NMS Q&A Family Medicine

chap ter 28Connective Tissue DiseasesExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 28-year-old woman has had deep vein thrombosisin the past 3 years and is in the emergency departmentwith a diagnosis of pulmonary embolism. Laboratorystudies over the following 2 days revealednormal levels of Proteins C and S and antithrombinIII. Further testing showed a positive lupus erythematosus(LE) preparation. Serologic test for syphilisis falsely positive. There is no rash; renal function isnormal. Which of the following might be the mosthelpful laboratory test at this point?(A) Complete blood cell (CBC)(B) Sedimentation rate(C) Anticardiolipin antibody level(D) Prothrombin time(E) Hemoglobin A1C2 A 34-year-old Caucasian woman has complained ofcolor change of her right index finger during coldor dampness exposure, particularly during times offatigue. The changes consist of whiteness of the skinof the finger well demarcated at the proximal interphalangealjoint. The change is associated with a subjectiveand objective feeling of coldness of the digit.The phenomenon lasts about an hour and recoverswith a red or purple color until another half hour later.More recently, she complains of difficulty swallowing.Which of the following is the likely diagnosis?(A) Sjögren disease(B) Systemic lupus erythematosus (SLE)(C) Scleroderma(D) Dermatomyositis(E) Raynauds disease3 A 72-year-old man begins to notice jaw pains on theright side while chewing. On examination, a bruit isheard over the left subclavicular area of anteriorchest. The sedimentation rate is 75 mm/hour. Each ofthe following statements is important in close observationof this situation except for which one?(A) There is a 50% chance of this patient havingshoulder and pelvic girdle stiffness.(B) There is a risk of unilateral blindness as a sequel.(C) There may be fever as high as 40 C (104 F).(D) There is likely a complaint of muscular weakness.(E) A course of glucocorticoid may be critical.4 A 34-year-old man notices a rash on the lowerextremities, present for 4 days. He had contracted aviral upper respiratory infection (URI) approximately10 days before. The patient lives in an urbansetting and had not sojourned in the wilderness forseveral years. Upon examination, the rash is found tobe erythematous papules that do not blanch withdigital pressure. He complains also of arthralgiasinvolving the knees and ankles and has noted bloodyurine. Each of the following statements regarding thiscondition may be true except for which one?(A) It has a 90% chance of being self-limited.(B) Renal biopsy will show glomerulonephritis withcrescent formation.(C) If the condition becomes chronic, it would betreated with immunosuppressive agents.(D) This is an autoimmune disorder.(E) Cases becoming chronic are more likely to be inchildren than adults.5 A 45-year-old woman who has been diagnosed withconjunctivitis twice over the past year and has beenfrequently complaining of pruritus now complainsof a foreign body sensation in the left eye. Examinationdiscloses corneal ulceration. Her office recordalso shows that she has complained of various muscularpains over the past year. Which of the followingis the most logical first test you might order?(A) Schirmer test(B) Antinuclear antibody (ANA) test(C) CBC count(D) Serum uric acid(E) Slit-lamp examination6 A 25-year-old African-American woman living in theMidwest complains of fever, fatigue, malaise, andweight loss over the past 3 months. Lately, she hasstarted to have a dry cough. She has never smoked cigarettes.A CBC is unremarkable. A chest x-ray showsbilateral lymphadenopathy and two noncavitating173