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MCQs on Rheumatology

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CASE SCENARIO ,,, A 32 year old nurse presents to your office with a complaint of intermittent episodes of pain, stiffness, and swelling in both hands and wrists for approximately 1 year. The episodes last for several weeks and then resolve. More recently, she noticed similar symptoms in her knee and ankles. Joint pain and stiffness are making it harder for her to get out of bed in the morning and are interfering with her ability to perform her duties at work. The joint stiffness usually last for several hours before improving. She also reports malaise and easy fatigability for the past few months, but she denies having fever, chills, skin rashes, and weight loss. Physical examination reveals a well-developed woman, with blood pressure 120/70 mmHg, heart rate 82 bpm, and respiratory rate 14 breaths per minute. Her skin does not reveal any rashes. Head, neck, cardiovascular, chest, and abdominal examinations are normal. There is no hepatosplenomegaly. The joint examination reveals the presence of bilateral swelling, redness and tenderness of most proximal interphalangeal (PIP) joints, metacarpophalangeal (MCP) joints, the wrists, and the knees. Laboratory studies show a mild anemia with hemoglobin 11.2 g/dl, hematocrit 32.5%, mean corpuscular volume (MCV) 85.7 fL, white blood cell (WBC) count 7.9/mm3 with a normal differential, and platelet count 300,000/mm3. The urinalysis is clear with no protein and no red blood cells (RBCs). The erythrocyte sedimentation rate (ESR) is 75 mm/h, and the kidney and liver function tests are normal.

• What is your most likely diagnosis?
• What is your next diagnostic step?

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MCQs on Rheumatology

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CASE SCENARIO ,,, A 48 year old man comes to your office complaining of severe right knee pain for 8 hours. He states that the pain, which started abruptly at 2 AM and woke him from sleep, was quite severe, so painful that even the weight of the bed sheets on his knee was unbearable. By the morning, the knee had become warm, swollen, and tender. He explains that he prefers to keep his knee bent, and extending his leg to straighten the knee causes the pain to worsen. He has never had pain, surgery, or injury to his knees. A year ago, he did have some pain and swelling at the base of his great toe on the left foot, which was not as severe as this episode, and resolved in 2 or 3 days after taking ibuprofen. His only medical history is hypertension, which is controlled with hydrochlorothiazide. He works as a financial analyst; he is married and does not smoke, but he does consume one or two drinks after work one to two times per week.
On examination, his temperature is 100.6F, heart rate 104 bpm, and blood pressure 136/78 mmHg. His head and neck examinations are unremarkable, his chest is clear, and his heart is tachycardic but regular, with no gallops or murmurs. His right knee is swollen, with a moderate effusion, and appears erythematous, warm, and very tender to palpation. He is unable to fully extend the knee because of pain. He has no other joint swelling, pain, or deformity, and no skin rashes.

• What is the most likely diagnosis?
• What is your next step?
• What is the best initial treatment?
   

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MCQs on Renal

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CASE SCENARIO ,,, A 48 year old Hispanic woman presents to your office complaining of persistent swelling of her feet and ankles, so much so that she cannot put on her shoes. She first noticed mild ankle swelling approximately 2-3 months ago. She borrowed a few diuretic pills from a friend; the pills seemed to help, but now she has run out. She also reports that she gained 20-25 lb over the last few months, despite regular exercise and trying to adhere to a healthy diet. Her medical history is significant for type 2 diabetes, for which she takes a sulfonylurea agent. She neither sees a doctor regularly nor monitors her blood glucose at home. She denies dysuria, urinary frequency, or urgency, but she does report that her urine has appeared foamy. She had no fever, joint pain, skin rashes, or gastrointestinal symptoms. Her physical examination is significant for mild periorbital edema, multiple hard exudates, and dot hemorrhages on funduscopic examination, and pitting edema of her hands, feet, and legs. Her chest is clear, her heart rhythm is regular without murmurs, and her abdominal examination is benign. She has diminished sensation to light touch in her feet and legs to mid-calf. A urine dipstick performed in the office shows 2+ glucose, 3+ protein, and negative leukocyte esterase, nitrates, and blood.

• What is the most likely diagnosis?
• What is the best intervention to slow the disease progression?

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MCQs on Renal

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CASE SCENARIO ,,, A 27 year old man presents to the outpatient clinic complaining of 2 days of facial and hand swelling. He first noticed swelling around his eyes 2 days ago, along with difficulty putting on his wedding ring because of swollen fingers. Additionally, he noticed that his urine appears reddish-brown and that he has had less urine output over the last several days. He has no significant medical history. His only medication is ibuprofen that he took 2 weeks ago for fever and sore throat, which have since resolved. On examination, he is afebrila, with heart rate 85 bpm and blood pressure 172/110 mmHg. He has periorbital edema: his funduscopic examination is normal without arteriovenous nicking or papilledema. His chest is clear to auscultation, his heart rhythm is regular with a nondisplaced point of maximal impulse (PMI), and he has no abdominal masses or bruits. He does have edema of his feet, hands, and face. A dipstick urinalysis in the clinic shows specific gravity of 1.025 with 3+ blood and 2+ protein, but it is otherwise negative.

• What is the most likely diagnosis?
• What is your next diagnostic step?

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MCQs on Renal

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MCQs on IBD

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