ABIM Exam Review Practice Question of the Week: 37-year old female with history of rheumatoid arthritis

This week’s sample ABIM Exam Review Question comes directly from the Knowmedge QVault which covers topics listed on the ABIM Board Exam blueprint




37-year-old female with history significant for rheumatoid arthritis is currently on hyroxychloroquine and methotrexate. She also takes a folic acid pill daily. She presents back to her rheumatologist for progressive synovitis for both her wrists. She also complains of shortness of breath and is found to have a pleural effusion on a chest xray. She also now notices some nodules on her extremities. Lab work reveals an elevated ESR and an elevated rheumatoid factor. All of the following are poor prognostic factors for rheumatoid arthritis except:


A. Progressive synovitis

B. Pleural effusion

C. Elevated ESR

D. Elevated rheumatoid factor

E. Rheumatoid nodules


ABIM Exam Practice Question Explanation



Rheumatoid arthritis occurs as a result of antibodies against the synovial fluid. These antibodies can travel into the circulation which leads to systemic involvement of kidneys, lungs, vascular system, heart, skin, blood and nerves.
Poor prognostic factors for rheumatoid arthritis include the following:


● Elevated ESR
● Elevated rheumatoid factor
● Rheumatoid nodules
● Vasculitis (ulceration of the hands and fingers)
● Progressive synovitis
● Erosive lesions on xray

Choice B (Pleural effusion) is the correct answer. Pleural effusions are a common extra-articular manifestation of rheumatoid arthritis. However, it is not considered a poor prognostic factor for the disease. The effusion of rheumatoid arthritis usually contains a glucose less than 30mg/dL.


You can see all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can also find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.

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