Question about board style questions-test taking strategy

[DrMetal]

I was doing this MKSAP 18 question:

82-yo F: we're told in the question stem that she's been previously "diagnosed with seronegative (negative RF, negative CCP) RA". She's attempted sulfasalazine, and infliximab, to no avail. She also has HTN/CKD. The physical exam describes classic RA features. Labs show negative RF, negative anit CCP, as described in the history. Xrays show chondrocalcinosis in knees/wrists.

Question: what do you offer next for treatment

A Adalimumab
B Allopurinol
C Low-dose prednisone
D Methotrexate
E NSAID therapy

Correct answer is C, Low-dose prednisone (I picked MTX, because it hadn't been attempted yet, and you can treat a seroneg-RA with MTX).

Now, in the answer explanation, it states that this really isnt sero-neg RA...it's actually CPPD (chronic calcium pyrophosphate disease). Therefore your choices are steroids and NSAIDS (you avoid the latter here b/c the patient has CKD).

I understand the explanation and the logic here. And in real life, this makes total sense. I'm sure people are incorrectly diagnosed with RA all of the time, when they really have something else (like OA, or CPPD).

But here's my question: for the sake of the boards, can I not trust what's given to me in the stem of the question? If I'm told the patient has sero-neg RA, can't I take that at face value? If I'm to question everything, then how do I know that the patient really has CKD? (no serum creatinine was given). or HTN?(no BP was given)

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[mdjo]

I think that's just bad question writing. Technically CPPD can have a pseudorheumatoid pattern but that is pretty obscure for the medicine boards. Lots of people have chondrocalcinosis on XR without having clinically significant CPPD so a better answer would be to aspirate a joint before changing someone's whole diagnosis because of a little chondrocal.
I took the boards last year and I did not have any problems with untrustworthy questions. The board questions are written in a much more rigorous and validated way than the MKSAP questions are.

 

[DrMetal]

The board questions are written in a much more rigorous and validated way than the MKSAP questions are.

I certainly hope so. The problem is, you get into these mindf*&k situations that cause a lot of angst, gives you concern about how you'd answer on the real test.