Internal-Medicine

Questions: 71–84 189
fluid analysis revealed calcium pyrophosphate
deposition disease crystals (CPPD). Which of
the following methods is the most effective prophylaxis
for this condition?
(C)
(D)
(E)
septic arthritis
reactivation of RA
calcium hydroxyapatite deposition
(A)
(B)
(C)
(D)
(E)
allopurinol
continuous NSAIDs
low-dose glucocorticoids
continuous antibiotic therapy
colchicine
81. A 79-year-old woman on chronic hemodialysis
presents with severe pain in her left knee. On
examination, the knee is warm, swollen, and
painful to move. Diagnostic joint aspiration is
performed. Which of the following is the most
likely finding in her joint fluid?
(A)
(B)
(C)
(D)
(E)
uric acid crystals
calcium pyrophosphate crystals (CPPD)
calcium hydroxyapatite crystals
calcium oxalate crystals
crystallized urea
82. An 81-year-old woman develops progressive
pain and immobility of her right shoulder. A
series of x-rays over 8 months reveals destruction
of the shoulder joint and an aspiration
reveals blood in the effusion. Her only other
articular manifestations are mild episodes of
pain in her knees. Which of the following is
the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
a chronic bacterial infection
uric acid deposition
CPPD disease
calcium oxalate deposition
calcium hydroxyapatite deposition
83. A 59-year-old woman with RA, under reasonable
control with methotrexate, develops a hot,
swollen, red knee. Joint aspiration removes
10 cc of an opaque yellow-colored fluid with a
white count of 100,000/µL, predominantly neutrophils.
The joint fluid protein is high and glucose
is much lower than blood. Which of the
following is the most likely diagnosis?
DIRECTIONS (Questions 84 through 88): 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.
(A) polyarteritis nodosa (PAN)
(B) Churg-Strauss disease
(C) Henoch-Schönlein purpura
(D) vasculitis associated with infectious
diseases
(E) vasculitis associated with connective
tissue diseases
(F) Wegener’s granulomatosis
(G) giant cell arteritis
(H) Kawasaki disease
(I) Behçet’s syndrome
For each patient with vasculitis syndrome, select
the most likely diagnosis.
84. A 48-year-old man presents with 3 weeks of
fever, fatigue, and shortness of breath. He has
a history of “nasal allergies” and asthma,
which have been poorly controlled in the past
month. Two days prior to presentation, he
developed weakness in his left foot and it
now “drags” when he walks. On examination,
his blood pressure is 165/90 mm Hg,
pulse 100/min, respirations 20/min, and
lungs have bilateral expiratory wheezes.
There is left foot drop, and the rest of the neurologic
examination is normal. Laboratory
evaluation reveals ESR of 90 mm/h, WBC of
14,000/mL with 10% eosinophils, and 1+ proteinuria.
A CXR shows bilateral pulmonary
infiltrates. (SELECT ONE)
(A)
(B)
uric acid deposition
CPPD deposition