IM Rosh Qs Ortho UPDATED ACTUAL Questions and CORRECT
Answers
1. A 48-year-old woman presents to the clinic with insid- polyarteritis nodosa
ious onset of fever, fatigue, decreased appetite, and
generalized weakness and pain in the extremities de-
veloping over weeks to months. Skin findings include
ulcerations and subcutaneous nodules on both lower
legs. An arterial medium-vessel biopsy shows necrotiz-
ing arteritis. Which of the following is the most likely
diagnosis?
2. A 52-year-old man presents to a primary care provider gouty arthritis
for severe joint pain in his great toe. He reports an
acute onset of pain yesterday and denies any injury
or trauma. He has had several similar presentations
intermittently throughout the past two decades. Vital
signs are T 38.1°C, BP 122/72 mm Hg, HR 86 bpm,
RR 18 breaths per minute, and pulse oximetry 99% on
room air. Physical examination reveals a great toe that
is swollen and erythematous and exquisitely tender
and warm to the touch. His WBC count is 14,600/mcL,
and his uric acid level is 5.9 mg/dL. A radiograph of his
toes is shown above. Which of the following is the most
likely diagnosis?
3. A 35-year-old woman presents to her primary care cyclophosphamide
provider for a one-week history of dark urine. She has a
past medical history of systemic lupus erythematosus
but is not currently on medication due to a lapse in in-
surance. Her blood pressure is 165/105 mm Hg. Urine
dipstick reveals 2+ protein and hematuria. Lab tests
reveal low complement protein and azotemia. The pa-
tient is started on prednisone. What other medication
, is indicated for the treatment of this complication of
systemic lupus erythematosus?
4. A 63-year-old woman presents to the emergency de- oral CCS treatment
partment for an initial presentation of a moderately
severe temporal headache, scalp tenderness, and pain GCA
with chewing for six days. She has no change to her
vision. She has a history of polymyalgia rheumatica
with specific symptoms of neck and shoulder stiffness.
Lab results indicate an elevated erythrocyte sedimen-
tation rate and C-reactive protein. Imaging studies are
pending. Which of the following is the first priority in
caring for this patient, even before the diagnosis is
confirmed?
5. A 56-year-old man presents to the emergency depart- purine
ment for an acute flare-up of gout to his right great
toe. He is currently taking allopurinol and has not had
a flare-up of gout in over two years. He recently went
on a cruise that had an all-you-can-eat buffet for all
three meals each day. Patients with gout should avoid
consuming foods containing which of the following
elements?
6. A 52-year-old woman presents to a primary care mononuclear cell infiltra-
provider with photosensitivity, foreign body sensation, tion
and eye fatigue bilaterally. She also reports a sore
tongue and dry, peeling lips. A Schirmer test and rose Sjogrens
bengal stain are positive in both eyes. What is the most
likely finding on salivary gland biopsy?
7. A 55-year-old woman presents with worsening dry
eyes over the past 6 months. She has tried using arti-
Answers
1. A 48-year-old woman presents to the clinic with insid- polyarteritis nodosa
ious onset of fever, fatigue, decreased appetite, and
generalized weakness and pain in the extremities de-
veloping over weeks to months. Skin findings include
ulcerations and subcutaneous nodules on both lower
legs. An arterial medium-vessel biopsy shows necrotiz-
ing arteritis. Which of the following is the most likely
diagnosis?
2. A 52-year-old man presents to a primary care provider gouty arthritis
for severe joint pain in his great toe. He reports an
acute onset of pain yesterday and denies any injury
or trauma. He has had several similar presentations
intermittently throughout the past two decades. Vital
signs are T 38.1°C, BP 122/72 mm Hg, HR 86 bpm,
RR 18 breaths per minute, and pulse oximetry 99% on
room air. Physical examination reveals a great toe that
is swollen and erythematous and exquisitely tender
and warm to the touch. His WBC count is 14,600/mcL,
and his uric acid level is 5.9 mg/dL. A radiograph of his
toes is shown above. Which of the following is the most
likely diagnosis?
3. A 35-year-old woman presents to her primary care cyclophosphamide
provider for a one-week history of dark urine. She has a
past medical history of systemic lupus erythematosus
but is not currently on medication due to a lapse in in-
surance. Her blood pressure is 165/105 mm Hg. Urine
dipstick reveals 2+ protein and hematuria. Lab tests
reveal low complement protein and azotemia. The pa-
tient is started on prednisone. What other medication
, is indicated for the treatment of this complication of
systemic lupus erythematosus?
4. A 63-year-old woman presents to the emergency de- oral CCS treatment
partment for an initial presentation of a moderately
severe temporal headache, scalp tenderness, and pain GCA
with chewing for six days. She has no change to her
vision. She has a history of polymyalgia rheumatica
with specific symptoms of neck and shoulder stiffness.
Lab results indicate an elevated erythrocyte sedimen-
tation rate and C-reactive protein. Imaging studies are
pending. Which of the following is the first priority in
caring for this patient, even before the diagnosis is
confirmed?
5. A 56-year-old man presents to the emergency depart- purine
ment for an acute flare-up of gout to his right great
toe. He is currently taking allopurinol and has not had
a flare-up of gout in over two years. He recently went
on a cruise that had an all-you-can-eat buffet for all
three meals each day. Patients with gout should avoid
consuming foods containing which of the following
elements?
6. A 52-year-old woman presents to a primary care mononuclear cell infiltra-
provider with photosensitivity, foreign body sensation, tion
and eye fatigue bilaterally. She also reports a sore
tongue and dry, peeling lips. A Schirmer test and rose Sjogrens
bengal stain are positive in both eyes. What is the most
likely finding on salivary gland biopsy?
7. A 55-year-old woman presents with worsening dry
eyes over the past 6 months. She has tried using arti-
