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Quiz for Students
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1

A 60-year-old female complains of dry mouth and a gritty sensation in her eyes. She states it is sometimes difficult to speak for more than a few minutes. There is no history of diabetes mellitus or neurologic disease. The patient is on no medications. On exam, the buccal mucosa appears dry and the salivary glands are enlarged bilaterally. The next step in evaluation is
A)Lip biopsy
B)Schirmer test and measurement of autoantibodies
C)IgG antibody to mumps virus
D)Use of corticosteroids
2

A 40-year-old male complains of exquisite pain and tenderness over the left ankle. There is no history of trauma. The patient is taking a mild diuretic for hypertension. On exam, the ankle is very swollen and tender. There are no other physical exam abnormalities. The next step in management is
A)Begin colchicine and broad-spectrum antibiotics
B)Obtain uric acid level and perform arthrocentesis
C)Begin allopurinol if uric acid level is elevated
D)Obtain ankle x-ray to rule out fracture
3

A 50-year-old male complains of low back pain and stiffness, which becomes worse on bending and is relieved by lying down. There are no symptoms of fever, chills, weight loss, or urinary problems. He has had similar pain several years ago. On exam, there is paraspinal tenderness and spasm of the lower lumbar back. There are no sensory deficits, and reflexes are normal. The next step in management is
A)Lumbosacral spine films
B)Stretching exercises
C)Weight training
D)Activity as tolerated, optional 2-day bedrest
E)MRI
4

A 60-year-old male complains of pain in both knees coming on gradually over the past 2 years. The pain is relieved by rest and worsened by the movement. There is bony enlargement of the knees with mild inflammation. Crepitation is noted on motion of the knee joint. There are no other findings except for bony enlargement at the distal interphalangeal joint. The patient is 5 feet 9 in. tall and weighs 190 lb. The best way to prevent disease progression is
A)Weight reduction
B)Calcium supplementation
C)Total knee replacement
D)Aspirin
E)Oral prednisone
5

A 22-year-old male develops the insidious onset of low back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, eye problems, or nail changes. On exam the patient has loss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. A plain film of the spine shows widening and sclerosis of the sacroiliac joints. Some calcification is noted in the anterior spinal ligament. Which of the following best characterizes this patient’s disease process?
A)He is most likely to have acute lumbosacral back strain and requires bed rest
B)The patient has a spondyloarthropathy, most likely ankylosing spondylitis
C)The patient is likely to die from pulmonary fibrosis and extrathoracic restrictive lung disease
D)A rheumatoid factor is likely to be positive
E)A colonoscopy is likely to show Crohn’s disease
6

A 20-year-old woman has developed low-grade fever, a malar rash, and arthralgias of the hands over several months. High titers of anti-DNA antibodies are noted, and complement levels are low. The patient’s white blood cell count is 3000/mL, and platelet count is 90,000/mL. The patient is on no medications and has no signs of active infection. Which of the following statements is correct?
A)If glomerulonephritis, severe thrombocytopenia, or hemolytic anemia develops, high-dose glucocorticoid therapy would be indicated
B)Central nervous system symptoms will occur within 10 years
C)The patient can be expected to develop Raynaud’s phenomenon when exposed to cold
D)The patient will have a false-positive test for syphilis
E)The disease process described is an absolute contraindication to pregnancy
7

A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, and difficulty swallowing solid food. The most useful test to make a definitive diagnosis is
A)Rheumatoid factor
B)Antinucleolar antibody
C)ECG
D)BUN and creatinine
8

A 20-year-old male complains of arthritis and eye irritation. He has a history of burning on urination. On exam, there is a joint effusion of the right knee and a dermatitis of the glans penis. Which of the following is correct?
A)Neisseria gonorrhoeae is likely to be cultured from the glans penis
B)The patient is likely to be rheumatoid factor positive
C)An infectious process of the GI tract may precipitate this disease
D)An ANA is very likely to be positive
9

A 35-year-old woman complains of aching all over. She says she sleeps poorly and all her joints hurt. Symptoms have progressed over several years. Physical exam shows multiple points of tenderness over the neck, shoulders, elbows, and wrists. There is no joint swelling or deformity. A complete blood count and erythrocyte sedimentation rate are normal. Rheumatoid factor is negative. There is no tenderness over the median third of the clavicle, the medial malleolus, or the forehead. The best therapeutic option in this patient is
A)Amitriptyline at night
B)Prednisone
C)Aspirin and methotrexate
D)Plaquenil
10

A 70-year-old female with mild dementia complains of hip pain. There is some limitation of motion in the right hip. The first step in evaluation is
A)CBC and erythrocyte sedimentation rate
B)Rheumatoid factor
C)X-ray of right hip
D)Bone scan
11

A 65-year-old woman who has a 12-year history of symmetrical polyarthritis is admitted to the hospital. Physical examination reveals splenomegaly, ulcerations over the lateral malleoli, and synovitis of the wrists, shoulders, and knees. There is no hepatomegaly. Laboratory values demonstrate a white blood cell count of 2500/mL and a rheumatoid factor titer of 1:4096. This patient’s white blood cell differential count is likely to reveal
A)Pancytopenia
B)Lymphopenia
C)Granulocytopenia
D)Lymphocytosis
E)Basophilia
12

A 50-year-old white female presents with aching and stiffness in the trunk, hip, and shoulders. There is widespread muscle pain after mild exertion. Symptoms are worse in the morning and improve during the day. They are also worsened by stress. The patient is always tired and exhausted. She has trouble sleeping at night. On exam, joints are normal but there are multiple points of tenderness over the occiput, neck, lateral epicondyle, and medial fat pad of the knee. ESR is normal, and there is no history of Lyme disease or HIV disease exposure. A definitive diagnosis is best made by
A)Trial of glucocorticoids
B)Muscle biopsy
C)Demonstration of 11 tender points
D)Psychiatric evaluation
13

A 35-year-old construction worker presents with complaints of nocturnal parasthesias of the thumb and the index and middle fingers. There is some atrophy of the thenar eminence. Tinel sign is positive. The most likely diagnosis is
A)Carpal tunnel syndrome
B)De Quervain’s tenosynovitis
C)Amyotrophic lateral sclerosis
D)Rheumatoid arthritis of the wrist joint
14

A 20-year-old female develops urticaria that lasts for 6 weeks and then resolves spontaneously. She gives no history of weight loss, fever, rash, or tremulousness. Physical exam shows no abnormalities. The most likely cause of the urticaria is
A)Connective tissue disease
B)Hyperthyroidism
C)Chronic infection
D)Not likely to be determined
15

A 20-year-old male is found to have weight loss and generalized lymphadenopathy. He has hypogammaglobulinemia with a normal distribution of immunoglobulin isotypes. Histologic exam of lymphoid tissue shows germinal center hyperplasia. A diagnosis of common variable immunodeficiency is made. Which of the following is correct?
A)The patient likely had symptoms in childhood
B)At least one parent is also afflicted with the disease
C)The patient may develop recurrent bronchitis and chronic idiopathic diarrhea
D)The patient should receive the standard vaccine protocol
16

A 25-year-old female complains of watery rhinorrhea and pruritus of the eyes and nose that occurs around the same season each year. Symptoms are not exacerbated by weather changes, emotion, or irritants. She is on no medications and is not pregnant. Which of the following statements is correct?
A)In this patient, symptoms are being produced by an IgE antibody against a specific allergen
B)The patient has vasomotor rhinitis
C)The patient’s nasal turbinates are likely to be very red
D)Avoidance measures alone are almost always effective
17

A 20-year-old nursing student complains of asthma while on her surgical rotation. She has developed dermatitis of her hands. Symptoms are worsened when she is in the operating room. Which of the following is correct?
A)This is an allergic reaction that is always benign
B)The patient should be evaluated for latex allergy by skin testing or demonstration of specific IgE antibody
C)This syndrome is less common now than 10 years ago
D)Oral corticosteroid is indicated
18

A 40-year-old white woman with a history of chronic otitis and sinusitis is found to have a serum IgA level of 1 mg/dL. All other immunoglobulin classes are found to be normal. Which of the following statements is correct?
A)She may suffer an anaphylactic reaction following the administration of serum products
B)Clinical improvement follows regular infusions of fresh plasma
C)Infection with Giardia should suggest a different diagnosis
D)The disease is more common in blacks and Asians than it is in whites
E)An associated autoimmune disorder would be very rare
19

A 55-year-old farmer develops recurrent cough, dyspnea, fever, and myalgia several hours after entering his barn. Which of the following statements is true?
A)Testing of pulmonary function several hours after an exposure will most likely reveal an obstructive pattern
B)Immediate-type IgE hypersensitivity is involved in the pathogenesis of his illness
C)The etiological agents may well be thermophilic actinomycete antigens
D)Demonstrating precipitable antibodies to the offending antigen confirms the diagnosis of hypersensitivity pneumonitis
20

A 35-year-old woman is concerned that she may be allergic to some foods. She believes that she gets a rash several hours after eating small amounts of peanuts. In evaluating this concern, which of the following is correct?
A)At least 30% of the adult population is allergic to some food substance
B)Symptoms occur hours after ingestion of the food substance
C)The foods most likely to cause allergic reactions include egg, milk, seafood, nuts, and soybeans
D)The organ systems most frequently involved in allergic reactions to foods in adults are the respiratory and cardiovascular systems
E)Immunotherapy is a proven therapy for food allergies
21

A 32-year-old woman experiences a severe anaphylactic reaction following a sting from a hornet. Which of the following statements is correct?
A)She would not have a similar reaction to a sting from a yellow jacket
B)She would have a prior history of an adverse reaction to an insect sting
C)Adults are unlikely to die as a result of an insect sting compared to children with the same history
D)She should be skin-tested with venom antigens and, if positive, immunotherapy should be started







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