100+ Free ESTER Reumatologia Practice Questions

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Practice Questions100 questions

2026 Statistics

Key Facts: ESTER Reumatologia Exam

100 Items

Curated English-language practice questions in this OpenExamPrep specialty module

OpenExamPrep SBR Board Adaptation

Multi-Stage

Official ESTER Examination Structure (Theoretical + Practical + Curricular)

Edital ESTER — SBR / AMB

R$ 1.800–3.600

Registration Fee depending on SBR/AMB Membership Status

Edital SBR / AMB

6.0–7.0 / 10

Minimum Passing Grade Benchmark (60%–70% Composite Threshold)

Regulamento Oficial ESTER / SBR

RQE Reumatologia

Specialist Qualification Registration Conferred with CFM

Conselho Federal de Medicina (CFM) / AMB

Annual

Official Examination Frequency Conducted by SBR / AMB

Sociedade Brasileira de Reumatologia (SBR)

The ESTER (Título de Especialista em Reumatologia) is the premier Brazilian rheumatology board certification examination administered annually by SBR and AMB. It tests comprehensive clinical rheumatology, basic immunology, diagnostic autoantibodies, and SBR/ACR/EULAR clinical guidelines across theoretical and practical case-based evaluation stages.

Sample ESTER Reumatologia Practice Questions

Try these sample questions to test your ESTER Reumatologia exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 26-year-old woman presents with polyarthralgias, malar erythema, and mild proteinuria (0.6 g/24h). Indirect immunofluorescence on HEp-2 cells reveals an antinuclear antibody (ANA / FAN) titer of 1:1280 with a homogeneous nuclear pattern (ICAP AC-1). In the International Consensus on ANA Patterns (ICAP), which autoantigens are primarily associated with the AC-1 homogeneous pattern?

A.Double-stranded DNA (dsDNA), histones, and nucleosomes

B.SSA/Ro60, SSA/Ro52, and SSB/La ribonucleoproteins

C.Centromere proteins A, B, and C (CENP-A/B/C)

D.Sm core proteins (B/B', D1, D2, D3, E, F, G) and U1-snRNP

Explanation: The AC-1 pattern (homogeneous nuclear) on HEp-2 cells corresponds to autoantibodies directed against chromatin components, specifically double-stranded DNA (dsDNA), histones, and nucleosomes. It is strongly associated with Systemic Lupus Erythematosus (SLE) and drug-induced lupus.

2An antinuclear antibody test performed by indirect immunofluorescence on HEp-2 cells demonstrates a fine speckled nuclear pattern designated as AC-4 by the International Consensus on ANA Patterns (ICAP). Which target autoantigen pair is most characteristically associated with this staining pattern?

A.Sm and U1-RNP spliceosomal proteins

B.SSA/Ro and SSB/La ribonucleoproteins

C.Topoisomerase I (Scl-70) and RNA Polymerase III

D.Histidyl-tRNA synthetase (Jo-1) and SRP

Explanation: The AC-4 pattern (nuclear fine speckled) is characteristic of autoantibodies targeting SSA/Ro60 and SSB/La ribonucleoproteins. This pattern is frequently observed in Sjögren syndrome, Systemic Lupus Erythematosus, subacute cutaneous lupus, and neonatal lupus.

3A 45-year-old woman is evaluated for symmetric inflammatory polyarthritis of the wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints lasting 10 weeks. Serologic evaluation reveals high titers of anti-cyclic citrullinated peptide (anti-CCP / ACPA) antibodies and IgM rheumatoid factor (RF). Regarding the pathophysiology and clinical significance of ACPA compared to RF, which statement is most accurate?

A.ACPA recognizes post-translationally modified peptides where lysine is converted to citrulline by peptidylarginine deiminase (PAD) enzymes, exhibiting higher diagnostic specificity (>95%) and prognostic power for erosive disease than RF.

B.ACPA is an IgM autoantibody directed against the Fc portion of IgG, with lower diagnostic specificity than RF in early rheumatoid arthritis.

C.ACPA recognizes post-translationally modified arginine residues converted to citrulline by peptidylarginine deiminase (PAD) enzymes, demonstrating significantly higher specificity (>95%) and predicting radiographic progression.

D.ACPA titers fluctuate directly with daily clinical disease activity, serving as the preferred laboratory marker over CRP to guide immediate monthly DMARD dose adjustments.

Explanation: Anti-citrullinated protein/peptide antibodies (ACPA/anti-CCP) target epitopes generated by the post-translational conversion of peptidylarginine to peptidylcitrulline catalyzed by calcium-dependent peptidylarginine deiminase (PAD) enzymes. ACPA possesses superior specificity (>95%) compared to rheumatoid factor and strongly correlates with joint damage and radiographic progression in RA.

4A 52-year-old woman presents with severe Raynaud phenomenon, sclerodactyly limited to the fingers and hands distal to the metacarpophalangeal joints, multiple facial telangiectasias, and subcutaneous calcinosis on the finger pads. Capillaroscopy shows enlarged giant capillaries without severe avascular areas. Which autoantibody profile is most characteristically associated with this clinical phenotype and confers a higher risk of isolated pulmonary arterial hypertension (PAH)?

A.Anti-Topoisomerase I antibodies (Anti-Scl-70)

B.Anti-RNA Polymerase III antibodies

C.Anti-U3 RNP (Anti-Fibrillarin) antibodies

D.Anti-Centromere antibodies (ACA / CENP-B)

Explanation: Anti-centromere antibodies (ACA) are the serologic hallmark of limited cutaneous Systemic Sclerosis (lcSSc, formerly CREST syndrome). Patients with ACA have a low risk of early severe interstitial lung disease but are at substantial risk for late-onset isolated precapillary Pulmonary Arterial Hypertension (PAH).

5A 48-year-old male with rapidly progressive diffuse cutaneous systemic sclerosis of 8 months duration undergoes routine serologic testing. Laboratory evaluation confirms high titers of anti-RNA polymerase III antibodies. Which clinical complication requires close surveillance in this patient due to its strong association with this antibody?

A.Scleroderma renal crisis (SRC) and synchronous internal malignancy

B.Isolated severe pulmonary arterial hypertension without lung fibrosis

C.Severe malabsorptive small bowel bacterial overgrowth syndrome

D.Recurrent non-infectious pericardial tamponade

Explanation: Anti-RNA polymerase III antibodies are strongly associated with rapidly progressive skin thickening, high risk of Scleroderma Renal Crisis (SRC), and synchronous malignancy (occurring within 2–3 years of scleroderma onset). Regular blood pressure monitoring and cancer screening are essential.

6A 40-year-old man presents with subacute crusting rhinosinusitis, bloody nasal discharge, saddle-nose deformity, bilateral pulmonary cavitary nodules, and rapidly progressive glomerulonephritis with active urinary sediment. Serum indirect immunofluorescence and ELISA testing confirm high titers of cytoplasmic ANCA (c-ANCA) with anti-Proteinase 3 (anti-PR3) specificity. According to the 2012 Revised International Chapel Hill Consensus Conference Nomenclature, what is the definitive diagnosis?

A.Microscopic Polyangiitis (MPA)

B.Granulomatosis with Polyangiitis (GPA)

C.Eosinophilic Granulomatosis with Polyangiitis (EGPA)

D.Goodpasture Disease (Anti-GBM Disease)

Explanation: Granulomatosis with Polyangiitis (GPA, formerly Wegener granulomatosis) is a necrotizing granulomatous small-vessel vasculitis predominantly affecting the upper and lower respiratory tracts and kidneys, strongly associated with c-ANCA targeting Proteinase 3 (PR3).

7A 38-year-old woman presents with cutaneous ulcerations over the metacarpophalangeal joints, violaceous palmar papules (inverse Gottron papules), and painful periungual erythema, but minimal proximal muscle weakness and normal serum creatine kinase (CK) levels. High-resolution chest CT reveals bilateral subpleural ground-glass opacities and rapidly progressive consolidations. Which myositis-specific autoantibody is strongly linked to this clinical presentation of clinically amyopathic dermatomyositis (CADM) with rapidly progressive interstitial lung disease (RPILD)?

A.Anti-Mi-2 (Nuclear Helicase)

B.Anti-TIF1-gamma (Transcriptional Intermediary Factor 1-gamma)

C.Anti-MDA5 (Melanoma Differentiation-Associated gene 5)

D.Anti-SRP (Signal Recognition Particle)

Explanation: Anti-MDA5 autoantibodies identify a distinct dermatomyositis subset characterized by clinically amyopathic or hypomyopathic disease, cutaneomucosal ulcers, inverse Gottron papules, and a high risk of rapidly progressive interstitial lung disease (RPILD) that often requires aggressive combination immunosuppressive therapy.

8A 62-year-old man is newly diagnosed with classic dermatomyositis presenting with heliotrope rash, Gottron papules, proximal quadriparesis, and elevated creatine kinase. Myositis antibody testing is positive for anti-TIF1-gamma (p155/140). Based on Brazilian and international rheumatology guidelines, what is the most critical next step in management?

A.Immediate initiation of anti-TNF biologic therapy as first-line induction.

B.Lifelong prophylactic anticoagulation with therapeutic low-molecular-weight heparin.

C.Routine screening for pulmonary arterial hypertension with right heart catheterization.

D.Immediate comprehensive age- and gender-appropriate malignancy screening with whole-body CT/PET imaging, endoscopy, and urologic/gastrointestinal evaluation.

Explanation: Anti-TIF1-gamma (and anti-NXP2) antibodies in adults over 50 years of age are strongly associated with cancer-associated dermatomyositis (paraneoplastic myositis). Comprehensive age-appropriate cancer screening (including thoracic/abdominal/pelvic CT, PET-CT, mammography, pelvic ultrasound/endoscopy) is mandatory at diagnosis and during follow-up.

9A 34-year-old woman with a history of two unprovoked deep vein thromboses is evaluated for Antiphospholipid Syndrome (APS). Coagulation testing reveals a prolonged activated partial thromboplastin time (aPTT) that fails to correct upon 1:1 mixing with normal pooled platelet-poor plasma, and demonstrates significant shortening when excess phospholipid is added (confirm test) in the dilute Russell Viper Venom Time (dRVVT). What is the physiological mechanism underlying this in vitro laboratory finding?

A.Lupus anticoagulant autoantibodies bind phospholipid-protein complexes (such as prothrombin or beta-2-glycoprotein I), competing with coagulation factors for phospholipid surfaces and prolonging phospholipid-dependent in vitro clotting assays.

B.Direct autoantibody-mediated neutralization of Factor VIII causing severe secondary hemophilia A.

C.Excessive consumption of fibrinogen and platelets due to acute disseminated intravascular coagulation (DIC).

D.Inhibition of Protein C activation by thrombin, which selectively prolongs the thrombin clotting time without affecting dRVVT.

Explanation: Lupus anticoagulants are heterogeneous autoantibodies directed against phospholipid-binding proteins (primarily beta-2-glycoprotein I and prothrombin). In vitro, they bind to phospholipids and interfere with the assembly of tenase and prothrombinase complexes, paradoxically prolonging phospholipid-dependent clotting assays (such as dRVVT), which corrects upon adding excess phospholipids.

10Which of the following pairings between a major human leukocyte antigen (HLA) allele and its corresponding rheumatologic disease association is correct?

A.HLA-DRB1 'shared epitope' — Primary Sjögren Syndrome

B.HLA-B27 — Ankylosing Spondylitis and Axial Spondyloarthritis

C.HLA-B*51 — Giant Cell Arteritis

D.HLA-B*58:01 — Susceptibility to Methotrexate-induced acute pneumonitis

Explanation: HLA-B27 has a quintessential genetic association with Ankylosing Spondylitis and Axial Spondyloarthritis (>85–90% positivity in primary radiographic axSpA). HLA-DRB1 shared epitope alleles are associated with Rheumatoid Arthritis; HLA-B51 is associated with Behçet disease; HLA-B*58:01 is associated with severe cutaneous adverse reactions (SCAR) to Allopurinol.

About the ESTER Reumatologia Exam

The Título de Especialista em Reumatologia is the official board certification for rheumatologists in Brazil, awarded by the Sociedade Brasileira de Reumatologia (SBR) in partnership with the Associação Médica Brasileira (AMB) and recognized by the Conselho Federal de Medicina (CFM). The examination is administered annually through the Exame de Suficiência para Obtenção do Título de Especialista em Reumatologia (ESTER) and rigorously evaluates competence in basic immunology, autoantibody interpretation (ICAP patterns), connective tissue diseases, spondyloarthropathies, systemic vasculitides, crystal arthropathies, metabolic bone diseases, pediatric rheumatology, and modern biologic/targeted synthetic DMARD therapeutics. Achieving the title confers the legal credential of Registro de Qualificação de Especialista (RQE) in Rheumatology.

Assessment

Examination administered by the Sociedade Brasileira de Reumatologia (SBR) through the AMB. In the 2026 edition the papers were sat in person at the UNIP Campus Vergueiro in São Paulo across two consecutive days: Prova Teórica in the morning of the first day, Prova Prática (Exame Físico) in the afternoon of the same day, and Prova Prática (Casos Clínicos) on the morning of the second day. The practical papers assess clinical reasoning, joint and systemic physical examination technique, and interpretation of imaging, capillaroscopy and autoantibody results.

Time Limit

Multi-stage examination administered over 1 to 2 days (Theoretical session followed by Practical stations)

Passing Score

Minimum composite score of 60%–70% (grade ≥6.0 or 7.0 / 10.0) depending on edital criteria across theoretical and practical stages

Exam Fee

Set each year in the official Edital; consult the current edital for the registration fee and any member discount. (Sociedade Brasileira de Reumatologia (SBR) — Associação Médica Brasileira (AMB))

ESTER Reumatologia Exam Content Outline

20%

Artrite Reumatoide e Terapias Avançadas

2010 ACR/EULAR classification criteria; early RA diagnosis; treat-to-target strategy; disease activity scores (DAS28, CDAI, SDAI); conventional synthetic DMARDs (methotrexate, leflunomide, sulfasalazine); biologic DMARDs (TNF inhibitors, IL-6 inhibitors, CTLA-4-Ig abatacept, anti-CD20 rituximab); targeted synthetic DMARDs (JAK inhibitors); extra-articular manifestations; and Felty syndrome.

18%

Lúpus Eritematoso Sistêmico e Síndrome Antifofolipídica

2019 EULAR/ACR SLE classification criteria; ISN/RPS lupus nephritis classes I–VI; induction and maintenance immunosuppression (mycophenolate mofetil, cyclophosphamide, voclosporin, belimumab); hydroxychloroquine dosing (≤5 mg/kg) and retinal screening; neuropsychiatric lupus; cutaneous lupus subtypes; and Antiphospholipid Syndrome (Sydney and 2023 ACR/EULAR criteria, thrombotic vs obstetric APS, anticoagulation targets).

15%

Espondiloartrites e Artrite Psoriásica

ASAS classification criteria for axial and peripheral SpA; Ankylosing Spondylitis (ASDAS, BASDAI); CASPAR criteria for Psoriatic Arthritis; enteropathic arthritis; reactive arthritis; HLA-B27 associations; radiographic vs non-radiographic axSpA; and targeted therapies (NSAIDs, TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors, JAK inhibitors).

12%

Vasculites Sistêmicas

Chapel Hill 2012 consensus nomenclature; Large vessel vasculitis (Giant Cell Arteritis, Takayasu arteritis); Medium vessel vasculitis (Polyarteritis Nodosa, Kawasaki disease); Small vessel ANCA-associated vasculitis (Granulomatosis with Polyangiitis, Microscopic Polyangiitis, Eosinophilic Granulomatosis with Polyangiitis); immune complex vasculitis (IgA vasculitis, Cryoglobulinemic vasculitis); and targeted therapies (rituximab, cyclophosphamide, avacopan, mepolizumab, tocilizumab).

15%

Esclerose Sistêmica, Síndrome de Sjögren e Miopatias Inflamatórias

Limited vs diffuse cutaneous Systemic Sclerosis; Scleroderma Renal Crisis (ACE inhibitors vs steroids); SSc-ILD (HRCT, MMF, nintedanib, tocilizumab); pulmonary arterial hypertension; 2016 ACR/EULAR Primary Sjögren syndrome criteria; extraglandular disease; MALT lymphoma risk; Idiopathic Inflammatory Myopathies (Dermatomyositis, Polymyositis, Inclusion Body Myositis); and myositis-specific antibodies (anti-Jo-1, anti-MDA5, anti-Mi-2, anti-TIF1-γ, anti-SRP).

10%

Artropatias Microcristalinas e Osteoartrite

Gout pathophysiology and ACR 2020 guidelines; urate-lowering therapy (allopurinol, febuxostat) and target serum urate levels; HLA-B*58:01 screening; acute flare treatment (colchicine, NSAIDs, glucocorticoids); Calcium Pyrophosphate Deposition (CPPD / Pseudogout) synovial fluid polarized light microscopy; and Osteoarthritis pathophysiology, diagnosis, and non-pharmacological/pharmacological management.

10%

Osteoporose, Doenças Ósseas Metabólicas e Reumatologia Pediátrica

Densitometry DXA T-score and Z-score interpretation; FRAX Brazil calibration; Trabecular Bone Score (TBS); antiresorptive therapy (bisphosphonates, denosumab); osteoanabolic agents (teriparatide, romosozumab); atypical femur fractures and ONJ; Pediatric Rheumatology: Juvenile Idiopathic Arthritis (ILAR classification), Macrophage Activation Syndrome (MAS), Kawasaki disease, and Autoinflammatory syndromes (Familial Mediterranean Fever).

How to Pass the ESTER Reumatologia Exam

What You Need to Know

Passing score: Minimum composite score of 60%–70% (grade ≥6.0 or 7.0 / 10.0) depending on edital criteria across theoretical and practical stages
Assessment: Examination administered by the Sociedade Brasileira de Reumatologia (SBR) through the AMB. In the 2026 edition the papers were sat in person at the UNIP Campus Vergueiro in São Paulo across two consecutive days: Prova Teórica in the morning of the first day, Prova Prática (Exame Físico) in the afternoon of the same day, and Prova Prática (Casos Clínicos) on the morning of the second day. The practical papers assess clinical reasoning, joint and systemic physical examination technique, and interpretation of imaging, capillaroscopy and autoantibody results.
Time limit: Multi-stage examination administered over 1 to 2 days (Theoretical session followed by Practical stations)
Exam fee: Set each year in the official Edital; consult the current edital for the registration fee and any member discount.

Keys to Passing

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ESTER Reumatologia Study Tips from Top Performers

1Master Diagnostic Autoantibodies and ICAP Patterns: Know the clinical associations and nuclear/cytoplasmic staining patterns (AC-1 to AC-29) for ANA/FAN, including anti-dsDNA, anti-Sm, anti-SSA/Ro (neonatal lupus, subacute cutaneous lupus), anti-SSB/La, anti-Centromere (limited SSc), anti-Scl-70 (diffuse SSc-ILD), anti-RNA polymerase III (scleroderma renal crisis), anti-Jo-1 and myositis-specific antibodies, and ANCA (c-ANCA/PR3 in GPA, p-ANCA/MPO in MPA/EGPA).

2Internalize RA Classification and Treat-to-Target: Memorize the 2010 ACR/EULAR RA classification criteria score cutoff (≥6/10), DAS28 remission (<2.6) and low disease activity (≤3.2) thresholds, methotrexate first-line dosing (15–25 mg/week) with mandatory folic acid supplementation, and step-up algorithms to biologic or targeted synthetic DMARDs (JAK inhibitors).

3Understand Spondyloarthritis and Psoriatic Arthritis Criteria: Master the ASAS axial/peripheral SpA criteria (imaging vs clinical arms), ASDAS-CRP disease activity cutoffs, CASPAR criteria for PsA, and indications for IL-17 inhibitors (secukinumab, ixekizumab) versus IL-23 inhibitors (guselkumab) and TNF inhibitors.

4Review Lupus Nephritis and APS Management: Know ISN/RPS classes I–VI (especially proliferative classes III/IV requiring aggressive induction with MMF or cyclophosphamide), hydroxychloroquine mandatory therapy (≤5 mg/kg actual body weight) and retinal OCT/visual field screening, and Antiphospholipid Syndrome classification criteria and target INR (2.0–3.0) with vitamin K antagonists.

5Recognize Scleroderma Emergencies and SSc-ILD: Remember that high-dose corticosteroids are contraindicated in Systemic Sclerosis due to precipitating Scleroderma Renal Crisis (SRC), which is managed emergently with ACE inhibitors (captopril). Understand screening and therapy for SSc-ILD (HRCT, PFTs, MMF, nintedanib, tocilizumab) and PAH (echocardiography, right heart catheterization).

6Consolidate Vasculitis, Gout, and Osteoporosis Guidelines: Review Chapel Hill 2012 vasculitis categories, ACR 2020 Gout guidelines (allopurinol titration, serum urate target <6.0 mg/dL or <5.0 mg/dL for tophi, HLA-B*58:01 screening), DXA T-score cutoffs (≤ -2.5 for osteoporosis), FRAX Brazil calibration, and sequential bone therapy (anabolics before antiresorptives in very high risk).

Frequently Asked Questions

What is the ESTER / Título de Especialista em Reumatologia and why is it essential?

The Título de Especialista em Reumatologia is the official medical specialist certification awarded by the Sociedade Brasileira de Reumatologia (SBR) in conjunction with the Associação Médica Brasileira (AMB). Earning this title allows physicians to obtain their Registro de Qualificação de Especialista (RQE) in Rheumatology with the Regional Medical Council (CRM) and Federal Council of Medicine (CFM), legally authorizing them to practice and advertise as medical rheumatologists in Brazil.

What are the eligibility requirements to sit for the SBR specialist examination?

Candidates must be fully licensed physicians in Brazil registered with a CRM and meet one of the following pathways: (1) Completion of an accredited Medical Residency Program (CNRM/MEC) in Rheumatology; (2) Completion of an SBR-accredited Specialization Course; or (3) Proven clinical practice in Rheumatology for at least double the duration of official residency training (4 to 6 years), along with qualifying curriculum vitae scores as specified in the annual edital.

How is the SBR / ESTER board examination structured?

The examination comprises multiple components administered over 1 to 2 days: (1) Prova Teórica (Theoretical Exam), consisting of multiple-choice questions focusing on basic immunology, autoantibody patterns, pathophysiology, SBR guidelines, and clinical evidence; (2) Prova Prática (Practical Exam), featuring clinical case scenarios, joint examination semiology, nailfold capillaroscopy, synovial fluid analysis, and imaging interpretation; and (3) Análise Curricular (Curriculum Analysis) evaluating academic output and clinical training.

What is the passing score and grading criteria for the SBR certification?

Candidates must achieve a minimum overall passing score (typically 60% or 70%, corresponding to a grade of 6.0 or 7.0 on a 10.0 scale) and meet eliminatory cutoff thresholds on both the theoretical and practical exam components as specified in the official annual Edital.

Which clinical guidelines and journals are primarily tested?

The examination heavily tests the official clinical guidelines published by the Sociedade Brasileira de Reumatologia (SBR) in its official journal, Advances in Rheumatology (formerly Revista Brasileira de Reumatologia), alongside international consensus recommendations from ACR and EULAR.

Why is this OpenExamPrep practice bank presented in English?

This practice bank is an English-language MCQ study adaptation designed to support international rheumatology fellows, Brazilian candidates preparing in bilingual academic settings, and global medical graduates. All official Portuguese terms, SBR guideline criteria, and statutory classification systems are preserved inline throughout the questions and detailed explanations.