MSN 622 Week 5 – Rheumatoid () Questions
and Verified Answers, 100% Guarantee Pass
A 72-year-old man presents to the clinic for pre-operative evaluation. The patient says he is
feeling well, remembers many years ago, was diagnosed with some joint condition, and was
advised to take medications for which he would have to do blood tests regularly. He was not
interested in doing regular blood tests and seeing a clinician regularly; hence he never took
treatment for the disease. On examination, he has bilateral ulnar deviation and subluxation of
the metacarpophalangeal (MCP) joints. Hand X-ray shows erosions of MCP and proximal
interphalangeal (PIP) joints. Rheumatoid factor (RF) and anti-CCP antibodies are positive. Which
of the following is the next best step in managing this patient? - CORRECT ANSWER -Cervical
spine radiographs
A 47-year-old woman presents to the clinic with swelling in both knees, morning stiffness lasting
more than an hour, and pain with walking. Further history reveals bilateral hand and wrist pain.
These symptoms have been present for about three months and have gradually progressed. The
patient has tried over-the-counter acetaminophen without relief from the symptoms. For the
past couple of months, she has felt tired and had a low-grade fever. She denies rashes, oral
ulcers, chest pain, and difficulty breathing. On examinations, she has synovitis of both knees,
metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints bilaterally. X-rays of the
hands do not show joint damage. Lab results for rheumatoid factor (RF), anti-CCP, and ANA are
negative. What is the most likely diagnosis? - CORRECT ANSWER -Rheumatoid arthritis
A 54-year-old man with a history of rheumatoid arthritis presents to the clinic for a regular
follow-up appointment. He has remained stable on methotrexate 15 mg every week, folic acid 1
mg daily, and etanercept 50 mg every week. His examination is unremarkable, with no joint
tenderness or swelling. Routine labs are within normal limits. The patient does mention some
pain along his spine. Involvement of which of the following spinal segments is associated with
the worst morbidity in this patient? - CORRECT ANSWER -Cervical spine
A 54-year-old female presented for evaluation at the outpatient clinic. She was diagnosed with
rheumatoid arthritis two years ago. She has been closely followed up and found to have low-
level disease activity. Currently, she is managed with NSAIDs and has never received disease-
modifying antirheumatic drugs (DMARDs). In patients with established disease, the American
, College of Rheumatology recommends what type of treatment? - CORRECT ANSWER -Start
monotherapy with a DMARD
A 65-year-old female patient complains of joint stiffness and swelling in both hands. The
stiffness worsens upon waking up in the morning and gradually improves after two to three
hours. She further reports having had more trouble opening her pill bottles in the past few
weeks. Which one of the following is going to be the most specific for reaching a diagnosis in
this patient? - CORRECT ANSWER -Anti-citrullinated protein antibodies (ACPA)
32-year-old woman presents to the healthcare provider with six months of fatigue. She also
reports joint pains, chest pain, and a 3 kg weight loss ever since the fatigue started. She denies
recent travel, fever, or new sexual partners. She has no past medical history and takes no
medications. She is sexually active with her husband of five years. Her mother has rheumatoid
arthritis. Vitals include a blood pressure of 123/80 mmHg, a heart rate of 81/min, a respiratory
rate of 18/min, and oxygen saturation of 99% on room air. On examination, she has a rash over
her nose and an ulcer on her hard palate. The chest examination reveals decreased air entry in
her right lung base. Her abdomen is soft, and there is no hepatosplenomegaly. Neurological
examination is within normal limits. Which of the following antibody titers most likely correlates
with the disease activity in this patient? - CORRECT ANSWER -Anti-double-stranded DNA
antibodies
A 24-year-old woman presents with diffuse aching and stiffness, worsened by cold weather and
stress. Her history is significant for Lyme disease 2 years ago treated with doxycycline 100 mg
twice a day for 4 weeks. Her joints show no tenderness or synovitis, but she is tender over
points bilaterally at the occiput, trapezius, lateral epicondyle, gluteals, and knee. What is the
most probable diagnosis? - CORRECT ANSWER -Fibromyalgia
30-year-old woman presents with widespread musculoskeletal pain, which is bilateral and
involves both upper and lower parts of the body for the past 4 months. She has normal
laboratory findings, and imaging studies are unremarkable. Which of the following is a first-line
medication used to treat this condition? - CORRECT ANSWER -Duloxetine
and Verified Answers, 100% Guarantee Pass
A 72-year-old man presents to the clinic for pre-operative evaluation. The patient says he is
feeling well, remembers many years ago, was diagnosed with some joint condition, and was
advised to take medications for which he would have to do blood tests regularly. He was not
interested in doing regular blood tests and seeing a clinician regularly; hence he never took
treatment for the disease. On examination, he has bilateral ulnar deviation and subluxation of
the metacarpophalangeal (MCP) joints. Hand X-ray shows erosions of MCP and proximal
interphalangeal (PIP) joints. Rheumatoid factor (RF) and anti-CCP antibodies are positive. Which
of the following is the next best step in managing this patient? - CORRECT ANSWER -Cervical
spine radiographs
A 47-year-old woman presents to the clinic with swelling in both knees, morning stiffness lasting
more than an hour, and pain with walking. Further history reveals bilateral hand and wrist pain.
These symptoms have been present for about three months and have gradually progressed. The
patient has tried over-the-counter acetaminophen without relief from the symptoms. For the
past couple of months, she has felt tired and had a low-grade fever. She denies rashes, oral
ulcers, chest pain, and difficulty breathing. On examinations, she has synovitis of both knees,
metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints bilaterally. X-rays of the
hands do not show joint damage. Lab results for rheumatoid factor (RF), anti-CCP, and ANA are
negative. What is the most likely diagnosis? - CORRECT ANSWER -Rheumatoid arthritis
A 54-year-old man with a history of rheumatoid arthritis presents to the clinic for a regular
follow-up appointment. He has remained stable on methotrexate 15 mg every week, folic acid 1
mg daily, and etanercept 50 mg every week. His examination is unremarkable, with no joint
tenderness or swelling. Routine labs are within normal limits. The patient does mention some
pain along his spine. Involvement of which of the following spinal segments is associated with
the worst morbidity in this patient? - CORRECT ANSWER -Cervical spine
A 54-year-old female presented for evaluation at the outpatient clinic. She was diagnosed with
rheumatoid arthritis two years ago. She has been closely followed up and found to have low-
level disease activity. Currently, she is managed with NSAIDs and has never received disease-
modifying antirheumatic drugs (DMARDs). In patients with established disease, the American
, College of Rheumatology recommends what type of treatment? - CORRECT ANSWER -Start
monotherapy with a DMARD
A 65-year-old female patient complains of joint stiffness and swelling in both hands. The
stiffness worsens upon waking up in the morning and gradually improves after two to three
hours. She further reports having had more trouble opening her pill bottles in the past few
weeks. Which one of the following is going to be the most specific for reaching a diagnosis in
this patient? - CORRECT ANSWER -Anti-citrullinated protein antibodies (ACPA)
32-year-old woman presents to the healthcare provider with six months of fatigue. She also
reports joint pains, chest pain, and a 3 kg weight loss ever since the fatigue started. She denies
recent travel, fever, or new sexual partners. She has no past medical history and takes no
medications. She is sexually active with her husband of five years. Her mother has rheumatoid
arthritis. Vitals include a blood pressure of 123/80 mmHg, a heart rate of 81/min, a respiratory
rate of 18/min, and oxygen saturation of 99% on room air. On examination, she has a rash over
her nose and an ulcer on her hard palate. The chest examination reveals decreased air entry in
her right lung base. Her abdomen is soft, and there is no hepatosplenomegaly. Neurological
examination is within normal limits. Which of the following antibody titers most likely correlates
with the disease activity in this patient? - CORRECT ANSWER -Anti-double-stranded DNA
antibodies
A 24-year-old woman presents with diffuse aching and stiffness, worsened by cold weather and
stress. Her history is significant for Lyme disease 2 years ago treated with doxycycline 100 mg
twice a day for 4 weeks. Her joints show no tenderness or synovitis, but she is tender over
points bilaterally at the occiput, trapezius, lateral epicondyle, gluteals, and knee. What is the
most probable diagnosis? - CORRECT ANSWER -Fibromyalgia
30-year-old woman presents with widespread musculoskeletal pain, which is bilateral and
involves both upper and lower parts of the body for the past 4 months. She has normal
laboratory findings, and imaging studies are unremarkable. Which of the following is a first-line
medication used to treat this condition? - CORRECT ANSWER -Duloxetine
