MSN 622 Week 5 – Rheumatoid Exam
Questions With Correct Answers
A |72-year-old |man |presents |to |the |clinic |for |pre-operative |evaluation. |The |patient |says |he |is |
feeling |well, |remembers |many |years |ago, |was |diagnosed |with |some |joint |condition, |and |was |
advised |to |take |medications |for |which |he |would |have |to |do |blood |tests |regularly. |He |was |not |
interested |in |doing |regular |blood |tests |and |seeing |a |clinician |regularly; |hence |he |never |took |
treatment |for |the |disease. |On |examination, |he |has |bilateral |ulnar |deviation |and |subluxation |of
|the |metacarpophalangeal |(MCP) |joints. |Hand |X-ray |shows |erosions |of |MCP |and |proximal |
interphalangeal |(PIP) |joints. |Rheumatoid |factor |(RF) |and |anti-CCP |antibodies |are |positive. |
Which |of |the |following |is |the |next |best |step |in |managing |this |patient? |- |CORRECT |
ANSWER✔✔-Cervical |spine |radiographs
A |47-year-old |woman |presents |to |the |clinic |with |swelling |in |both |knees, |morning |stiffness |
lasting |more |than |an |hour, |and |pain |with |walking. |Further |history |reveals |bilateral |hand |and |
wrist |pain. |These |symptoms |have |been |present |for |about |three |months |and |have |gradually |
progressed. |The |patient |has |tried |over-the-counter |acetaminophen |without |relief |from |the |
symptoms. |For |the |past |couple |of |months, |she |has |felt |tired |and |had |a |low-grade |fever. |She |
denies |rashes, |oral |ulcers, |chest |pain, |and |difficulty |breathing. |On |examinations, |she |has |
synovitis |of |both |knees, |metacarpophalangeal |(MCP), |and |proximal |interphalangeal |(PIP) |joints
|bilaterally. |X-rays |of |the |hands |do |not |show |joint |damage. |Lab |results |for |rheumatoid |factor |
(RF), |anti-CCP, |and |ANA |are |negative. |What |is |the |most |likely |diagnosis? |- |CORRECT |
ANSWER✔✔-Rheumatoid |arthritis
A |54-year-old |man |with |a |history |of |rheumatoid |arthritis |presents |to |the |clinic |for |a |regular |
follow-up |appointment. |He |has |remained |stable |on |methotrexate |15 |mg |every |week, |folic |acid
|1 |mg |daily, |and |etanercept |50 |mg |every |week. |His |examination |is |unremarkable, |with |no |joint
|tenderness |or |swelling. |Routine |labs |are |within |normal |limits. |The |patient |does |mention |some
|pain |along |his |spine. |Involvement |of |which |of |the |following |spinal |segments |is |associated |with
|the |worst |morbidity |in |this |patient? |- |CORRECT |ANSWER✔✔-Cervical |spine
A |54-year-old |female |presented |for |evaluation |at |the |outpatient |clinic. |She |was |diagnosed |
with |rheumatoid |arthritis |two |years |ago. |She |has |been |closely |followed |up |and |found |to |have |
low-level |disease |activity. |Currently, |she |is |managed |with |NSAIDs |and |has |never |received |
, disease-modifying |antirheumatic |drugs |(DMARDs). |In |patients |with |established |disease, |the |
American |College |of |Rheumatology |recommends |what |type |of |treatment? |- |CORRECT |
ANSWER✔✔-Start |monotherapy |with |a |DMARD
A |65-year-old |female |patient |complains |of |joint |stiffness |and |swelling |in |both |hands. |The |
stiffness |worsens |upon |waking |up |in |the |morning |and |gradually |improves |after |two |to |three |
hours. |She |further |reports |having |had |more |trouble |opening |her |pill |bottles |in |the |past |few |
weeks. |Which |one |of |the |following |is |going |to |be |the |most |specific |for |reaching |a |diagnosis |in |
this |patient? |- |CORRECT |ANSWER✔✔-Anti-citrullinated |protein |antibodies |(ACPA)
32-year-old |woman |presents |to |the |healthcare |provider |with |six |months |of |fatigue. |She |also |
reports |joint |pains, |chest |pain, |and |a |3 |kg |weight |loss |ever |since |the |fatigue |started. |She |
denies |recent |travel, |fever, |or |new |sexual |partners. |She |has |no |past |medical |history |and |takes |
no |medications. |She |is |sexually |active |with |her |husband |of |five |years. |Her |mother |has |
rheumatoid |arthritis. |Vitals |include |a |blood |pressure |of |123/80 |mmHg, |a |heart |rate |of |81/min,
|a |respiratory |rate |of |18/min, |and |oxygen |saturation |of |99% |on |room |air. |On |examination, |she |
has |a |rash |over |her |nose |and |an |ulcer |on |her |hard |palate. |The |chest |examination |reveals |
decreased |air |entry |in |her |right |lung |base. |Her |abdomen |is |soft, |and |there |is |no |
hepatosplenomegaly. |Neurological |examination |is |within |normal |limits. |Which |of |the |following
|antibody |titers |most |likely |correlates |with |the |disease |activity |in |this |patient? |- |CORRECT |
ANSWER✔✔-Anti-double-stranded |DNA |antibodies
A |24-year-old |woman |presents |with |diffuse |aching |and |stiffness, |worsened |by |cold |weather |
and |stress. |Her |history |is |significant |for |Lyme |disease |2 |years |ago |treated |with |doxycycline |100
|mg |twice |a |day |for |4 |weeks. |Her |joints |show |no |tenderness |or |synovitis, |but |she |is |tender |
over |points |bilaterally |at |the |occiput, |trapezius, |lateral |epicondyle, |gluteals, |and |knee. |What |is |
the |most |probable |diagnosis? |- |CORRECT |ANSWER✔✔-Fibromyalgia
30-year-old |woman |presents |with |widespread |musculoskeletal |pain, |which |is |bilateral |and |
involves |both |upper |and |lower |parts |of |the |body |for |the |past |4 |months. |She |has |normal |
laboratory |findings, |and |imaging |studies |are |unremarkable. |Which |of |the |following |is |a |first-
line |medication |used |to |treat |this |condition? |- |CORRECT |ANSWER✔✔-Duloxetine
Questions With Correct Answers
A |72-year-old |man |presents |to |the |clinic |for |pre-operative |evaluation. |The |patient |says |he |is |
feeling |well, |remembers |many |years |ago, |was |diagnosed |with |some |joint |condition, |and |was |
advised |to |take |medications |for |which |he |would |have |to |do |blood |tests |regularly. |He |was |not |
interested |in |doing |regular |blood |tests |and |seeing |a |clinician |regularly; |hence |he |never |took |
treatment |for |the |disease. |On |examination, |he |has |bilateral |ulnar |deviation |and |subluxation |of
|the |metacarpophalangeal |(MCP) |joints. |Hand |X-ray |shows |erosions |of |MCP |and |proximal |
interphalangeal |(PIP) |joints. |Rheumatoid |factor |(RF) |and |anti-CCP |antibodies |are |positive. |
Which |of |the |following |is |the |next |best |step |in |managing |this |patient? |- |CORRECT |
ANSWER✔✔-Cervical |spine |radiographs
A |47-year-old |woman |presents |to |the |clinic |with |swelling |in |both |knees, |morning |stiffness |
lasting |more |than |an |hour, |and |pain |with |walking. |Further |history |reveals |bilateral |hand |and |
wrist |pain. |These |symptoms |have |been |present |for |about |three |months |and |have |gradually |
progressed. |The |patient |has |tried |over-the-counter |acetaminophen |without |relief |from |the |
symptoms. |For |the |past |couple |of |months, |she |has |felt |tired |and |had |a |low-grade |fever. |She |
denies |rashes, |oral |ulcers, |chest |pain, |and |difficulty |breathing. |On |examinations, |she |has |
synovitis |of |both |knees, |metacarpophalangeal |(MCP), |and |proximal |interphalangeal |(PIP) |joints
|bilaterally. |X-rays |of |the |hands |do |not |show |joint |damage. |Lab |results |for |rheumatoid |factor |
(RF), |anti-CCP, |and |ANA |are |negative. |What |is |the |most |likely |diagnosis? |- |CORRECT |
ANSWER✔✔-Rheumatoid |arthritis
A |54-year-old |man |with |a |history |of |rheumatoid |arthritis |presents |to |the |clinic |for |a |regular |
follow-up |appointment. |He |has |remained |stable |on |methotrexate |15 |mg |every |week, |folic |acid
|1 |mg |daily, |and |etanercept |50 |mg |every |week. |His |examination |is |unremarkable, |with |no |joint
|tenderness |or |swelling. |Routine |labs |are |within |normal |limits. |The |patient |does |mention |some
|pain |along |his |spine. |Involvement |of |which |of |the |following |spinal |segments |is |associated |with
|the |worst |morbidity |in |this |patient? |- |CORRECT |ANSWER✔✔-Cervical |spine
A |54-year-old |female |presented |for |evaluation |at |the |outpatient |clinic. |She |was |diagnosed |
with |rheumatoid |arthritis |two |years |ago. |She |has |been |closely |followed |up |and |found |to |have |
low-level |disease |activity. |Currently, |she |is |managed |with |NSAIDs |and |has |never |received |
, disease-modifying |antirheumatic |drugs |(DMARDs). |In |patients |with |established |disease, |the |
American |College |of |Rheumatology |recommends |what |type |of |treatment? |- |CORRECT |
ANSWER✔✔-Start |monotherapy |with |a |DMARD
A |65-year-old |female |patient |complains |of |joint |stiffness |and |swelling |in |both |hands. |The |
stiffness |worsens |upon |waking |up |in |the |morning |and |gradually |improves |after |two |to |three |
hours. |She |further |reports |having |had |more |trouble |opening |her |pill |bottles |in |the |past |few |
weeks. |Which |one |of |the |following |is |going |to |be |the |most |specific |for |reaching |a |diagnosis |in |
this |patient? |- |CORRECT |ANSWER✔✔-Anti-citrullinated |protein |antibodies |(ACPA)
32-year-old |woman |presents |to |the |healthcare |provider |with |six |months |of |fatigue. |She |also |
reports |joint |pains, |chest |pain, |and |a |3 |kg |weight |loss |ever |since |the |fatigue |started. |She |
denies |recent |travel, |fever, |or |new |sexual |partners. |She |has |no |past |medical |history |and |takes |
no |medications. |She |is |sexually |active |with |her |husband |of |five |years. |Her |mother |has |
rheumatoid |arthritis. |Vitals |include |a |blood |pressure |of |123/80 |mmHg, |a |heart |rate |of |81/min,
|a |respiratory |rate |of |18/min, |and |oxygen |saturation |of |99% |on |room |air. |On |examination, |she |
has |a |rash |over |her |nose |and |an |ulcer |on |her |hard |palate. |The |chest |examination |reveals |
decreased |air |entry |in |her |right |lung |base. |Her |abdomen |is |soft, |and |there |is |no |
hepatosplenomegaly. |Neurological |examination |is |within |normal |limits. |Which |of |the |following
|antibody |titers |most |likely |correlates |with |the |disease |activity |in |this |patient? |- |CORRECT |
ANSWER✔✔-Anti-double-stranded |DNA |antibodies
A |24-year-old |woman |presents |with |diffuse |aching |and |stiffness, |worsened |by |cold |weather |
and |stress. |Her |history |is |significant |for |Lyme |disease |2 |years |ago |treated |with |doxycycline |100
|mg |twice |a |day |for |4 |weeks. |Her |joints |show |no |tenderness |or |synovitis, |but |she |is |tender |
over |points |bilaterally |at |the |occiput, |trapezius, |lateral |epicondyle, |gluteals, |and |knee. |What |is |
the |most |probable |diagnosis? |- |CORRECT |ANSWER✔✔-Fibromyalgia
30-year-old |woman |presents |with |widespread |musculoskeletal |pain, |which |is |bilateral |and |
involves |both |upper |and |lower |parts |of |the |body |for |the |past |4 |months. |She |has |normal |
laboratory |findings, |and |imaging |studies |are |unremarkable. |Which |of |the |following |is |a |first-
line |medication |used |to |treat |this |condition? |- |CORRECT |ANSWER✔✔-Duloxetine
