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MSN 622 FINAL EXAM QUESTIONS
WITH SOLUTIONS
A 48-year-old woman presents with pain in her hand joints for about 4 months. A
history of present illness reveals joint stiffness in the mornings usually lasting for 2
hours. A review of systems is positive for swelling of the hand joints over the past
2 months. She denies pain, swelling, or stiffness of the shoulders, elbows, knees,
and ankles. On physical examination, she has swelling, stiffness, and tenderness
of the second and third metacarpophalangeal (MCP) joints of the right hand.
Laboratory testing shows an elevated erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP). Which of the following is the most specific diagnostic test?
- correct-answer - Anti-cyclic citrullinated peptide antibody
A 73-year-old patient presents with a 6-month history of progressive fatigue, with
difficulty climbing stairs and brushing her hair. These symptoms are different than
her usual symptoms. Her medical history is significant for rheumatoid arthritis
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diagnosed 15 years ago. During this time, the patient has tried multiple biological
agents with most of these medications discontinued because of adverse effects or
loss of efficacy. The patient declined to try rituximab and requested to continue
steroids. She has been on 10 mg of prednisone daily for about 10 years. Her dose
is increased to 15 mg daily when the patient experiences an increase in joint pain,
which happens about twice a month. What is the most likely etiology of the
patient's symptoms? - correct-answer - The patient probably has proximal muscle
weakness secondary to corticosteroids.
A 47-year-old woman presents with swelling in both knees, morning stiffness
lasting more than an hour, and pain when walking. Associated symptoms include
bilateral hand and wrist pain. These symptoms are present for about 3 months
and are gradually progressing. The patient tried over-the-counter acetaminophen
without relief from the symptoms. A review of systems is positive for fatigue and
a low-grade fever. She denies rashes, oral ulcers, chest pain, and difficulty
breathing. On physical examination, she demonstrates synovitis of both knees
and metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
bilaterally. X-rays of the hands do not show joint damage. Laboratory test results
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for rheumatoid factor (RF), anti-CCP, and ANA are negative. What is the most
likely diagnosis? - correct-answer - Rheumatoid arthritis
Which of the following is the most likely presentation of new-onset rheumatoid
arthritis (RA)? - correct-answer - Symmetric polyarthritis of the hands, wrists, and
feet
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
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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 25-year-old woman presents with complaints of a facial rash that started a few
months ago and has worsened. She states that the rash is often itchy and worsens
when she goes out in the sun. In the last few days, she has noticed generalized
aches all over her body. She denies any trauma, allergies, or recent travel. She did
try several over-the-counter products, but nothing helped. The appearance of her
rash is shown in the image. Which of the following is the first-line drug in
managing her rash? - correct-answer - Hydroxychloroquine
MSN 622 FINAL EXAM QUESTIONS
WITH SOLUTIONS
A 48-year-old woman presents with pain in her hand joints for about 4 months. A
history of present illness reveals joint stiffness in the mornings usually lasting for 2
hours. A review of systems is positive for swelling of the hand joints over the past
2 months. She denies pain, swelling, or stiffness of the shoulders, elbows, knees,
and ankles. On physical examination, she has swelling, stiffness, and tenderness
of the second and third metacarpophalangeal (MCP) joints of the right hand.
Laboratory testing shows an elevated erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP). Which of the following is the most specific diagnostic test?
- correct-answer - Anti-cyclic citrullinated peptide antibody
A 73-year-old patient presents with a 6-month history of progressive fatigue, with
difficulty climbing stairs and brushing her hair. These symptoms are different than
her usual symptoms. Her medical history is significant for rheumatoid arthritis
,2|Page
diagnosed 15 years ago. During this time, the patient has tried multiple biological
agents with most of these medications discontinued because of adverse effects or
loss of efficacy. The patient declined to try rituximab and requested to continue
steroids. She has been on 10 mg of prednisone daily for about 10 years. Her dose
is increased to 15 mg daily when the patient experiences an increase in joint pain,
which happens about twice a month. What is the most likely etiology of the
patient's symptoms? - correct-answer - The patient probably has proximal muscle
weakness secondary to corticosteroids.
A 47-year-old woman presents with swelling in both knees, morning stiffness
lasting more than an hour, and pain when walking. Associated symptoms include
bilateral hand and wrist pain. These symptoms are present for about 3 months
and are gradually progressing. The patient tried over-the-counter acetaminophen
without relief from the symptoms. A review of systems is positive for fatigue and
a low-grade fever. She denies rashes, oral ulcers, chest pain, and difficulty
breathing. On physical examination, she demonstrates synovitis of both knees
and metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints
bilaterally. X-rays of the hands do not show joint damage. Laboratory test results
,3|Page
for rheumatoid factor (RF), anti-CCP, and ANA are negative. What is the most
likely diagnosis? - correct-answer - Rheumatoid arthritis
Which of the following is the most likely presentation of new-onset rheumatoid
arthritis (RA)? - correct-answer - Symmetric polyarthritis of the hands, wrists, and
feet
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
, 4|Page
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 25-year-old woman presents with complaints of a facial rash that started a few
months ago and has worsened. She states that the rash is often itchy and worsens
when she goes out in the sun. In the last few days, she has noticed generalized
aches all over her body. She denies any trauma, allergies, or recent travel. She did
try several over-the-counter products, but nothing helped. The appearance of her
rash is shown in the image. Which of the following is the first-line drug in
managing her rash? - correct-answer - Hydroxychloroquine
