Just like the actual exam

Based on the FMCLA Content Outline. 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.

  • Must address important content
  • Must be well structured


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?

A Fibromyalgia
B Osteoarthritis
C Reactive arthritis
D Rheumatoid arthritis

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.


Written with a purpose

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.

  • Created for optimal learning and recall
  • Help reinforce your knowledge
  • Focus on the essential information


Created to enhance learning

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.

Rheumatoid arthritis

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One Step Further

Taking your learning to the next level

After each explanation is a straightforward question with a simple, memorizable answer that reinforces the corresponding topic.

  • Strengthens your knowledge
  • Stands alone from the main explanation so you’re not rereading content

Q: What is first line in the treatment of early-onset rheumatoid arthritis?

Reveal Answer

A: Methotrexate.

Rheumatoid Arthritis

  • More common in women and those aged 40–50 years
  • Morning stiffness lasting > 30 minutes
  • PE will show symmetrical soft, red, tender swelling in joints (MCP, PIP)
  • Bilateral ulnar deviation at MCP, boutonnière deformity, and swan-neck deformity
  • Labs will show positive RF, anti-cyclic citrullinated peptide antibodies
  • Most commonly caused by autoimmune destruction of synovial joints
  • Treatment is DMARDs

Rapid Review

Keeping things simple

These bulleted reviews focus on condensed, high-yield concepts about the main topic, from patient presentation to preferred management.

  • Cover the fundamentals in one list
  • Allow you to quickly scan the must-know information
I'm someone who learns best by doing questions, so I really enjoyed Rosh Review. The questions are high-yield and the detailed explanations are a huge benefit. It helped me truly understand topics and not just memorize them.


Get a little more clarification

Should I use a Qbank for the FMCLA?
Depends on whether you're interested in familiarizing yourself with FMCLA content ahead of time—read more in Do You Need to Study for the FMCLA?. With the FMCLA, you answer 25 open-book questions each quarter, so you get to choose the resources you find most helpful.

One of the many useful features of the FMCLA Qbank is the global search, which allows you to easily search your Qbank to find specific images and information (which can be especially useful with open-book questions). Learn more here.
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If you sign up for an account that is linked to CME, here’s what you need to do:
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Once that’s complete, here’s how to claim and download your certificate:
  • Go to the Account Settings tab (only on desktop/laptop)
  • Select Claim next to the subscription package name (see an example)
  • Complete the survey
  • Download your certificate
You’ll earn up to 100 AMA PRA Cat 1 CME credits.
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Whether you have a trial account or you purchased a subscription, access Rosh Review by logging in at To access the Qbank, go to the Create Exam tab to begin making and taking exams made up of questions from the Qbank. You can find any boost exams under the My ExamsBoost Exam tab. Once you've completed and submitted a few exams, you can see your statistics under the Performance Analysis tab.
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