NMS Q&A Family Medicine

chapter 26Rheumatology in Primary CareExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Each of the following complications or associatedconditions decreases the 10-year survival projectionfor a patient with systemic lupus erythematosus(from 85% to 55%) except for which one?(A) Nephrotic syndrome(B) Elevated serum albumen(C) Proliferative glomerular changes(D) Serum creatinine 1.4 mg/dL(E) Hypertension2 A 60-year-old woman who takes hydrochlorothiazideand triamterene in combination for hypertensioncomplains of acute onset of pain in the left great toemetatarsophalangeal (MTP) joint that is surroundedby angry red erythema for a diameter of 4 to 5 cm.The family doctor diagnoses gout and considers prescribinga uric acid lowering agent. Each of the followingis an indication for instituting such agentsexcept for which one?(A) Presence of tophi(B) Erosive arthritis on x-ray(C) Uric kidney stones(D) Uric acid level 7.5 mg/dL(E) Three attacks of gout/year3 It is now believed that early diagnosis, hence earlytreatment, of rheumatoid arthritis (RA), permits notonly earlier alleviation of symptoms and preventionof later complications but also prolongation of survival.Which of the following would secure a diagnosisof RA?(A) Presence of a positive rheumatoid factor byserum test(B) Sedimentation rate over 60 mm/hour, combinedwith positive rheumatoid factor(C) Choice B combined with morning stiffness ofarthralgic joints(D) One hour of morning stiffness; 3 swollen joints;joint erosions on XR; rheumatoid nodules(E) More than 6 weeks of symptoms; hand involvement,symmetric involvement4 A 35-year-old woman consults you for pain in the leftknee region that appears to be associated with aneffusion. No other musculoskeletal pain is presentand there is no history of trauma. Each of the followingis among the first group of measures to take indiagnosing this patient, except which one?(A) Take a complete history and perform a relevantphysical examination(B) Determine whether the pain emanates from theknee joint(C) Obtain plain x-ray films of the joint(D) Perform arthrocentesis(E) Order a magnetic resonance imaging of theknee5 Regarding the patient in Question 4, you determinethat she has an effusion in the left knee joint, which iswarm to the touch. The pain had its onset only overthe past 3 weeks. The bouts of this pain have had norelationship to atmospheric changes. There has beenno history of trauma, whether acute or chronic.Which of the following is the most likely cause of themonoarthritis in this patient?(A) RA(B) Gout(C) Staphylococcal septic arthritis(D) Gonococcal arthritis(E) Osteoarthritis6 Regarding the patient in Questions 4 and 5, aspirationyields no crystals and shows a white blood cell (WBC)count of 35,000/mm 3 . To your surprise, a culture of thejoint fluid yields growth of Gram-negative rods. Whichof the following items might explain this departurefrom the flora expected in this situation?(A) Positive human immunodeficiency virus (HIV)titer(B) Positive antinuclear antibody(C) A uric acid level of 11 mg/mL(D) A transferrin saturation level of 60%(E) A reexamination shows erythema migrans163