Multiple Choice Questions (MCQ)

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Category: Medicine--->Rheumatology
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Question 1# Print Question

A 40-year-old woman complains of 7 weeks of pain and swelling in both wrists and knees. She has several months of fatigue. After a period of rest, resistance to movement is more striking. On examination, the meta-carpophalangeal joints and wrists are warm and tender. There are no other joint abnormalities. There is no alopecia, photosensitivity, kidney disease, or rash. Which of the following is correct?

A. The clinical picture suggests early rheumatoid arthritis, and a rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptide) should be obtained
B. The prodrome of lethargy suggests chronic fatigue syndrome
C. Lack of systemic symptoms suggests osteoarthritis
D. X-rays of the hand are likely to show joint space narrowing and erosion
E. An aggressive search for occult malignancy is indicated

Question 2# Print Question

 A 70-year-old man complains of fever and pain in his left knee. Several days previously, he suffered an abrasion of his knee while working in his garage. The knee is red, warm, and swollen. An arthrocentesis is performed, which shows 200,000 leukocytes/µL and a glucose of 20 mg/dL. No crystals are noted. Which of the following is the most important next step?

A. Gram stain and culture of joint fluid
B. Urethral culture
C. Uric acid level
D. Antinuclear antibody
E. Antineutrophil cytoplasmic antibody

Question 3# Print Question

A 60-year-old woman complains of dry mouth and a gritty sensation in her eyes. She states it is sometimes difficult to speak for more than a few minutes. There is no history of diabetes mellitus or neurologic disease. The patient is on no medications. On examination, the buccal mucosa appears dry and the salivary glands are enlarged bilaterally. Which of the following is the best next step in evaluation?

A. Lip biopsy
B. Schirmer test and measurement of autoantibodies
C. IgG antibody to mumps virus
D. A therapeutic trial of prednisone for 1 month
E. Administration of a benzodiazepine

Question 4# Print Question

A 40-year-old man complains of acute onset of exquisite pain and tenderness in the left ankle. There is no history of trauma. The patient is taking hydrochlorothiazide for hypertension. On examination, the ankle is very swollen and tender. There are no other physical examination abnormalities. Which of the following is the best next step in management?

A. Begin colchicine and broad-spectrum antibiotics
B. Perform arthrocentesis
C. Begin allopurinol if uric acid level is elevated
D. Obtain ankle x-ray to rule out fracture
E. Apply a splint or removable cast

Question 5# Print Question

A 48-year-old woman complains of joint pain and morning stiffness for 4 months. Examination reveals swelling of the wrists and MCPs as well as tenderness and joint effusion in both knees. The rheumatoid factor is positive, antibodies to cyclic citrullinated protein are present, and subcutaneous nodules are noted on the extensor surfaces of the forearm. Which of the following statements is correct?

A. Prednisone 60 mg per day should be started
B. The patient should be evaluated for disease-modifying antirheumatic therapy
C. A nonsteroidal anti-inflammatory drug should be added to aspirin
D. The patient’s prognosis is highly favorable
E. The patient should receive a 3-month trial of full-dose nonsteroidal anti-inflammatory agent before determining whether and/or what additional therapy is indicated

Category: Medicine--->Rheumatology
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