Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Rheumatology
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Question 6# Print Question

A 27-year-old man presents with worsening low back pain over the past 5 months. He reports that the pain is most severe in the morning and describes a “back stiffness” when getting out of bed. He reports moderate improvement with walking. The patient denies any systemic symptoms and reports an insignificant past medical history. On physical examination, the patient is afebrile with normal vital signs. On musculoskeletal examination, there is marked tenderness over the sacroiliac joints with limited range of motion on forward flexion of the lower back.

Of the following tests, which is the best test for the likely diagnosis in this patient?

A. MRI of the spine
B. HLA-B27 serologic testing
C. Plain film x-ray of the sacroiliac joints
D. Rheumatoid factor testing

Question 7# Print Question

A 47-year-old woman who has not seen a physician in over 20 years presents with painful joints, fatigue, weakness, and what she describes as “hideously misshapen hands.” Family history is significant for type 1 diabetes. Physical examination reveals deformed hands and a 2-cm soft mass that that is mobile and tender to palpation in the left popliteal fossa.

Which of the following is the underlying pathophysiology of this popliteal fossa mass?

A. Monosodium urate crystal deposition
B. Redundant bone growth
C. Obstruction of lymphatic drainage
D. Fluid production from inflamed synovium

Question 8# Print Question

A 47-year-old obese man presents with pain in his bilateral knees that has worsened over the last year. The pain is alleviated by rest and worsened by walking. The patient has never taken any medications for the pain, but warm compresses temporarily cause relief. The patient has a history of type 2 diabetes and hyperlipidemia. Physical examination shows a BMI of 33 kg/m2 . A “grating” sound is appreciated on palpation over the knee joints bilaterally.

Which of the following is the best initial treatment for this patient?

A. Intra-articular corticosteroid injection
B. Acetaminophen
C. Naproxen
D. Allopurinol

Question 9# Print Question

A 53-year-old woman presents with a 2-week history of fatigue and weakness in her hips. She has also started developing weakness in her shoulders while trying to brush her hair in the mornings. The patient denies any difficulty chewing, blurry vision, or facial weakness. The patient is otherwise healthy and does not report any family history other than pancreatic cancer in her maternal uncle. Neurologic examination reveals 3/5 strength in the proximal muscles of her upper and lower extremities. The patient’s erythrocyte sedimentation rate (ESR) is elevated at 92 mm/h and the creatine kinase (CK) is moderately elevated. Other laboratory values (including TSH and free T4) are within normal limits.

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

A. Amyotrophic lateral sclerosis (ALS)
B. Polymyositis
C. Drug-induced myopathy
D. Fibromyalgia

Question 10# Print Question

A 67-year-old woman presents with severe headaches, joint pain, painful chewing, and fever. On physical examination, prominent vasculature is noted in the temporal region of the scalp. Decreased pulses are noted throughout the body. Laboratory testing reveals an ESR of 94 mm/h.

Which of the following is associated with this condition?

A. Aortic aneurysm
B. Inflammatory bowel disease
C. Hepatitis B
D. Smoking history

Category: Q&A Medicine--->Rheumatology
Page: 2 of 5