Musculoskeletal Flashcards
A 45-year-old woman comes to her primary care physician for evaluation of joint pain and stiffness. Her symptoms are most prominent in the hands, worse in the morning and gradually improve after two-hours of physical activity. In addition, she complains of malaise and decreased appetite for the past several months. The patient has a 40-pack-year smoking history. Vitals are within normal limits. Physical examination reveals swelling of the bilateral proximal interphalangeal joints. Ulnar deviation is observed at the bilateral metacarpophalangeal joints. Serology testing is notable for elevated anti-cyclic citrullinated peptide antibodies. Which of the following is the most common cause of mortality in patients with this condition?
1. Kidney failure
2. cardiovascular disease
3. spinal cord compression
4. septic shock
5. Pulmonary fibrosis
cardiovascular disease
A 55-year-old woman comes to her outpatient provider for evaluation of joint pain and stiffness. The symptoms are most prominent in the hands, worse in the morning, and gradually improve with activity. In addition, the patient reports feeling tired in the morning despite getting more than eight-hours of sleep each night. Vitals are within normal limits. Physical examination reveals mild deformation of the bilateral metacarpophalangeal and proximal interphalangeal joints. The patient is prescribed a disease modifying anti-rheumatic drug. She is warned about its side effects, which include hepatotoxicity, stomatitis, and pulmonary fibrosis. Which of the following best describes the mechanism of action of the prescribed medication?
1. inhibition of intracellular NF-KB pathway
2. Inhibition of tumor necrosis factor
3. Inhibition of dihydrofolate reductase
4. Inhibition of thymidylate synthase
5. Inhibition of cyclooxygenase enzymes
Inhibition of dihydrofolate reductase
A 50-year-old woman comes to her primary care physician because of progressively worsening pain, stiffness, and swelling in her joints. The patient endorses morning stiffness that improves after about two hours. In addition, she reports generalized fatigue despite getting adequate rest each evening. She has tried ibuprofen and acetaminophen for the pain, but neither was effective in improving her symptoms. Social history is notable for a 30-pack-year smoking history. Serology testing is positive for antinuclear and anti-cyclic citrullinated peptide antibodies. Which of the following joints will most likely be affected in this patient?
1. metacarpophalangeal joint
2. shoulder joint
3. hip joint
4. distal interphalangeal joint
5. sacroiliac joint
Metacarpophalangeal joint
A 52-year-old woman comes to her primary care physician because of joint pain and stiffness. Her symptoms are worse in the morning and subsequently improve after two-hours of physical activity. Past medical history is notable for type 2 diabetes mellitus, for which she is currently taking metformin. She has a 40-pack-year smoking history and currently smokes half-a-pack of cigarettes daily. The patient lives in rural Maryland and recalls several insect bites while hiking a few weeks ago. Vitals are within normal limits. Physical examination is notable for swelling and pain on passive motion in the bilateral metacarpophalangeal, wrist, and metatarsophalangeal joints. Which of the following best describes the cause of this patient’s condition?
1. Deposition of uric acid in the joint space
2. inflammatory damage of the muscles
3. autoimmune inflammation and destruction of the joints
4. degenerative disorder of the joint articular cartilage
5. infection by tick-transmitted spirochete
autoimmune inflammation and destruction of the joints
A 40-year-old woman comes to her outpatient provider for evaluation of joint pain and stiffness. Her symptoms began 7 months ago. She reports that the symptoms are worse in the morning and improve after about two-hours of physical activity. In addition, the patient describes feeling tired in the morning despite getting over eight hours of sleep each night. She has had no sensation of dry eyes. Temperature is 37.6°C (99.7°F), blood pressure is 140/83 mmHg, and BMI is 29 kg/m2. Physical examination is notable for swelling and pain on passive motion of the bilateral proximal interphalangeal and metacarpophalangeal joints. No rash is observed on the patient’s body. The remainder of the examination is noncontributory. Which of the following antibodies is most specific to her condition?
1. anti-double stranded DNA antibody
2. Rheumatoid factor
3. Anti-Ro antibody
4. Antinuclear antibody
5. anti-cyclic citrullinated peptide antibody
anti-cyclic citrullinated peptide antibody
Radiography of a patient with psoriatic arthritis reveals an asymmetric “pencil-in-cup” deformity in the (distal/proximal) interphalangeal joints of the fingers.
distal
Radiography of a patient with _________ arthritis reveals an asymmetric “pencil-in-cup” deformity in the distal interphalangeal joints of the fingers.
psoriatic
The medication, ________, is a pyrimidine synthesis inhibitor indicated in the treatment of rheumatoid arthritis and psoriatic arthritis.
leflunomide
Like other seronegative arthropathies, psoriatic arthritis is associated with HLA- _____.
B27
________ arthritis is a seronegative spondyloarthropathy seen in about ten percent of patients with psoriasis.
psoriatic
_______ arthritis is a seronegative spondyloarthropathy that involves irregular joint pain and stiffness associated with psoriasis and fingernail lesions.
psoriatic
Psoriatic arthritis is typically (more/less) severe than rheumatoid arthritis.
less
Finding dactylitis can help with the diagnosis of _______ arthritis in patients with a history of scaly papules and plaques on their skin.
psoriatic
________ arthritis is a seronegative spondyloarthropathy that involves dactylitis at the distal interphalangeal joints of the hands and feet.
psoriatic
