Internal-Medicine

Questions: 56–70 187
from them. He is also experiencing back, shoulder,
and hip discomfort, which is worse in the
morning. His head and neck examination is
normal. Range of motion in the shoulders and
hips is reduced because of discomfort but there
is no active inflammation. Which of the following
signs or symptoms is most helpful in
the diagnosis?
(A)
(B)
(C)
(D)
(E)
throat pain on swallowing
pain in the jaw when chewing
malaise
fatigue
sweating
63. A 60-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 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 characteristics is a
risk factor for this condition?
(A)
(B)
(C)
(D)
(E)
being Chinese
being African
being male
being overweight
hyperthyroidism
64. Which of the following is the most common
location for osteoarthritis?
(A)
(B)
(C)
(D)
(E)
hip
base of thumb
knee
spine
DIP joints of hand
DIRECTIONS (Questions 65 through 74): Each set
of matching questions in this section consists of a
list of lettered options followed by several numbered
items. For each numbered item, select the
appropriate lettered option(s). Each lettered option
may be selected once, more than once, or not at all.
EACH ITEM WILL STATE THE NUMBER OF
OPTIONS TO SELECT. CHOOSE EXACTLY THIS
NUMBER.
Questions 65 through 69
(A) associated with hemolysis
(B) seen in mixed connective tissue disease
(C) most sensitive test for SLE
(D) most sensitive test for drug-induced
lupus
(E) causes false-positive VDRL (Venereal
Disease Research Laboratory)
(F) relatively disease specific
For each autoantibody, select the most likely clinical
manifestation.
65. ANA (SELECT ONE)
66. Anti-dsDNA (SELECT ONE)
67. Antiphospholipid (SELECT ONE)
68. Antihistone (SELECT ONE)
69. Anti-ribosomal nuclear protein (RNP) (SELECT
ONE)
Questions 70 through 74
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Felty’s syndrome
rheumatoid vasculitis
episcleritis
Sjögren’s syndrome
rheumatoid nodules
rheumatoid pleural involvement
Caplan’s syndrome
pericardial disease
For each extra-articular manifestation of RA, select
the most likely diagnosis.
70. May present as small brown spots in the nail
folds (SELECT ONE)