Internal-Medicine

178 9: Muscles and Joints
16. A 27-year-old man has a history 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. X-ray of
the lumbar spine shows sacroiliitis. In addition
to recommending physiotherapy and exercise,
which of the following is the most appropriate
next step in management?
(A)
(B)
(C)
(D)
(E)
NSAID therapy
phenylbutazone
azathioprine
acetaminophen
prednisone
Figure 9–1.
17. A 24-year-old woman notices pain in her left
arm, made worse with use. She also has fatigue,
fever, night sweats, and arthralgias. On examination,
there are no palpable lymph nodes,
and the joints and muscle strength are normal.
The left radial pulse is absent, and there is a
bruit over the left subclavian and common
carotid arteries. Preliminary laboratory investigations
reveal an elevated ESR and mild
anemia. Which of the following vascular findings
is most likely to be found in her?
(A)
(B)
(C)
(D)
(E)
high pressure in the legs and low
pressure in the arms
low pressure in the legs and high
pressure in the arms
high-pitched diastolic murmur
a relentless course to death
hypotension
18. Figure 9–1 shows an x-ray of a 40-year-old
Caucasian man with symptoms of sinusitis and
an incidental finding in the skull. Which of the
following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
normal variant
osteomyelitis
Paget’s disease
hemangioma
metastatic disease
19. A 34-year-old woman develops a red rash over
her cheeks, frequent oral ulcers, and pain and
swelling in both wrists as well as in several
small joints in her hands. Medical evaluation
reveals a positive ANA, and 3+ proteinuria.
Which of the following organ involvement will
cause the most symptoms during the course of
this disease?
(A)
(B)
(C)
(D)
(E)
renal pathology
cardiopulmonary pathology
musculoskeletal pathology
thrombotic events
skin changes
20. A 29-year-old woman develops painful swelling
of both hands. She is also very stiff in the morning.
Physical examination reveals involvement
of the proximal interphalangeal joints and
metacarpophalangeal (MCP) joints. Her RF is
positive and ANA is negative. Which of the
following medications is most likely to
improve her joint pain symptoms?
(A)
(B)
(C)
(D)
(E)
D-penicillamine
an antimalarial
methotrexate
NSAID or aspirin
gold