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ABIM Rheumatology Practice Tests & Exam Prep Questions - Free Test


Our free ABIM Rheumatology (RHEUM) Practice Test was created by experienced educators who designed them to align with the official American Board of Internal Medicine content guidelines. They were built to accurately mirror the real exam's structure, coverage of topics, difficulty, and types of questions.

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ABIM Rheumatology sample question

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You are the clinic attending called to the radiology suite where a patient with acute monoarticular knee pain and swelling has just undergone joint aspiration and knee radiographs. The 72-year-old man has hypertension, stage 3 chronic kidney disease (eGFR 45 mL/min/1.73m2), and a history of osteoarthritis. Synovial fluid is inflammatory (WBC 35,000/µL, neutrophil predominant); Gram stain is negative. Radiology report notes chondrocalcinosis of the menisci. What is your next best step for follow-up and monitoring in management of this suspected calcium pyrophosphate deposition disease (CPPD) flare?
Correct Answer:
Confirm diagnosis with synovial fluid polarized light microscopy for weakly positively birefringent, rhomboid-shaped crystals; treat the acute knee with intra-articular glucocorticoid injection and arrange rheumatology follow-up in 1–2 weeks with monitoring of renal function and drug interactions if initiating colchicine or NSAID therapy.

why rrect: in suspected cppd (pseudogout) the diagnostic and immediate management priorities are confirmation of crystals and rapid symptom control while minimizing systemic toxicity. synovial fluid polarized light microscopy demonstrating weakly positively birefringent, rhomboid-shaped calcium pyrophosphate crystals is the diagnostic standard. for a single acutely inflamed knee in an older patient with ckd, an intra-articular glucocorticoid injection provides rapid local control with less systemic exposure than high-dose oral glucocorticoids or nsaids. because colchicine and nsaids have renal and drug-interaction concerns, arranging rheumatology follow-up in 1–2 weeks allows tailored decisions about short-course low-dose colchicine (with dose adjustment for egfr and concomitant drugs) or cautious nsaid use if appropriate. monitoring renal function and reviewing medications that interact with colchicine (for example macrolides, certain statins) is necessary before initiating systemic therapy.

why the other answers are incorrect: answer b: high-dose oral prednisone risks systemic adverse effects (hyperglycemia, infection, osteoporosis) and is not preferred as first-line for a single accessible joint when intra-articular glucocorticoid is feasible; rapid local therapy is safer in ckd. answer c: allopurinol treats gout (monosodium urate crystal disease) and is not indicated for cppd; initiating chronic urate-lowering therapy based on this presentation is inappropriate. answer d: with an inflammatory synovial fluid and symptomatic effusion, treating the inflammation is required; discharging without antiinflammatory therapy and only physical therapy would leave the acute flare undertreated and risks prolonged pain and joint damage.