NMS Q&A Family Medicine

174 NMS Q&A Family Medicinenodules. Which of the following is least likely in thedifferential diagnosis?(A) Pulmonary tuberculosis(B) Histoplasmosis(C) Hypersensitivity pneumonitis(D) Pneumococcal pneumonia(E) Sarcoidosis7 The patient in Question 6 began to feel significantlybetter and has been followed for several more weeks.A tuberculosis skin test, repeated after 2 weeks, wasnegative. The serum calcium is elevated slightly, andin a bronchial lavage specimen, the ratio of CD4 toCD8 lymphocytes is 4.0. Now she complains of painfulred nodules on her lower legs. Which of the followingis the most likely diagnosis?(A) Pulmonary tuberculosis(B) Histoplasmosis(C) Hypersensitivity pneumonitis(D) Acquired immunodeficiency syndrome (AIDS)(E) Sarcoidosis8 A 35-year-old African-American woman has complainedof weight loss and fatigue for several weeks. Inadvising her on the phone as to measures to take beforeher appointment with you the following week, youasked her to keep a record of her temperature 4 timesper day. She arrives for the appointment with the record.She also notes diffusely thinning hair. The temperaturegraph shows that her temperature has sometimes beenas high as 101 F. However, the high points of the dailygraphs appear at various times in the early hours of themorning or late mornings, not in the afternoons or evenings.She complains also of arthralgia involving hermetacarpophalangeal joints of the first and second fingersbilaterally, with 30 to 60 minutes of stiffness in themorning. A urinalysis yields microscopic hematuriaand red cell casts. Which of the following diagnoses ismost likely, given the combination of clinical findings?(A) Chronic glomerulonephritis(B) Alopecia areata(C) LE(D) Chronic pyelonephritis(E) Pulmonary tuberculosis9 A 35-year-old white woman has had two bouts ofpleurisy and a bout of pericarditis, none associatedwith infection, within 3 months. In addition, shemanifests a hemolytic anemia with reticulocytosisand leukopenia (3,500 white blood cells/mm 3 ) ontwo occasions. You suspect a connective tissue diseaseand order an ANA test. The result is positive for thehomogeneous pattern. Which of the following is thebest conclusion to draw from that result?(A) The patient has SLE.(B) The patient could have a connective tissuedisease or drug-induced SLE.(C) The patient has had undiagnosed pneumonia.(D) The patient should be evaluated formesothelioma.(E) The patient has a blood dyscrasia.10 Each of the following is characteristic of scleroderma,except for which one?(A) Polyarthralgia(B) Raynaud phenomenon(C) Intestinal malabsorption(D) Positive test for Sm antibodies(E) Pulmonary hypertension11 A 45-year-old woman complains of difficulty initiatingswallowing and increasingly early onset of fatigueof her legs as she climbs stairs and in her arms as shelifts baskets of laundry. She notices skin changes thatyou see consist of violaceous coloration about theeyes and in the periungual areas that also are manifestedover the shoulders and anterior chest. Younotice also clubbing of her nails and that she has acough that she relates to her smoking. Which of thefollowing accounts for her systemic symptoms andrash?(A) Photosensitivity eruption(B) Contact dermatitis(C) Polymyositis(D) Dermatomyositis(E) SLE12 Regarding the patient in Question 11, which of thefollowing most likely accounts for the nail clubbing?(A) Chronic obstructive pulmonary disease(B) Reversal of left-to-right shunt through aninterventricular septal defect (the Eisenmengersyndrome)(C) Hepatic cirrhosis(D) Congenital variant(E) Lung cancer13 A 25-year-old man complains of prolonged upperrespiratory congestion. You have treated him forsinusitis twice and for otitis media over the past year,although these are the first such occasions he has hadthese problems in his adult life. This week, he complainsof redness of the eyes with vascular ectasia thatdoes not move over the sclera the way one notes theconjunctival movement with changes in gaze. Bloodpressure levels are normal. You consult by telephoneyour favorite rheumatologist, who suggests orderinga number of antibody levels. Their results are as follows:ANA, anti-Sm, SS-A, SS-B, and anticentromere,