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Select the ONE answer that is BEST in each case.
A 45-year-old man has had several weeks of fever, abdominal pain, weight loss, and lack of energy. Three days prior to assessment, he developed a left foot drop. His blood pressure is 160/90 mm Hg, pulse 80/min, and physical examination confirms left peroneal nerve damage and a bilateral sensory peripheral neuropathy in both legs. There are no skin rashes. Laboratory evaluation reveals ESR of 105 mm/h, WBC of 14,000/mL, and negative serologic tests for ANCA and ANA. Eosinophil count is normal. Which of the following chronic viral infections is sometimes associated with this condition?
About 20–30% of patients with PAN have hepatitis B antigenemia. Circulating immune complexes containing hepatitis B antigen and immunoglobulin have been detected, and immunofluorescence of blood vessel walls have also demonstrated hepatitis B antigen. Antiviral therapy has been used in these cases.
See all quizzes of the Muscles and joints at here:
|41. A 45-year-old man has had several weeks of fever, abdominal pain, weight loss, and lack of energy. Three days prior to assessment, he developed a left foot drop. His blood pressure is 160/90 mm Hg, pulse 80/min, and physical examination confirms left peroneal nerve damage and a bilateral sensory peripheral neuropathy in both legs. There are no skin rashes. Laboratory evaluation reveals ESR of 105 mm/h, WBC of 14,000/mL, and negative serologic tests for ANCA and ANA. Eosinophil count is normal. Which of the following chronic viral infections is sometimes associated with this condition?
(A) high cytomegalovirus (CMV) titers
(B) herpesvirus material in circulating immune complexes
(C) hepatitis B material in circulating immune complexes
(D) epidemiologic relationship to Coxsackie B virus
(E) triggering of symptoms following viral gastroenteritis secondary to rotavirus infection
|42. A 19-year-old man has a chronic papulosquamous skin disorder involving his knees and elbows. He now has dull low back pain and morning stiffness that lasts a few hours. On examination, forward flexion at the lumbar spine is reduced but neck movements are normal. There is stress tenderness of both sacroiliac joints. Which of the following is the most likely diagnosis?
(B) ankylosing spondylitis (AS)
(C) psoriatic arthritis
(D) reactive arthritis
|43. A 63-year-old man is worried that he has RA because his RF serology is positive in a low titer. He has pain in his left hand and right knee, which usually bother him in the evening. He has not noticed any inflammation or swelling and there is no history of morning stiffness. On examination, there are no active joints. Which of the following statements regarding the presence of RF is correct?
(A) is positive in 10–20% of people over age 65
(B) is positive in almost 100% of “classical” RA
(C) is seen only in RA
(D) is always abnormal
(E) is frequently present in osteoarthritis
|44. A 45-year-old man has had intermittent swelling and pain in the superior part of his auricles for several years. Mild arthritis usually accompanies these episodes. Last year he also had redness, pain, and swelling over the bridge of his nose. Which of the following is the most likely diagnosis?
(A) psoriatic arthritis
(B) Behçet’s syndrome
(C) Wegener’s granulomatosis
(D) relapsing polychondritis
(E) rheumatoid arthritis
|45. Which of the following features is a characteristic of Ehlers-Danlos syndrome?
(A) thickening of the skin
(B) mental retardation
(C) an increased incidence of skin carcinoma
(E) habitual dislocation of joints
|46. A 72-year-old man injures his right knee in a car accident, and now it is swollen and extremely painful to bend the knee. X-rays of the knee rule out a fracture, and joint fluid aspiration reveals an opaque-colored fluid containing rhomboid crystals with weak-positive birefringence. Which of the following is the most appropriate next step in management?
(A) oral prednisone
(B) intravenous antibiotics
(C) oral NSAIDs
|47. A 64-year-old man is having difficulty getting out of a chair. He has lost 15 lb and feels tired all the time. On examination, there is a blue purple rash on his eyelids and knuckles, and muscle strength in his proximal muscles is rated 4 out of 5. His creatinine kinase (CK) level is elevated and he is started on prednisone. Which of the following is the most important in monitoring response to therapy?
(A) testing of muscle strength
(B) sedimentation rates
(C) urine transaminase enzymes
(E) alkaline phosphatase
|48. A 25-year-old woman with SLE notices increasing fatigue and shortness of breath on exertion. Her usual SLE symptoms of joint discomfort, chest pain, and fevers are not present. On examination, there are no active joints, but she is jaundiced. Laboratory studies show hemoglobin 9 g/dL, WBC 5000/mL, platelets 150,000/mL, reticulocyte count 4%, direct antiglobulin test: positive, total bilirubin 4 g/dL, direct 0.5 mg/dL, aspartate amino transferase (AST) 20 U/L, alanine amino transferase (ALT) 15 U/L, LDH 300 U/L. Which of the following is the most likely diagnosis?
(A) autoimmune hepatitis
(B) hemolytic anemia
(C) viral hepatitis
(D) acute blood loss
(E) Gilbert syndrome
|49. A 38-year-old man has had 3 months of intermittent joint pain and swelling in both knees. The symptoms last weeks at a time and then improve spontaneously. His only past medical history is that of an oval-shaped, red pruritic skin lesion in his right axilla 4 months earlier, which appeared shortly after a camping trip. His immunoglobulin G (IgG) serology for Borrelia burgdorferiis positive. Which of the following is the most appropriate next step in management?
(A) high-dose glucocorticoids
(B) low-dose glucocorticoids
(C) high-dose NSAID therapy
(D) long-term penicillin
(E) long-term doxycycline
|50. A 26-year-old man has had a year of intermittent joint pain and swelling in both knees. The symptoms last weeks at a time and then improve. He has always been healthy. His only past medical history is that of a round, pruritic skin lesion in his left groin 2 years earlier, which appeared shortly after a camping trip. Which of the following is the most appropriate initial diagnostic test?
(A) positive serologic studies only
(B) synovial fluid analysis
(C) skin biopsy
(D) positive serology and clinical symptoms
(E) synovial biopsy
|51. Which of the following statements concerning the articular manifestations of RA is correct?
(A) wrists are rarely involved
(B) involvement of hands is characteristically asymmetric
(C) fever up to 104°F is common with joint involvement
(D) ulnar deviation at the wrist is common
(E) absence of morning stiffness makes RA an unlikely cause of articular symptoms
|52. A 22-year-old man has symptoms of low back pain and stiffness. After several months of mild symptoms, he notes more severe stiffness at night and hip pain. On physical examination, there is paravertebral muscle tenderness and limited flexion of the lumbar spine. Figure 9–3 shows an x-ray of the lumbar spine. Which of the following is the most likely diagnosis?
(A) Reiter syndrome
(B) Marfan syndrome
(C) ankylosing spondylitis (AS)
|53. A 64-year-old woman presents with fatigue, and musculoskeletal symptoms. She reports of no headache, jaw discomfort, or visual disturbance. Her physical examination is normal, and laboratory testing reveals an elevated ESR of 75 mm/h. She is started on prednisone 10 mg/day and notices a dramatic improvement in her symptoms after 1 week. Which of the following are the most typical symptoms of this disorder?
(A) heliotrope rash
(B) proximal muscle weakness
(C) painful peripheral neuropathies
(D) stiffness and pain of proximal muscles
|54. A 69-year-old man comes to the office complaining of fatigue, and weight loss for 3 months. He also reports having frequent headaches, which are new for him. There are no other constitutional symptoms of fever, chills or night sweats. He does have chronic lower back pain but lately he has noticed pain in his shoulder, and hip as well. The muscle and joint symptoms are worse in the morning, and the stiffness lasts for 1 hour. His jaw also hurts when he is chewing food. Head and neck examination is normal, there is no lymphadenopathy and fundoscopy is normal. Range of motion in the shoulders and hips is reduced because of discomfort but there is no active inflammation. Which of the following is the most feared complication in patients with this condition?
(B) cortical stroke
(C) limb claudication
(D) renal infarction
(E) aortic aneurysm
|55. A 67-year-old woman has pain in her left hand and right knee, which is interfering with her activities. The pain came on gradually, first in her hand 6 months ago and now in her knee. It is usually fine when she wakes up, but gets worse as the day progresses. There is no history of any trauma, and she is otherwise well. Taking over-the-counter NSAIDs usually relieves the pain. On examination, there is bony soft tissue swelling of his second and third DIP joints in the left hand and crepitus over the right knee with flexion. There is no erythema or joint effusion. Which of the following best describes this disease condition?
(A) disease of the synovial membrane
(B) disease of the articular cartilage
(C) disease of the entire joint
(D) disease of the subchondral bone
(E) disease of the ligaments
|56. A very tall, slender 16-year-old boy is referred for evaluation. Physical examination reveals long fingers, pectus excavatum, and a high arched palate. Which of the following is most likely to be seen on his CXR?
(B) aortic dilatation
(D) apical interstitial fibrosis
(E) rib notching
|57. A 29-year-old woman develops symptoms of painful swelling, and stiffness of both hands. Physical examination reveals involvement of the proximal interphalangeal joints and MCP joints. A clinical diagnosis of rheumatoid arthritis is made. Which of the following is the most likely cause of the inflammation in her joints?
(A) activated T cells
(B) antineutrophil antibodies
(C) microvascular injury
(D) interleukin-4 (IL-4)
(E) precipitated RF
|58. A 25-year-old woman develops painful swelling of both hands and wrists. She is also very stiff in the morning. Physical examination reveals erythema, swelling and joint line tenderness of the proximal interphalangeal, MCP, and wrists joints. Her RF is positive, ANA is negative, and x-rays of the hands show early erosive joint changes. Which of the following medications is most likely to prevent progression of disease?
(D) NSAID or aspirin
|59. A 22-year-old woman develops a red rash over her cheeks, and pain and swelling in both knees as well as several small joints in her hands. Medical evaluation reveals oral ulceration and 3+ proteinuria. Which of the following is the most sensitive test for the diagnosis of this condition?
(A) LE cells
|60. A 39-year-old man has had several weeks of fever, abdominal pain, weight loss, and lack of energy. Three days prior to assessment, he developed a left foot drop. Physical examination confirms left peroneal nerve damage and a bilateral sensory peripheral neuropathy in both legs. Laboratory evaluation reveals ESR of 105 mm/h, WBC of 14,000/mL, and a negative serologic test for ANCA. The eosinophil count is normal. Which of the following is a reasonable method of establishing a diagnosis?
(A) testicular biopsy
(B) skin biopsy
(C) spiral computerized tomography (CT) of chest
(D) further serologic testing
(E) abdominal angiography