Internal-Medicine

176 9: Muscles and Joints
5. A young woman presents with a facial rash,
arthralgias, and fatigue. The rash on her face is
erythematous and raised, her heart and lungs
are normal, and wrists are swollen and tender
on palpation. She has mild thrombocytopenia
(90,000/mL). Which of the following is the
most appropriate initial autoantibody test?
(A)
(B)
(C)
(D)
(E)
anti-double-stranded (ds)
deoxyribonucleic acid (DNA)
anti-Sm
anti-Ro or La
ANA
antiphospholipid antibodies
(lupus anticoagulant)
6. A 39-year-old woman complains of developing
painful pale fingers on cold exposure for the
past 5 years. Recently, she has noticed swollen
fingers and tight skin, which limit flexion and
extension. She also has new abdominal symptoms
that are bothersome. On examination, the
skin on the fingers is smooth and shiny with
associated edema. The rest of the examination
is normal. Which part of the gastrointestinal
(GI) tract is most frequently involved in this
condition?
(D)
(E)
low-dose (prednisone 40 mg/day)
steroids by mouth
topical steroid creams
8. A 57-year-old man has pain in his left hand
and right knee, which is interfering with his
work. The pain came on gradually, first in his
hand 6 months ago and now in his knee. It is
usually fine when he wakes up, but gets worse
as the day progresses. There is no history of
any trauma, and he 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 distal interphalangeal
(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 is the initial change noticed in the
pathogenesis of osteoarthritis?
(A) abnormal chondrocyte function
(B) a defect in the extracellular matrix of
cartilage
(C) inflammatory changes in subchondral
bone
(D) ligament inflammation
(E) synovial inflammation
(A)
(B)
(C)
(D)
(E)
esophagus
stomach
duodenum
ileum
colon
9. A 22-year-old woman develops color change in
her fingers with cold exposure. The fingers turn
white, then blue, and finally red. Which of the
following statements regarding this condition
is incorrect?
7. A 57-year-old woman is complaining of frequent
headaches and scalp tenderness. She also
has arthralgias, fatigue, and discomfort in her
jaw when she chews. On examination, her head
and neck is normal, but the right temporal
artery is tender on palpation. Her erythrocyte
sedimentation rate (ESR) is 50 mm/h and
hemoglobin 10.5 g/dL. A temporal artery biopsy
is obtained for diagnostic confirmation. Which
of the following is the most appropriate next
step in management?
(A)
(B)
(C)
intravenous high-dose steroids
acetylsalicylic acid
indomethacin
(A) may lead to gangrene of the fingers
(B) may precede the onset of scleroderma
(C) symptoms can be brought on by vibration
or stress
(D) pallor (white color) associated with
coldness and numbness while rubor
(red color) associated with pain and
tingling
(E) affects the sexes equally
10. A 63-year-old man develops pain and swelling
in his knee. It appears warm, red, and swollen
with decreased range of movement. A diagnostic
aspiration is performed. Which of the