Internal-Medicine

186 9: Muscles and Joints
56. A very tall, slender 16-year-old boy is referred
for evaluation. Physical examination reveals
long fingers, pectus excavatum, and a high
arched palate. Which of the following is most
likely to be seen on his CXR?
(A)
(B)
(C)
(D)
(E)
dextrocardia
aortic dilatation
pneumothorax
apical interstitial fibrosis
rib notching
57. A 29-year-old woman develops symptoms of
painful swelling, and stiffness of both hands.
Physical examination reveals involvement of
the proximal interphalangeal joints and MCP
joints. A clinical diagnosis of rheumatoid arthritis
is made. Which of the following is the most
likely cause of the inflammation in her joints?
(A)
(B)
(C)
(D)
(E)
activated T cells
antineutrophil antibodies
microvascular injury
interleukin-4 (IL-4)
precipitated RF
58. A 25-year-old woman develops painful
swelling of both hands and wrists. She is also
very stiff in the morning. Physical examination
reveals erythema, swelling and joint line tenderness
of the proximal interphalangeal, MCP,
and wrists joints. Her RF is positive, ANA is
negative, and x-rays of the hands show early
erosive joint changes. Which of the following
medications is most likely to prevent progression
of disease?
(A)
(B)
(C)
(D)
(E)
D-penicillamine
antimalarial
methotrexate
NSAID or aspirin
gold
59. A 22-year-old woman develops a red rash over
her cheeks, and pain and swelling in both
knees as well as several small joints in her
hands. Medical evaluation reveals oral ulceration
and 3+ proteinuria. Which of the following
is the most sensitive test for the diagnosis of
this condition?
(A)
(B)
(C)
(D)
(E)
LE cells
ANAs
anti-Sm
anti-Ro
antiphospholipid
60. A 39-year-old man has had several weeks of
fever, abdominal pain, weight loss, and lack of
energy. Three days prior to assessment, he
developed a left foot drop. Physical examination
confirms left peroneal nerve damage and
a bilateral sensory peripheral neuropathy in
both legs. Laboratory evaluation reveals ESR of
105 mm/h, WBC of 14,000/mL, and a negative
serologic test for ANCA. The eosinophil
count is normal. Which of the following is a
reasonable method of establishing a diagnosis?
(A) testicular biopsy
(B) skin biopsy
(C) spiral computerized tomography (CT)
of chest
(D) further serologic testing
(E) abdominal angiography
61. A 32-year-old woman complains of having
intermittent arthralgias of multiple joints and
occasional swelling in both knees. The symptoms
started about 6 months ago and usually
last for weeks at a time and then improve spontaneously.
She reports no morning stiffness or
any constitutional symptoms. About 1 year
ago, she recalls having a round, red, pruritic
skin lesion along her belt line, which resolved
on its own. Serologic tests confirm a clinical
diagnosis of Lyme disease. Which of the following
mechanisms is the most likely cause of
this syndrome?
(A)
(B)
(C)
(D)
(E)
autoimmune
viral infection
spirochetal infection
circulating immune complexes
metabolic (abnormal crystal metabolism)
62. A 74-year-old man presents with a history of
increasing frequency of headaches, fatigue, and
weight loss for 3 months. He has had migraine
headaches in the past, but these are different