Rheumatology: biologic therapy safety: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: biologic therapy safety

Sample item

A 45-year-old man in India has active rheumatoid arthritis despite methotrexate, and adalimumab is planned. Which pre-treatment investigation is most important?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Screening for latent tuberculosis with chest radiograph and IGRA or tuberculin test

TNF-alpha is central to granuloma maintenance, so TNF inhibitors can reactivate latent tuberculosis, which is especially relevant in India. Screening for latent TB, with treatment if positive, and for hepatitis B and C is performed before starting. HLA-B27 relates to spondyloarthritis, and uric acid and ASO do not influence the safety of the drug.

Option by option

  • A. Serum uric acid

    Uric acid screens for gout and does not guide TNF inhibitor safety.

  • B. Anti-streptolysin O titre

    ASO titre indicates recent streptococcal infection and does not guide therapy.

  • C. HLA-B27 typing

    HLA-B27 typing helps diagnose spondyloarthritis and is irrelevant to biologic safety.

  • D. Screening for latent tuberculosis with chest radiograph and IGRA or tuberculin test (correct)

    Correct. Reactivation of latent TB is the key hazard of TNF blockade.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Screening for latent tuberculosis with chest radiograph and IGRA or tuberculin test. TNF-alpha is central to granuloma maintenance, so TNF inhibitors can reactivate latent tuberculosis, which is especially relevant in India.

Why is "Serum uric acid" not the answer?

Uric acid screens for gout and does not guide TNF inhibitor safety.

Why is "Anti-streptolysin O titre" not the answer?

ASO titre indicates recent streptococcal infection and does not guide therapy.

Why is "HLA-B27 typing" not the answer?

HLA-B27 typing helps diagnose spondyloarthritis and is irrelevant to biologic safety.

What concept does this question test?

It tests Rheumatology: biologic therapy safety in General Medicine. Screening for latent TB, with treatment if positive, and for hepatitis B and C is performed before starting. HLA-B27 relates to spondyloarthritis, and uric acid and ASO do not influence the safety of the drug.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: biologic therapy safety?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.