Your-Doctor Multiple Choice Questions (MCQ)

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Category: Medicine--->Rheumatology
Page: 4

Question 16#Print Question

A 65-year-old man develops the onset of severe knee pain over 24 hours. The knee is red, swollen, and tender. The patient does not have fever or systemic symptoms. He has a history of diabetes mellitus and cardiomyopathy. Definitive diagnosis is best made by which of the following? 

a. Serum uric acid
b. Serum calcium
c. Arthrocentesis and identification of positively birefringent rhomboid crystals
d. Rheumatoid factor
e. ANA

Question 17#Print Question

A 35-year-old woman complains of aching all over. She sleeps poorly and all her muscles and joints hurt. Her symptoms have progressed over several years. She reports she is desperate because pain and weakness often cause her to drop things. Physical examination shows multiple points of tenderness over the neck, shoulders, elbows, and wrists. There is no joint swelling or deformity. A complete blood count and erythrocyte sedimentation rate are normal. Rheumatoid factor is negative. Which of the following is the best therapeutic option in this patient? 

a. Graded aerobic exercise
b. Prednisone
c. Weekly methotrexate
d. Hydroxychloroquine
e. A nonsteroidal anti-inflammatory drug

Question 18#Print Question

A 38-year-old man has pain and stiffness of his right knee. This began 2 weeks ago after he fell while skiing. On two occasions he had the sense that his knee was locked in a semiflexed position for a few seconds. He has noted a popping sensation when he bends his knee. On examination there is tenderness over the medial joint line of the knee. Marked flexion and extension of the knee are painful. The Lachman test (anterior displacement of the lower leg with the knee at 20° of flexion) and the anterior drawer test are negative. What is the most likely diagnosis?

a. Medial meniscus tear
b. Osteoarthritis
c. Anterior cruciate ligament tear
d. Chondromalacia patellae
e. Lumbosacral radiculopathy

Question 19#Print Question

Over the last 6 weeks a 35-year-old nurse has developed progressive difficulty getting out of chairs and climbing stairs. She can no longer get in and out of the bathtub. She has no muscle pain and takes no regular medications. She does not use alcohol and does not smoke cigarettes. On examination she has a purplish rash that involves both eyelids. There is weakness of the proximal leg muscles. What is the best next diagnostic test?

a. Vitamin B12 level
b. Chest x-ray
c. HLA B27
d. MRI scan of the lumbar spine
e. Creatine kinase (CK)

Question 20#Print Question

A previously healthy and active 72-year-old woman presents to your office with a complaint of stiffness and pain in her neck and shoulders. The symptoms are much worse in the morning and improve throughout the day. The pain affects the soft tissues and does not appear localized to the shoulder or hip joints. She denies headache or jaw claudication. Physical examination is unrevealing; there is no inflammatory synovitis, muscle tenderness, or skin rash. Muscle strength is normal in the deltoid and iliopsoas muscle groups. She has normal range of motion of the shoulder and hip joints. Laboratory studies reveal an elevated erythrocyte sedimentation rate of 92 mm/h and a mild normocytic anemia. Which of the following is the best next step in management of this patient? 

a. Empiric trial of prednisone 15 mg daily
b. Graded exercise regimen
c. MRI of bilateral shoulders
d. Trapezius muscle biopsy
e. Temporal artery biopsy

Category: Medicine--->Rheumatology
Page: 4 of 6