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Download ALL MCQs for RHEUMATOLOGY SOLUTIONS 100% VERIFIED 2024 NEW UPDATE and more Exams Nursing in PDF only on Docsity! ALL MCQs for RHEUMATOLOGY SOLUTIONS 100% VERIFIED 2024 NEW UPDATE  When compared with patients with rheumatoid arthritis (RA) who do not have anti-cyclic citrullinated protein (CCP) antibodies, patients with RA who have anti-CCP antibodies: a. Are less likely to develop extra-articular manifestations of RA (e.g., vasculitis) b. are less likely to have history of smoking c. Develop fewer subchondral bone erosions on imaging over their disease course. d. have higher prevalence of shared epitope (HLADRB1) risk allels * e. Have lower scores for physical disability  Which of the following conditions is nearly twice as common in patients with diffuse cutaneous systemic sclerosis than in limited cutaneous systemic sclerosis? a. Esophageal involvement b. Pulmonary arterial hypertension c. Pulmonary fibrosis * d. Raynaud phenomenon e. Skin involvement  All of the following agents have been shown to have disease modifying antirheumatic drug efficacy in patients with rheumatoid arthritis EXCEPT: a. Infliximab b. Leflunomide c. Methotrexate d. Naproxen * e. Rituximab  A patient with primary Sjogren syndrome that was diagnosed 6 years ago and treated with tear replacement for symptomatic relief notes continued parotid swelling for the last 3 months. She has also noted enlarging posterior cervical lymph nodes. Evaluation shows leukopenia and low C4 complement levels. What is the most likely diagnosis? a. Amyloidosis b. Chronic pancreatitis c. HIV d. Lymphoma * e. Secondary Sjogren syndrome  Which of the following is the most common extra-articular manifestation of ankylosing spondylitis? a. Anterior uveitis * b. Aortic insufficiency c. Inflammatory bowel disease d. Pulmonary fibrosis e. Third-degree heart block  Lung biopsy has the greatest diagnostic yield in which of the following vasculitis syndrome? a. Cryoglobulinemic vasculitis b. Cutaneous vasculitis c. Granulomatosis with polyangiitis * d. IgA vasculitis (Henoch-Schonlein) e. Polyarteritis nodosa  All of the following have been implicated in the proposed pathogenesis of sarcoidosis EXCEPT: a. Exposure to mold b. Genetic susceptibility c. Immune response to mycobacterial proteins d. Infection with Propionibacterium acnes e. Malignant expansion of helper T cells * Which of the following statements regarding pulmonary sarcoidosis is true? Pulmonary infiltrates in sarcoidosis tend to be predominantly an upper lobe process.  Which of the following statements regarding osteoarthritis is true? a. During the diagnostic workup of a suspected osteoarthritis joint, MRI is warranted to evaluate for any other causes. b. Loss of cartilage causes pain due to direct stimulation of pain receptors in joint cartilage itself. b. Deep venous thrombosis c. Folliculitis d. Genital ulcers e. Scleritis * **17- Which of the following disorders is associated with relapsing polychondritis? a. Giant cell arteritis b. Granulomatosis with polyangiitis (formerly Wegener disease) c. Rheumatoid arthritis d. Psoriasis e. B and C All of the following conditions are associated with relapsing polychondritis EXCEPT: A. Myelodysplastic syndrome B. Primary biliary cirrhosis C. Scleroderma D. Spondyloarthritides E. Systemic lupus erythematosus Relapsing polychondritis is a disease of unknown cause characterized by inflammation of the cartilage predominantly in the ears, nose, and laryngotracheobronchial tree. Although it may be a primary disorder, relapsing polychondritis is often associated with a number of other conditions including systemic vasculitis, systemic lupus erythematosus, Sjögren’s syndrome, spondyloarthritides, Behçet’s disease, inflammatory bowel disease, primary biliary cirrhosis, and myelodysplastic syndrome. It is not associated with scleroderma, which causes distinct skin changes that are typically not inflammatory and are not associated with cartilaginous inflammatory disease. 18- Which of the following statements regarding pulmonary sarcoidosis is true? a. Lung involvement is the second most common manifestation of sarcoidosis, behind only cutaneous involvement. b. Obstructive disease is a rare manifestation of pulmonary sarcoidosis patients. c. pulmonary hypertension never responds to therapy in sarcoidosis patients d. Pulmonary infiltrates in sarcoidosis tend to be predominantly an upper lobe process. e. The presence of cough should prompt evaluation for a cause other than pulmonary sarcoidosis. 19- Which of the following finding is typically seen in patients with fibromyalgia? a. elevated C-reactive protein b. elevated thyroid stimulating hormone c. erosions of the metacarpophalangeal joints on radiographs d. Positive anti-nuclear antibody e. Skin roll tenderness on physical examination 20- Which of the following skin lesions is associated with Lyme disease? a. Erythema marginatum b. Erythema infectiosum c. Erythema migrans d. Erythema multiforme e. Erythema nodosum **21- 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. The patient has multiple tender points to palpation on physical examination. She asks about the best treatment option for her condition. After telling her it is still under investigation, which is the most accurate next statement? a. Tricyclic antidepressants have proven to be the single most effective medication for the disorder. b. Given the fact that lack of restorative sleep has been determined to exacerbate the condition, the use of sleep-inducing medications such as zolpidem has been instrumental in the treatment. c. Low urinary cortisol in these patients has been noted; hence beginning long term, low dose prednisone has been effective in relieving symptoms. d. Chronic opiates are the first line of treatment for this debilitating condition. e. A multidisciplinary approach is most effective including treatment of any depression, physical therapy, an exercise program, support group attendance, and possibly the use of acetaminophen, gabapentin or similar medications as needed. 22- A 44-year-old woman presents with diffuse myalgias and excessive fatigue. She has morning stiffness and pain of all her joints, especially her wrists, elbows, shoulders, hips, knees, and neck. She does not sleep well at night. Her symptoms have been progressing for over four years. On physical examination, the patient has 13 tender points at the elbows, knees, shoulders, and hips. Which of the following is the most likely diagnosis? a. Polymyalgia rheumatica b. Rheumatoid arthritis c. Fibromyalgia syndrome d. Polymyositis e. Scleroderma 23- A 30-year-old woman presents to an internal medicine clinic for evaluation of joint pain and swelling of about 2 years duration accompanied by morning stiffness. She denies any back or neck pain. Symptoms have primarily affected her lower extremities. She notes intermittent swelling in her Achilles tendon, ankles, and knees. She denies any psoriasis or family history of skin disease. She denies any Achilles enthesitis, left ankle synovitis, and dactylitis of the third and fourth fingers of her right hand. Imaging of her sacroiliac joints with MRI shows no erosions or bone marrow edema. Laboratory testing shows an elevated C-reactive protein, negative rheumatoid factor, and negative anti-cyclic citrullinated protein antibodies. Which of the following is the most likely diagnosis? A. Ankylosing spondylitis B. Peripheral spondylarthritis C. Psoriatic arthritis D. Reactive arthritis E. Rheumatoid arthritis 24- A 57-year-old woman with depression and chronic migraine headache reports several years of dry mouth and dry eyes, her primary complaint is that she can no longer eat her favorite crackers, although she does report photosensitivity and eye burning on further questioning. She has no other associated symptoms. Examination shows dry, erythematous sticky oral mucosa. All of the following tests are likely to be positive in this patient EXCEPT: a. La/SS-B antibody b. Ro/SS-A antibody c. Schirmer test d. Scl-70 antibody * e. sialometry d. Lymphoma Y e. Osteoporosis Y 32- Which of the following is the earliest plain radiographic finding of rheumatoid arthritis? a. Juxta-articular osteopenia b. No abnormality c. Soft tissue swelling d. Subchondral erosions e. Symmetric joint space loss 33- Most of the manifestations of acute rheumatic fever present approximately 3 weeks after the precipitating group A streptococcal infection. Which manifestation may present several months after the precipitating infection? a. Chorea b. Erythema marginatum c. Fever d. Polyarthritis e. Subcutaneous nodules 34- A 60-year-old, mildly obese woman presents complaining of bilateral medial right knee pain that occurs with prolonged standing. The pain does not occur with sitting or climbing stairs but seems to be worse with other activity and at the end of the day. The patient denies morning stiffness. Examination of the knees reveals no deformity, but there are small effusions. Some mild pain and crepitus are produced with palpation of the medial aspect of the knees. Which of the following is the most likely diagnosis? a. Psoriatic arthritis b. Rheumatoid arthritis c. Osteoarthritis d. Chondromalacia patellae e. Gouty arthritis 35- A 34-year-old woman has a 15-year history of Crohn’s disease. She presents to your office with the acute onset of right ankle and left knee pain. She recalls a worsening of her gastrointestinal symptoms a few days before the joint symptoms developed. Radiographs of the knee and ankle demonstrate soft tissue swelling and small effusions but no bone destruction. Which of the following statements is true? a. The patient requires high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) b. The patient is experiencing the most common extraintestinal manifestation of inflammatory bowel disease c. The patient is not HLA-B27 positive d. The patient will go on to develop bone erosion and destruction of the knee and ankle e. Controlling the intestinal symptoms will eliminate the knee and ankle arthritis 36- A 28-year-old woman presents with her third episode of left lower extremity deep venous thrombosis. She has a history of two second trimester miscarriages in the past. Laboratory data reveal an elevated activated partial thromboplastin time (PTT) that is not corrected by dilution with normal plasma and an abnormal dilute Russell’s viper venom. Which of the following is the most likely diagnosis? a. Libman-Sacks disease b. Antiphospholipid syndrome c. Takayasu’s arteritis d. Livedo reticularis e. Sjögren’s syndrome 37- A 49-year-old man presents with painful, recurring episodes of swelling in his left great toe. He takes 25 mg of hydrochlorothiazide daily for blood pressure control but otherwise is in good health. On physical examination, the patient is afebrile, but his great toe is warm, swollen, erythematous, and exquisitely tender to palpation. He has several subcutaneous nodules in his pinna. Which of the following is the most likely diagnosis? a. Calcium phosphate deposition disease b. Osteoarthritis of the great toe c. Monosodium urate deposition disease d. Calcium pyrophosphate dihydrate deposition disease e. Calcium oxalate deposition disease 38- A 31-year-old man presents with fever and arthralgias for one day. He complains of diffuse abdominal pain and inability to move his left foot due to weakness. He also states he has had hematuria for several hours. On physical examination, the patient has a temperature of 38.4°C (101.2°F). He has diffuse abdominal tenderness on palpation but has no rebound tenderness. Testicular exam reveals marked tenderness of the testes but no urethral discharge. Neurologic examination reveals a left footdrop. Which of the following is the most likely diagnosis? a. Polyarteritis nodosa b. Whipple’s disease c. Behçet’s syndrome d. Osteonecrosis 39- A 40-year-old woman complains of pain and swelling in both wrists and ankles for 7 weeks. She has several months of fatigue. Morning stiffness impairs her activities for approximately 2 hours. OTC naproxen provides temporary relief. On examination, the metacarpophalangeal (MCP) joints and wrists are warm and tender; there is slight tenderness to pressure over the ankles and metatarsophalangeal (MTP) joints as well. All other joints are normal. There is no alopecia, photosensitivity, kidney disease, or rash. Which of the following is correct? a. The clinical picture suggests early rheumatoid arthritis (RA), and a rheumatoid factor and anticyclic citrullinated peptide (antiCCP) should be obtained. b. An aggressive search for occult malignancy is indicated. c. Lack of systemic symptoms suggests osteoarthritis. d. The prodrome of lethargy suggests chronic fatigue syndrome (CFS). e. X-rays of the hand are likely to show joint space narrowing and erosion. 40- A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, and difficulty swallowing solid food. She has a few telangiectasias over the chest but no erythema of the face or extensor surfaces. There is slight thickening of the skin over the hands, arms, and torso. What is the best diagnostic workup? a. BUN and creatinine b. Antinuclear, anti-Scl-70, and anticentromere antibodies c. Creatine kinase (CK) and antisynthetase antibodies (such as anti-Jo-1) d. Rheumatoid factor and anti-CCP antibodies e. Reproduction of symptoms and findings by immersion of hands in cold water 41- A 65-year-old man develops the onset of severe right knee pain over 24 hours. The knee is red, swollen, and tender. The patient does not have fever or systemic symptoms; he has never had severe joint pain before. Plain film of the knee shows linear calcification of the articular cartilage without destructive change. Definitive diagnosis is best made by which of the following? a. Rheumatoid factor a. Antinuclear antibody (ANA) b. Antineutrophil cytoplasmic antibody (ANCA) c. Gram stain and culture of joint fluid d. Uric acid level e. Urethral culture 49- 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 allopurinol if uric acid level is elevated. b. Obtain ankle x-ray to rule out fracture. c. Perform arthrocentesis. d. Begin colchicine and broad-spectrum antibiotics. e. Apply a splint or removable cast. 50- A 22-year-old man develops the insidious onset of low back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, rash, or nail changes. On examination, the patient has loss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. Which test or group of tests would be most supportive of your suspected diagnosis? a. A positive rheumatoid factor, anti-CCP, and an elevated C-reactive protein level. b. MRI of the lumbosacral spine showing spinal compression fractures associated with bony destruction. c. Lumbosacral x-rays showing vertebral joint space narrowing and osteophyte formation at various levels. d. An elevated sedimentation rate, a mild anemia on CBC, positive HLA-B27 in blood and sclerosis of the sacroiliac joints on plain films of the back. e. A colonoscopy with biopsy results consistent with Crohn disease. 51- A 75-year-old man complains of headache. On one occasion he transiently lost vision in his right eye. He also complains of aching in the shoulders and neck, particularly in the morning. There are no focal neurologic findings. Carotid pulses are normal without bruits. Laboratory data show a mild anemia. Erythrocyte sedimentation rate (ESR) is 85. Which of the following is the best approach to management? a. Schedule temporal artery biopsy and begin corticosteroids based on biopsy results and clinical course. b. Start aspirin and defer any invasive studies unless further symptoms develop. c. Follow ESR and consider further studies if it remains elevated. d. Schedule carotid angiography. e. Begin glucocorticoid therapy and arrange for temporal artery biopsy. 52- 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 Hydroxychloroquine e. A nonsteroidal anti-inflammatory drug 53- 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 vagin*l 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. 54- 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 reproduced 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. Granulomatosis with polyangiitis (Wegener granulomatosis) d. Henoch-Schönlein purpura e. Classic polyarteritis nodosa 55- A 17-month-old boy has a history of multiple fractures due to “brittle bones.” The child is short in stature and has a deformed skull. Physical examination is normal except for the finding of blue scleras. Which of the following is the most likely diagnosis? a. Osteoporosis b. Osteomalacia c. Achondroplasia d. Osteitis deformans e. Osteogenesis imperfect 56- A 25-year-old man presents with morning back pain and stiffness and tenderness over the sacroiliac joints. The patient denies any previous history of eye or genitourinary problems. On physical examination, there is diminished chest expansion with breathing. Which of the following is the most likely diagnosis? a. Sjögren’s syndrome b. Ankylosing spondylitis c. Systemic lupus erythematosus d. Reiter’s syndrome e. Rheumatoid arthritis 57- A 28-year-old law student complains of blanching and cyanosis of her fingertips in cold weather and in times of emotional stress. She complains that her fingers become numb and painful during these episodes. She has a six-month history of dysphagia and arthralgias. She does not smoke or take any medications. On physical examination, the skin of her hands appears to be taut and atrophic, with a flexion deformity from the tight skin (sclerodactyly). Which of the following is the most likely diagnosis? a. Sarcoidosis b. Ulcerative colitis c. Rheumatoid arthritis d. Progressive systemic sclerosis e. Dermatomyositis e. Syphilis 65- A 46-year-old woman with SLE presents with episodic swelling of her ears and nose. On physical examination, her nose is swollen and tender to palpation. Her ears are not acutely inflamed but are atrophic and deformed. This patient is at increased risk for which of the following conditions? a. Asphyxiation b. Myocarditis c. Bacteremia d. Embolus e. Blindness 66- A 24-year-old man with a two-year history of ankylosing spondylitis presents for his regularly scheduled appointment. An electrocardiogram reveals first-degree heart block. Which of the following heart sounds is most likely to be audible in this patient? a. Pericardial friction rub b. Diastolic rumbling murmur c. Systolic murmur that radiates to the carotid artery d. Midsystolic click with systolic murmur e. Holosystolic murmur that radiates to the axilla f. Diastolic murmur with an opening snap 67- Which of the following laboratory findings is most consistent with poststreptococcal glomerulonephritis? a. Positive antinuclear antibody titers b. Positive blood cultures c. Positive cryoglobulin titers d. Elevated ASO titers 68- A 24-year-old woman is newly diagnosed with systemic lupus erythematosus. Which of the following organ system complications is she most likely to have over the course of her lifetime? a. Renal b. Cutaneous c. Cardiopulmonary d. Hematologic e. Musculoskeletal 69- A 76-year-old man complains of a 1-year history of low back and buttock pain that worsens with walking and is relieved by sitting or bending forward. He has hypertension and takes hydrochlorothiazide but has otherwise been healthy. There is no history of back trauma, fever, or weight loss. On examination, the patient has a slightly stooped posture, pain on lumbar extension, and has a slightly wide based gait. Pedal pulses are normal and there are no femoral bruits. Examination of peripheral joints and skin is normal. What is the most likely cause for this patient’s back and buttock pain? a. Herniated nucleus pulposus b. Atherosclerotic peripheral vascular disease c. Facet joint arthritis d. Lumbar spinal stenosis e. Prostate cancer 70- A 30-year-old quadriplegic man presents to the emergency room with fever, dyspnea, and cough. He has a chronic indwelling Foley catheter. Recurrent urinary tract infections have been a problem for a number of years. He has been on therapy to suppress the urinary tract infections. On examination, the patient has a temperature of 38°C (100.4°F), HR 88, and BP 126/76. Mild wheezing is audible over both lungs. A diffuse erythematous rash is noted. The chest x-ray shows diffuse alveolar infiltrates. The CBC reveals a WBC of 13,500, with 50% segmented cells, 30% lymphocytes, and 20% eosinophils. Which of the following is the most likely diagnosis? a. Acute exacerbation of COPD b. Drug reaction to one of his medications c. Health care-related pneumonia d. Sepsis with acute respiratory distress syndrome (ARDS) secondary to urinary tract infection e. Lymphocytic interstitial pneumonitis 72- Patients with antiphospholipid syndrome will often falsely test positive for which of the following infectious diseases? a. Syphilis b. Schistosomiasis c. Malaria d. Hepatitis C e. Human immunodeficiency virus (HIV) 73- A 28-year-old woman has been told she has rheumatic heart disease, specifically mitral stenosis. Which of the following murmurs is most likely present? a. Diastolic rumble at apex of the heart b. Late-peaking systolic murmur at right upper sternal border c. Holosystolic murmur at apex d. Early diastolic decrescendo at right upper sternal border 74- 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 best describes the pathophysiology of the condition? a. Previous exposure to group A streptococcal organisms have stimulated an autoimmune response that leads to cross-reactivity between host and organism with tissue destruction and reduced tear and saliva production. b. Necrotizing vasculitis of small arteries and veins leads to granuloma formation and decreased exocrine function of salivary and lacrimal glands. c. T cells infiltrate exocrine glands and B cells become hyper-reactive. Auto-antibodies ensue including anti-Ro/SSA and anti-La/SSB. Both pro- and anti-apoptotic messages are sent to ductal and acinar epithelial cells. d. Activated T cells and monocytes accumulate in the skin leading to induration for unknown reasons. This inflltration leads to structural abnormalities in various tissues and organs hence a reduction in normal functioning. Anti-topoisomerase-I and anti-centromere autoantibodies are commonly present. e. Immune complexes form and deposit in vessel walls. Vasoactive amines including histamine, bradykinin, and leukotrienes are released, and vessel permeability is increased. Complement activation occurs and mononuclear cells are attracted causing infiltration and decreased gland function. 75- The woman in the previous question is disturbed by her new diagnosis, not only because of the personal pain and suffering she may endure throughout the treatment of her lifelong condition, but also because she wonders about the implications for her four sons who are between the ages of 20 and 26 years. She requests information about the epidemiology and genetics of the condition. Choose the most accurate educational statement from the choices below. a. This condition is rare and has no particular familial predilection so she can rest assured about her children. a. Pseudogout b. Rheumatoid arthritis c. Gout d. Gonococcal arthritis e. Systemic Lupus Erythematosus f. Osteoarthritis Cervical discharge and inflammatory joint are consistent with gonococcal arthritis, which can also present as a migratory arthritis. 82- Symmetric bilateral ulnar deviation of both hands in a 42-year-old woman a. Pseudogout b. Rheumatoid arthritis c. Gout d. Gonococcal arthritis e. Systemic Lupus Erythematosus f. Osteoarthritis Rheumatoid arthritis gives the ulnar deviation of the fingers 83- Painful, swollen metatarsophalangeal great toe (unilateral) with redness and warmth after eating steak and shrimp dinner in a 45-year-old man. a. Pseudogout b. Rheumatoid arthritis c. Gout d. Gonococcal arthritis e. Systemic Lupus Erythematosus f. Osteoarthritis Gouty arthritis often affects the first metatarsophalangeal joint and can be precipitated by various food or alcohol. 84- A 17-year-old sexually active adolescent male presents with a 5- day history of fever, chills, and persistent left ankle pain and swelling. On physical examination, maculopapular and pustular skin lesions are noted on the trunk and extremities. He denies any symptoms of Genitourinary tract infection. Synovial fluid analysis is most likely to show which of the following? a. WBCs 500/mm3 with 25% polymorphonuclear leukocytes b. WBCs 48000/mm3 with 80% lymphocytes c. RBCs 100 000/mm3, WBCs 1000/mm3 d. WBCs 75000/mm3 with 95% polymorphonuclear leukocytes 85- a 65-year-old man with a history of chronic hypertension, diabetes mellitus, and degenerative joint disease presents with acute onset of severe pain of the metatarsophalangeal (MTP) joint and swelling of the left first toe. Physical examination show exquisite tenderness of the joint, with swelling, warmth, and erythema. The patient has no history of trauma or other significant medical problems. Synovial fluid analysis and aspiration is most likely to show which of the following? a. Hemorrhagic fluid b. Gram-negative organisms c. Rhomboidal, positively birefringent crystals d. Noninflammatory fluid e. Needle-shaped, negatively birefringent crystals 86- Which of the following patients is most likely to be a candidate for bone mineral density screening? a. A 35-year-old asthmatic woman who took prednisone 40 mg/d for a 2-week course 1 week ago b. A 65-year-old, thin, white woman who smokes and is 15 years postmenopausal c. A healthy 75-year-old white man who is sedentary d. A 60-year-old overweight African American woman e. A 40-year-old white woman who exercises daily and still menstruates. 87- Which of the following diagnostic tests is most likely to give the diagnosis for the Gonococcal arthritis? * a. Culture of joint fluid b. Crystal analysis of joint fluid c. Blood culture d. Cervical culture 88- A 23-year-old woman is evaluated by her primary care physician because she is concerned that she may have systemic lupus erythematosus after hearing a public health announcement on the radio. She has no significant past medical history, and her only medication is occasional ibuprofen. She is not sexually active and works in a grocery store. She reports that she has had intermittent oral ulcers and right knee pain. Physical examination shows no evidence of alopecia, skin rash, or joint swelling/inflammation. Her blood work shows that she has a positive antinuclear antibody (ANA) at a titer of 1:40, but no other abnormalities. Which of the following statements is true? a. If a urinalysis shows proteinuria, she will meet criteria for systemic lupus erythematosus. b. The demonstration of a positive ANA alone is adequate to diagnose systemic lupus erythematosus. c. Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus; this patient has three. d. She meets criteria for systemic lupus erythematosus because she has three criteria for disease. e. Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus; this patient has two. * 89- A 36-year-old woman was seen by her physician due to pain in her hands, wrists, and knees. She is diagnosed with rheumatoid arthritis. Which of the following treatments will reduce joint inflammation and slow progeression of the disease ? a. Joint aspiration b. NSAIDs c. Systemic corticosteroids d. Methotrexate 90- A previously healthy 18-year-old college freshman presents to the student health clinic complaining of pain on the dorsum of the left wrist and in her right ankle, fever, and a pustular rash on the extensor surfaces of both of her forearms. She has mild swelling and erythema of her ankle, and pain on passive flexion of her wrist. Less than 1 mL of joint fluid is aspirated from her ankle, which shows 8000 polymorphonuclear(PMN) cells per high-power field (hpf) but no organisms on Gram stain. Which of the following is the best initial treatment? a. Indomethacin orally b. Cochicine orally c. Intravanous ceftriaxone d. Intraarticular prednisone e. Intravanous ampicillin 99- A 19-year-old man was seen at the university student health clinic a week ago complaining of pharyngitis, and now returns because he has noted discoloration of his urine. He is noted to have elevated blood pressure (178/110 mm Hg), and urinalysis reveals red blood cell (RBC) casts, dysmorphic RBCs, and 1+ proteinuria. Which of the following is the most likely diagnosis? a. SLE b. Amyloidosis c. HIV nephropathy d. Poststreptococcal glomerulonephritis 100- A 19-year-old recent immigrant from Ethiopia comes to your clinic to establish primary care. She currently feels well. Her past medical history is notable for a recent admission to the hospital for new- onset atrial fibrillation. As a child in Ethiopia, she developed an illness that caused uncontrolled flailing of her limbs and tongue lasting approximately 1 month. She also has had three episodes of migratory large-joint arthritis during her adolescence that resolved with pills that she received from the pharmacy. She is currently taking metoprolol and warfarin and has no known drug allergies. Physical examination reveals an irregularly irregular heart beat with normal blood pressure. Her point of maximal impulse (PMI) is most prominent at the midclavicular line and is normal in size. An early diastolic rumble and 3/6 holosystolic murmur are heard at the apex. A soft early diastolic murmur is also heard at the left third intercostal space. You refer her to a cardiologist for evaluation of valve replacement and echocardiography. What other intervention might you consider at this time? a. Monthly penicillin G injections b. Daily doxycycline c. Daily aspirin d. Low-dose corticosteroids e. Penicillin G injections as needed for all sore throats 101- Rheumatic fever develops due to an autoimmune process. Which of the following mechanisms of autoimmunity is primarily responsible for the development of rheumatic fever? a. Intrinsic cytokine imbalance b. Endocrine abnormalities c. Increased T-cell help due to cytokine stimulation d. Increased B-cell function e. Molecular mimicry Links https://quizlet.com/708547860/immuno-harrison-qbank-flash-cards/

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