Multiple Choice Questions (MCQ)

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Category: Medicine--->Rheumatology
Page: 5

Question 21# Print Question

A 28-year-old woman presents to her primary care physician with a 3-month history of fatigue. Her past medical history includes severe acne. She has had 3 uncomplicated vaginal deliveries and has healthy children aged 5, 3, and 2 years. Questioning reveals that she develops an erythematous rash upon minimal sun exposure, and has heavy menstrual periods despite being on oral contraceptives for the past 2 years. For the past 6 months, she has taken minocycline for acne. Physical examination reveals small joint effusions and tenderness to palpation of the knees bilaterally. Lab testing reveals a normocytic anemia, thrombocytopenia, mild hyper-bilirubinemia, and a marked elevation in her ANA titer. Which of the following statements best characterizes this patient’s illness?

A. Her anemia is due to bone marrow suppression from chronic disease
B. Her anemia is due to iron deficiency
C. Minocycline should be discontinued
D. Anti-histone antibodies are likely to be negative
E. The likelihood of this patient developing venous thromboembolism is comparable to the general population

Question 22# Print Question

A 42-year-old woman presents to the clinic with a 4-week history of nonproductive cough, progressive dyspnea on exertion, and joint pain. During this time she has developed night sweats and moderate fatigue. She was born in the United States and denies travel outside the country, homelessness, or incarceration. Review of systems highlights the fact that she recently visited an optometrist secondary to blurred vision, but a change in glasses did not improve the symptom. A 5-lb unintentional weight loss is noted in her chart since her last clinic visit 3 months ago. Current vital signs include BP 110/68, HR 88, RR 22, and oxygen saturation 95% on room air. Her lungs are clear, but she has mild peripheral lymphadenopathy, with bilateral supraclavicular and axillary nodes up to 2 cm in size. The nodes are rubbery and nontender. A chest radiograph performed in your office indicates bilateral hilar lymphadenopathy, with a small area of infiltrate in the right upper lobe.

Of the following, which is the best next step in management of this patient? 

A. Place a tuberculin skin test to assess for active TB infection
B. Arrange for biopsy of a lymph node
C. Arrange for repeat chest x-ray in 3 months
D. Begin empiric anti-tuberculous therapy
E. Begin empiric corticosteroids

Question 23# Print Question

A 32-year-old Japanese woman has a long history of recurrent aphthous oral ulcers. In the last 2 months she has had recurrent genital ulcers. She now presents with a red painful eye that was diagnosed as anterior uveitis. What is the most likely diagnosis?

A. Herpes simplex
B. HIV infection
C. Behçet disease
D. Diabetes mellitus
E. Systemic lupus erythematosus

Question 24# Print Question

A 53-year-old man presents with arthritis, cough, hemoptysis, and bloody nasal discharge. Urinalysis reveals 4+ proteinuria, RBCs, and RBC casts. Chest x-ray shows several bilateral cavitary nodules. CT scan of chest is shown below. ANCA is positive in a cytoplasmic pattern. Antiproteinase 3 (PR3) antibodies are present, but antimyeloperoxidase (MPO) antibodies are absent.

Which of the following is the most likely diagnosis?


A. Behçet syndrome
B. Sarcoidosis
C. Wegener granulomatosis
D. Henoch-Schönlein purpura
E. e. Classic polyarteritis nodosa

Question 25# Print Question

A 50-year-old white woman presents with aching and stiffness in the trunk, hip, and shoulders. There is widespread muscle pain after mild exertion. Symptoms are worse in the morning and improve during the day. They are also worsened by stress. The patient is always tired and exhausted. She has trouble sleeping at night. On examination, joints are normal. ESR is normal, and Lyme antibody and HIV test are negative. A diagnosis is best made by which of the following?

A. Trial of glucocorticoid
B. Muscle biopsy
C. Demonstration of 11 tender points
D. Psychiatric evaluation
E. Trial of an NSAID

Category: Medicine--->Rheumatology
Page: 5 of 6