line
NSAID
SSRI - Duloxetine
Intra-articular glucocorticoid
Intra-articular hyaluronic acid - not effective
Arthroplasty
Mainstay of fibromyalgia treatment - Answers Nonpharmacologic therapy, including regular aerobic
exercise
FDA approved meds for fibromyalgia. - Answers Pregabalin, duloxetine, and milnacipran
The 4 disorders of spondyloarthritis - Answers + Ankylosing spondylitis
+ Psoriatic arthritis,
+ Inflammatory bowel disease (IBD)-associated
arthritis, and
+ Reactive arthritis (formerly known as Reiter syndrome)
Low back pain and stiffness that are prominent in the morning (>1 hour), worse after immobility and are
better with use - Answers Ankylosing spondylitis
Hyperkeratotic rash found on the soles and palms that may be indistinguishable from pustular psoriasis.
- Answers keratoderma blenorrhagicum,
* consistent with reactive arthritis
Treatment of Ankylosing spondylitis - Answers -NSAIDs - first line
-TNFα inhibitor such as adalimumab - refractory
Worst sequelae of Sjögren syndrome - Answers Lymphoma
