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 stiffness. Examination of the knees reveals no deformity, but there are small effusions. Some mild pain and crepitus is produced with palpation of the medial aspect of the knees. Which of the following is the most likely diagnosis?
320. Which of the following statements is true regarding Libman-Sacks endocarditis?
a. Aortic insufficiency is often a sequela b. Mitral valve insufficiency is often a sequela c. It only affects the tricuspid valve d. It may be a source for cerebral emboli e. It is not associated with antiphos-pholipid antibody syndrome f. It is a bacterial endocarditis
321. A 17-month-old boy has a history of multiple fractures due to "brittle bones." The child is short in stature and has a deformed skull. Physical examination is normal except for the finding of blue scle-rae. Which of the following is the most likely diagnosis?
a. Osteoporosis b. Achondroplasia c. Osteomalacia d. Osteitis deformans e. Osteogenesis imperfecta
322. A 34-year-old woman has a 15-year history of Crohn's disease. She presents to your office with the acute onset of right ankle and left knee pain. She recalls a worsening of her gastrointestinal symptoms a few days before the joint symptoms developed. Radiographs of the knee and ankle demonstrate soft tissue swelling and small effusions but no bone destruction. Which of the following statements is true?
a. The patient is not HLA-B27 positive b. The patient is experiencing the most common extraintestinal manifestation of inflammatory bowel disease c. Controlling the intestinal symptoms will eliminate the knee and ankle arthritis d. The patient will go on to develop bone erosion and destruction of the knee and ankle e. The patient requires high-dose nonsteroidal anti-inflammatory drugs (NSAIDS)
323. Which of the following cardiac disorders may be seen in patients with ankylosing spondylitis?
a. Aortic stenosis b. Aortic insufficiency c. Tricuspid insufficiency d. Mitral stenosis e. Mitral regurgitation f. Pulmonic stenosis
324. A 25-year-old man presents with morning back pain and stiffness and tenderness over the sacroiliac joints. The patient denies any previous history of eye or genitourinary problems. On physical examination, there is diminished chest expansion with breathing. Which of the following is the most likely diagnosis?
a. Rheumatoid arthritis b. Ankylosing spondylitis c. Sjögren syndrome d. Systemic lupus erythematosus e. Reiter syndrome
325. A 28-year-old woman presents with her third episode of left lower extremity deep venous thrombosis. She has a history of two second-trimester miscarriages in the past. Laboratory data reveals an elevated activated partial throm-boplastin time (PTT) that is not corrected by dilution with normal plasma and an abnormal dilute Russell's viper venom. Which of the following is the most likely diagnosis?
a. Libman-Sacks disease b. Livedo reticularis c. Antiphospholipid syndrome d. Takayasu's arteritis e. Sjögren syndrome
326. A 61-year-old woman with a 10-year history of rheumatoid arthritis presents with painful swelling at the back of the knee that is visible on physical examination only when the knee is extended. Which of the following is the most likely diagnosis?
a. Anserine bursitis b. Baker's cyst c. Deep venous thrombosis d. Prepatellar bursitis e. Infrapatellar bursitis
327. A 28-year-old law student complains of blanching and cyanosis of her fingertips in cold weather and in times of emotional stress. She complains that her fingers become numb and painful during these episodes. She has a 6-mo history of dysphagia and arthralgias. She does not smoke or take any medications. On physical examination, the skin of her hands appears to be taut and atrophic with a flexion deformity from the tight skin (sclerodactyly). Which of the following is the most likely diagnosis?
a. Rheumatoid arthritis b. Progressive systemic sclerosis c. Dermatomyositis d. Ulcerative colitis e. Sarcoidosis
328. A 9-year-old girl with no past medical history presents with the acute onset of fever, arthralgias, abdominal pain, hematochezia, and hematuria. Physical examination reveals purpura on the patient's lower extremities bilaterally. Which of the following is the most likely diagnosis?
a. Cryoglobulinemia b. Kawasaki's disease c. Wegener's granulomatosis d. Goodpasture's disease e. Henoch-Schonlein purpura
329. A 49-year-old man presents with painful, recurring episodes of swelling in his left great toe. He takes 25 mg of hydrochlorothiazide daily for blood pressure control but otherwise is in good health. On physical examination, the patient is afebrile but his great toe is warm, swollen, erythematous, and exquisitely tender to palpation. He has several subcutaneous nodules in his pinna. Which of the following is the most likely diagnosis?
a. Calcium pyrophosphate dihydrate deposition disease b. Calcium oxalate deposition disease c. Monosodium urate deposition disease d. Calcium phosphate deposition disease e. Osteoarthritis of the great toe
330. A 41-year-old music teacher presents with a 10-mo history of prolonged morning stiffness accompanied by swelling of her wrists and the proximal interpha-langeal joints of both hands. Now she feels that her knees are also swollen and painful. Physical examination reveals synovial tenderness and swelling of her knees, wrists, and proximal interpha-langeal joints. She has subcutaneous nodules in the extensor area of her right forearm. The right knee has a positive bulge sign consistent with an effusion. Which of the following is the most likely diagnosis?
a. Osteoarthritis b. Rheumatoid arthritis c. Septic arthritis d. Chondrocalcinosis e. Scleroderma
331. A 43-year-old man presents with fever and arthritis. During the past 2 mo, he has been treated four times for a maxillary sinus infection. He also complains of the recent onset of hematuria. Which of the following is the most likely diagnosis?
a. Churg-Strauss syndrome b. Wegener's granulomatosis c. Lofgren syndrome d. Sjogren syndrome e. Sarcoidosis
332. A 31-year-old man presents with fever and arthralgias for 1 day. He complains of diffuse abdominal pain and inability to move his left foot due to weakness. He also states he has had hematuria for several hours. On physical examination, the patient has a temperature of 101.2°F He has diffuse abdominal tenderness on palpation but has no rebound tenderness. Testicular exam reveals marked tenderness of the testes but no urethral discharge. Neurologic examination reveals a left footdrop. Which of the following is the most likely diagnosis?
a. Polyarteritis nodosa b. Behcet syndrome c. Whipple's disease d. Osteonecrosis
333. Which of the following fulfills 1 of the 11 criteria for systemic lupus erythematosus (as published by the American College of Rheumatology)?
a. Alopecia b. Oral ulcers c. Arthralgias d. Erosive arthritis e. Photophobia f. Anemia of chronic disease
334. A 44-year-old woman presents with diffuse myalgias and excessive fatigue. She has morning stiffness and pain of all her joints, especially her wrists, elbows, shoulders, hips, knees, and neck. She does not sleep well at night. Her symptoms have been progressing for over 4 years. On physical examination, the patient has 13 tender points at the elbows, knees, shoulders, and hips. Which of the following is the most likely diagnosis?
a. Polymyalgia rheumatica b. Fibromyalgia syndrome c. Rheumatoid arthritis d. Scleroderma e. Polymyositis
DIRECTIONS: Each set of matching items in this section consists of a list of lettered options followed by several numbered items. For each numbered item, select the appropriate lettered option(s). Each lettered option may be selected once, more than once, or not at all. Each item will state the number of options to select. Choose exactly this number.
Was this article helpful?