Aligned with the American Board of Family Medicine format. Authored & peer-reviewed by faculty, clinicians, and program directors.
Each question is written to resemble the format and topics on the exam, meaning you won’t see any negatively phrased questions, no “all of the following except,” no “A and B”…you know what we mean. Most importantly, all questions include selective distractors (incorrect answer choices), which will help you think critically.
A 58-year-old man presents to the clinic with bilateral hand and wrist pain that has been progressively worsening for 6 months. He says the pain is accompanied by morning stiffness that now lasts up to 45 minutes, which slows him down when getting up for work. On physical exam, you note the proximal joints of both hands are swollen and tender. Which of the following is the most likely diagnosis?
Rheumatoid arthritis is considered an autoimmune disease that presents with symmetrical, inflammatory polyarthritis, often associated with morning stiffness lasting over 30 minutes. Rheumatoid arthritis commonly affects the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. The joints are described as swollen and boggy, secondary to synovial hypertrophy or effusion. X-rays consistent with rheumatoid arthritis show bony erosions or subchondral cysts or both. The diagnosis can be confirmed with anti-cyclic citrullinated protein antibodies, with or without a positive rheumatoid factor. ESR and CRP are both nonspecific to rheumatoid arthritis but are likely to be elevated secondary to inflammation. Arthritis presenting for less than a few weeks should prompt further workup for alternate causes, as rheumatoid arthritis is a chronic condition and considered appropriate when symptoms have been present for 6 weeks or more.
Fibromyalgia (A) is a diagnosis of exclusion in a patient who presents with widespread pain as well as somatic or psychiatric symptoms. Although tenderness on exam is common in fibromyalgia, the presence of swelling, warmth, and decreased joint range of motion points more toward rheumatoid arthritis as the likely diagnosis. It is possible for fibromyalgia to develop concurrently with other conditions such as arthritis. Osteoarthritis (B) in the hands usually affects the distal interphalangeal (DIP) joints and reveals narrowed joint spacing on imaging. It may present with morning pain or stiffness, but it is transient, not lasting more than 30 minutes. Osteoarthritis is also classically associated with Heberden and Bouchard nodes, which are hard, bony swellings on the DIP and PIP joints, respectively, unlike the soft, boggy, swelling seen in the joints of rheumatoid arthritis. Reactive arthritis (C) is an inflammatory and asymmetric arthritis associated with infections. It affects the larger joints, as opposed to the smaller peripheral joints. The classic triad of reactive arthritis includes joint pain, conjunctivitis or uveitis, and urethritis or cervicitis. A patient who presents with recent urethritis or enteric infection along with monoarticular joint pain should lead to concern for reactive arthritis.
Understanding why an answer choice is incorrect is just as important as knowing why one is correct. That’s why every Rosh Review question includes detailed explanations for the correct and incorrect answer choices. These comprehensive summaries link the most important components of a topic—from risk factors to diagnostics and treatment—giving you the context to build relationships between them.
Custom illustrations and tables help further clarify the core concepts. When information is presented visually, you can focus on meaning, easily reorganize and group similar ideas, and make better use of your memory.
Your personal analytics allow you to see your progress at all times, so you can create an efficient and effective learning strategy and stay on pace with your plan.
Deep insights to determine your strengths and weaknesses so you can spend your time on the subjects that matter.
Discover how your answer choices align with those selected by learners across the country.
Using data generated by previous users, your Qbank gives a prediction of how likely you are to pass your exam.
After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.
Q: What is first line in the treatment of early-onset rheumatoid arthritis?Reveal Answer
These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.