Your-Doctor Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Rheumatology
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Question 1#Print Question

A 71-year-old man with a history of hypertension and hyperlipidemia presents with severe left knee pain and fever. Physical examination demonstrates a swollen left knee with limited range of motion. The patient is noted to have a temperature of 38.8°C and a blood pressure of 150/100 mmHg. Synovial fluid is drawn from the left knee and reveals the following.

  • Leukocyte count 28,000/mm3 (94% neutrophils)
  • Crystals Positively birefringent, rhomboid-shaped
  • Gram stain Negative

Which of the following is likely to be present in this patient’s condition?

a. Calcification of articular cartilage
b. Rheumatoid factor
c. Tophi
d. S. aureus bacteremia

Question 2#Print Question

A 68-year-old man presents with pain in his shoulders, hips, and neck for the last 5 months. The patient reports that the pain is worse in the morning and typically resolves within a few hours. The patient is otherwise healthy and denies headache, visual disturbances, or difficulty chewing. Physical examination does not demonstrate swelling and normal range of motion is noted at all joints. Palpation of the scalp arteries fails to elicit tenderness. Laboratory results reveal the following.

  • Leukocyte count  8,000/mm3
  • Hemoglobin  12.4 g/dL
  • Platelets  380,000/mm3
  • Erythrocyte sedimentation rate  92 mm/h
  • TSH  2.1 μU/mL

Which of the following is the best next step in management for this patient’s condition?

a. High-dose corticosteroids
b. Low-dose corticosteroids
c. Temporal artery biopsy
d. Nonsteroidal anti-inflammatory drugs (NSAIDs)

Question 3#Print Question

A 28-year-old man with a history of asthma presents with worsening lower back pain. He describes the pain as constantly aching and deep. The pain is exacerbated with movement, but not relieved entirely by rest. He is unable to recall any inciting event. Review of systems is otherwise unremarkable. The patient refuses to give a social history. The patient has a temperature of 37°C, blood pressure of 120/80 mmHg, and heart rate of 76 beats per minute. On physical examination, there is exquisite tenderness to gentle percussion over the lumbar vertebral spinous processes. A straight leg test is performed and is normal. Laboratory results are within normal limits except for a significantly elevated erythrocyte sedimentation rate (ESR) of 240 mm/h.

Which of the following is the most likely diagnosis in this patient?

a. Prostate cancer
b. Ankylosing spondylitis
c. Vertebral osteomyelitis
d. Disk herniation

Question 4#Print Question

A 46-year-old obese woman with a history of type 2 diabetes mellitus presents with severe left-sided foot pain for the last 6 weeks. The patient has had much difficulty ambulating and has to use a wheelchair now due to the pain. Physical examination demonstrates a severely deformed left foot and x-rays confirm extra-articular bone fragments, varying sizes of osteophytes, and several effusions in the small joints of the left foot.

Which of the following is the underlying mechanism of this patient’s disease?

a. Avascular necrosis
b. Nerve damage
c. Uric acid deposition
d. Autoimmune destruction

Question 5#Print Question

A 43-year-old woman presents with chronic pain that she describes as occurring “all over her body.” Any movement exacerbates the pain and she reports much difficulty falling asleep at night. She constantly feels fatigued, but she denies fever, weight loss, or obvious muscle weakness. The patient has tried acetaminophen to no avail and has even attempted to run 1 to 2 miles per day with no improvement in her symptoms. The patient has an insignificant past medical history. Physical examination is significant for tenderness to palpation over several specific locations on her body. Neurologic examination is unremarkable and laboratory results are all within normal limits.

Given this patient’s most likely diagnosis, which of the following is the best initial treatment?

a. Prednisone
b. Naproxen
c. Amitriptyline
d. Colchicine

Category: Q&A Medicine--->Rheumatology
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