Musculoskeletal/Rheum - Primary Care Questions and answers 100% VERIFIED,2024

A 75 year-old female presents with complaints of stiffness, aching, and pain in the muscles of her neck, shoulders, lower back, hips, and thighs. There is no associated weakness associated with the stiffness and achiness. Laboratory evaluation shows an elevated C reactive protein and erythrocyte sedimentation rate. Which of the following medications is used to treat this condition immediately and will also serve to prevent a known complication from this disorder? Methotrexate (Rheumatrex) Azathioprine (Imuran) Cyclophosphamide (Cytoxan) Glucocorticoids - Glucocorticoids A 51- year-old man recently underwent a physical examination during which you obtained a routine chemistry profile. All values were normal except for a serum uric acid of 7.5 mg /dL. He has no history of gouty arthritis, renal disease, or urolithiasis. The most appropriate management of this problem would be to: Begin Probenecid therapy to prevent renal stone formation Initiate therapy with Allopurinol to prevent urate nephropathy Follow the patient expectantly without pharmacologic intervention Treat the patient with prophylactic indomethacin to prevent gout None of the above - Follow the patient expectantly without pharmacologic intervention A 52 year-old male presents with a severely painful, swollen right great toe. He denies recent trauma, but reports several similar episodes of toe pain and swelling over the past two to three years. He has a history of alcohol abuse and hypertension, for which he "takes medication" of unknown type. Examination reveals bright erythema and edema associated with the right first MCP joint. Which of the patient's antihypertensive medications may be contributing to this condition? Hydrochlorothiazide (HCTZ) Lisinopril (Prinivil) Metoprolol (Lopressor) Diltiazem (Cardizem) - Hydrochlorothiazide (HCTZ) Disease-modifying antirheumatic drugs(DMARDS) include all of the following EXCEPT? Hydroxychloroquine NSAID's Methrotrexate Sulfasalazine D-penicillamine - NSAID's A 56 year-old white post-menopausal female had a recent surveillance DEXA bone densitometry. The T-score is -2.7 for her right hip. In counseling this patient, in addition to medications, which of the following would you recommend? Weight bearing exercises Daily red wine consumption Limit sun exposure Water aerobics - Weight bearing exercises Which of the following medications is the initial treatment of choice for suppressing the progression of rheumatoid arthritis (RA)? Gold salts Methotrexate (Rheumatrex) Prednisone Naproxen sodium (Naprosyn) - Methotrexate (Rheumatrex) A 34 year-old female, with a past medical history of irritable bowel syndrome and migraines, presents with fatigue, generalized aching and stiffness of the trunk, hip, and shoulder girdles. She complains of pain and tightness in the neck and across the upper posterior shoulders. She complains of poor sleep, but denies depression. Physical examination is unremarkable except for numerous tender points on palpation. Laboratory evaluation was unremarkable. Which of the following is the best intervention for this patient? Corticosteroids Supervised exercise program Hydrocodone (Vicodin) Refer to endocrinologist - Supervised exercise program What is the first DOC for the suppression of inflammation in a patient with RA? Hydroxychloroquine Oral prednisone NSAID's D-penicillamine Methotrexate - NSAID's A 70-year-old man with renal insufficiency and recurrent attacks of proven gouty arthritis has elevated serum and urine uric acid levels. He is now asymptomatic. The most appropriate approach is Chronic allopurinol Chronic celecoxib Chronic probenecid Chronic colchicine No chronic therapy - Chronic allopurinol An elderly woman slipped in her driveway, injuring her right wrist. Radiographs show a Colles fracture. Before sending the patient to orthopedics, intervention should include immobilization with which splint Volar Ulnar gutter Thumb spica Cock up - Volar An otherwise healthy 12-year-old patient presents for a preparticipation sports PE. On PE, the patient has a spinal curve abnormality with marked elevation of the right scapula and a right thoracic hump. Results of spinal films indicate a 25 degree curvature. Which is the most important plan for treatment? Monitor the patient every 3 months until menarche Send the patient for aggressive PT Refer the patient to a chiropractor for therapy Refer the patient for evaluation by an orthopedic surgeon - Refer the patient for evaluation by an orthopedic surgeon A 20 year old female fell off of her mountain bike at Markham Park and presents to your urgent care center for evaluation later that day. She notes that she fell "over the handlebars" and tried to "catch" herself with outstretched arms. She has terrible pain in the left wrist and is in obvious distress. There is swelling and she doesn't let you move it without a fight. Pain is primarily on the radial aspect of the wrist and she has exquisite snuff box tenderness on deep palpation. There are no fractures on the A/P and oblique x-rays of her wrist (and you remember to get comparison of the good right wrist also). The next step in treatment would be which of the following? Long arm splint with repeat radiographs in 10-12 days of the left wrist Arm sling and instructions for early motion physical therapy to avoid stiffness Thumb spica slint of left wrist & referral to orthopedist MRI of the wrist CT scan of the wr - Thumb spica slint of left wrist & referral to orthopedist The wife of a 52 year old steelworker, who is a regular patient with chronic low back pain, calls the office in a panic. The patient has suddenly developed "saddle" distribution numbness, and urinary bladder incontinence after bending over to pick up a bundle of branches from the yard. You instruct her to call an ambulance or have him transported to the local emergency room immediately. You next step would be which of the following? Arrange for hospital admission and a urology consult. Call in orders for admission to the floor for low back traction, muscle relaxers, and analgesic medication.