Rheumatoid nodules

Arthritis of more than three joint areas 5. Involvement of the joints of the hands and wrists patients may have swan-neck deformity (hyperextension of the proximal interphalangeal joints with compensatory flexion of the distal joint), boutonni re deformity (extension of the distal interphalangeal joint), and ulnar deviation of the digits 6. A positive rheumatoid factor (RF) 7. Erosions or decalcification on radiographs 331. The answer is b. (Fauci, 14 e, pp 1901-1903, 1914-1917, 1924.)...

Answers

The answer is b. (Tierney, 39 e, pp 1130-1133.) Cushing syndrome occurs secondary to corticosteroid use, nonpituitary neoplasms (i.e., small cell carcinoma of the lung), adrenal adenomas, adrenal carcinomas, and bilateral adrenal nodular hyperplasia. Cushing's disease is hypercortisolism due to ACTH hypersecretion by the pituitary gland, usually because of a small (< 1 cm), benign pituitary microadenoma. Symptoms include central obesity, striae, hirsutism, easy bruisability, proximal...

Infectious Diseases

The answer is d. (Tintinalli, 5 e, pp 943-946.) The patient has gono-coccal urethritis (gram stain is a sensitive and specific method of making the diagnosis) and concomitant Chlamydia trachomatis infection. Patients require treatment for the gonococcal infection (usually ceftriaxone intramuscularly) and doxycycline or a macrolide for eradication of the chla-mydial infection. Gonococcal resistance to penicillin and tetracycline (but not to ceftriaxone) has developed. Patients with...

Can Compressed L5 S1 Disk Cause Petechiae

The answer is b. (Mehta, pp 173-190.) Lower back pain is a very common complaint. The differential diagnosis includes soft tissue problems (muscles and ligaments), disk problems (prolapse), facet problems (degenerative joint disease), spinal canal disease (spinal stenosis), and vertebral body diseases (osteoporosis causing a compression fracture, infection, metastatic disease, spondylolisthesis). Patients with disk herniation at L5-S1 may present with S1 nerve root compression (the...

Rheumatology

The answer is d. (Mehta, pp 313-316. Fauci, 14 e, pp 1935-1938.) Osteoarthritis most often affects the weight-bearing joints and is associated with obesity or other forms of mechanical stress. It has no systemic manifestations. It is more common in women and onset is usually after the age of 50. Pain often occurs on exertion and is relieved with rest, after which the joint may become stiff. Distal interphalangeal joints may be involved with the production of Heberden nodes. Bouchard nodes...

Info

A 45-year-old swimmer presents with a sore right shoulder for nearly 2 mo. He was taking non-steroidal anti-inflammatory agents throughout this period with minimal relief. Over the last several days, he has developed pain with elevation of his arm above the horizontal and has some loss of passive motion in external rotation and with abduction. The pain is relieved after you inject 2 ml of lidocaine into the sub-acromial space. Which of the following is the most likely diagnosis a. Fracture...

Questions

DIRECTIONS Each of the numbered items or incomplete statements in this section is followed by answers or by completion of the statements. Select the one lettered answer or completion that is best in each case. 319. A 60-year-old, mildly obese woman presents complaining of bilateral medial right knee pain that occurs with prolonged standing. The pain does not occur with sitting or climbing stairs but seems to be worse with other activity and at the end of the day. The patient denies morning...