7 board-style questions on rheumatoid arthritis in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.
A 56-year-old woman with a 20-year history of rheumatoid arthritis on methotrexate presents with 6 months of progressive dyspnea on exertion and a dry, nonproductive cough. Physical examination reveals bilateral fine inspiratory crackles at the lung bases and digital clubbing. Chest CT shows bilateral peripheral reticular opacities with honeycombing and traction bronchiectasis predominantly in the lower lobes. Pulmonary function tests show FVC 62% predicted, FEV1 70% predicted, FEV1/FVC ratio 0.82, and DLCO 48% predicted. What is the most likely diagnosis?
A 38-year-old woman presents with 8 weeks of bilateral hand pain and swelling involving the MCP and PIP joints. She reports morning stiffness lasting 90 minutes daily. On examination, there is symmetric synovitis of the 2nd and 3rd MCP joints and 2nd PIP joints bilaterally with boggy swelling. Her DIP joints are spared. Labs show RF positive at 85 IU/mL, anti-CCP positive at 120 U/mL, ESR 48 mm/hr, and CRP 2.8 mg/dL. CBC and metabolic panel are normal. Hand X-rays show periarticular osteopenia but no erosions. What is the most appropriate next step?
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