ADULT H&P COMPREHENSIVE ASSESSMENT OF AUTOIMMUNE
ILLNESS NURS 5220 - ADVANCED HEALTH ASSESSMENT AND
DIAGNOSTIC REASONING
1. A 45-year-old female presents with progressive fatigue, joint pain, and a
malar rash. Which antibody test has the highest sensitivity for Systemic Lupus
Erythematosus (SLE)?
A. Anti-dsDNA
B. Anti-Smith (Sm)
C. Antinuclear Antibody (ANA)
D. Anti-Ro (SS-A)
Correct Answer: C - ANA has the highest sensitivity (95-100%) for SLE but lacks
specificity. Anti-dsDNA and Anti-Smith are highly specific but less sensitive. Anti-
Ro is associated with Sjögren's syndrome and subacute cutaneous lupus.
2. A 32-year-old woman with SLE reports new-onset shortness of breath and
pleuritic chest pain. Which diagnostic test is most appropriate initially?
A. Chest X-ray
B. High-resolution CT chest
C. Echocardiogram
D. Pulmonary function tests
Correct Answer: A - Chest X-ray is the initial screening test for pleural effusion or
infiltrates. High-resolution CT is more sensitive but reserved for complex cases.
Echocardiogram evaluates cardiac involvement. PFTs assess restrictive patterns
but are not first-line.
,3. Which medication is considered first-line treatment for mild to moderate SLE
without major organ involvement?
A. Methotrexate
B. Hydroxychloroquine
C. Prednisone
D. Azathioprine
Correct Answer: B - Hydroxychloroquine is the first-line immunomodulator for
mild to moderate SLE. It reduces flares, improves survival, and has a favorable
safety profile. Methotrexate and azathioprine are steroid-sparing agents used in
refractory cases. Prednisone is for acute flares.
4. A 28-year-old male presents with painful, swollen joints in his hands and feet,
morning stiffness lasting 2 hours, and rheumatoid nodules. What is the most
specific diagnostic marker?
A. Rheumatoid factor (RF)
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. C-reactive protein (CRP)
D. Erythrocyte sedimentation rate (ESR)
Correct Answer: B - Anti-CCP has 95-98% specificity for rheumatoid arthritis and
may appear early in disease. RF is less specific (70-80%). CRP and ESR are
inflammatory markers but are not specific to RA.
5. A 55-year-old woman with known Rheumatoid Arthritis develops dry eyes
and dry mouth. Which secondary autoimmune condition is most likely?
A. Systemic Lupus Erythematosus
B. Sjögren's Syndrome
C. Scleroderma
D. Mixed Connective Tissue Disease
,Correct Answer: B - Sjögren's syndrome commonly occurs as a secondary
condition in RA (20-30% of patients). Sicca symptoms (dry eyes, dry mouth) are
hallmark features. SLE, scleroderma, and MCTD can also have sicca but are less
common secondary associations with RA.
6. Which physical examination finding is most characteristic of Systemic Sclerosis
(Scleroderma)?
A. Malar rash
B. Heliotrope rash
C. Sclerodactyly
D. Erythema nodosum
Correct Answer: C - Sclerodactyly (thickening and tightening of skin on fingers) is
pathognomonic for systemic sclerosis. Malar rash is SLE; heliotrope rash is
dermatomyositis; erythema nodosum is associated with sarcoidosis and
inflammatory bowel disease.
7. A 40-year-old patient with Systemic Sclerosis reports progressive dysphagia
and heartburn. What is the most likely underlying mechanism?
A. Achalasia
B. Lower esophageal sphincter dysfunction
C. Esophageal stricture
D. Hiatal hernia
Correct Answer: B - Lower esophageal sphincter dysfunction due to smooth
muscle atrophy and fibrosis causes gastroesophageal reflux and dysphagia in
systemic sclerosis. Achalasia is a separate disorder. Strictures are a complication of
chronic reflux, not the primary mechanism.
, 8. Which autoantibody is most specifically associated with Limited Cutaneous
Systemic Sclerosis (CREST syndrome)?
A. Anti-Scl-70 (anti-topoisomerase I)
B. Anti-centromere antibody
C. Anti-Jo-1
D. Anti-U1-RNP
Correct Answer: B - Anti-centromere antibodies are present in 70-90% of limited
cutaneous systemic sclerosis (CREST). Anti-Scl-70 is associated with diffuse
cutaneous systemic sclerosis. Anti-Jo-1 is associated with polymyositis. Anti-U1-
RNP is associated with mixed connective tissue disease.
9. A 50-year-old male presents with muscle weakness in proximal upper and
lower extremities, heliotrope rash, and Gottron's papules. Which diagnosis is
most likely?
A. Polymyalgia Rheumatica
B. Dermatomyositis
C. Systemic Lupus Erythematosus
D. Inclusion Body Myositis
Correct Answer: B - Dermatomyositis presents with proximal muscle weakness
and classic skin findings: heliotrope rash (purple discoloration of eyelids) and
Gottron's papules (erythematous lesions over knuckles). Polymyalgia rheumatica
has no rash. Inclusion body myositis affects distal muscles asymmetrically.
10. Which enzyme is the most sensitive marker for muscle inflammation in
dermatomyositis and polymyositis?
A. Creatine kinase (CK)
B. Aldolase
C. Aspartate aminotransferase (AST)
D. Lactate dehydrogenase (LDH)
ILLNESS NURS 5220 - ADVANCED HEALTH ASSESSMENT AND
DIAGNOSTIC REASONING
1. A 45-year-old female presents with progressive fatigue, joint pain, and a
malar rash. Which antibody test has the highest sensitivity for Systemic Lupus
Erythematosus (SLE)?
A. Anti-dsDNA
B. Anti-Smith (Sm)
C. Antinuclear Antibody (ANA)
D. Anti-Ro (SS-A)
Correct Answer: C - ANA has the highest sensitivity (95-100%) for SLE but lacks
specificity. Anti-dsDNA and Anti-Smith are highly specific but less sensitive. Anti-
Ro is associated with Sjögren's syndrome and subacute cutaneous lupus.
2. A 32-year-old woman with SLE reports new-onset shortness of breath and
pleuritic chest pain. Which diagnostic test is most appropriate initially?
A. Chest X-ray
B. High-resolution CT chest
C. Echocardiogram
D. Pulmonary function tests
Correct Answer: A - Chest X-ray is the initial screening test for pleural effusion or
infiltrates. High-resolution CT is more sensitive but reserved for complex cases.
Echocardiogram evaluates cardiac involvement. PFTs assess restrictive patterns
but are not first-line.
,3. Which medication is considered first-line treatment for mild to moderate SLE
without major organ involvement?
A. Methotrexate
B. Hydroxychloroquine
C. Prednisone
D. Azathioprine
Correct Answer: B - Hydroxychloroquine is the first-line immunomodulator for
mild to moderate SLE. It reduces flares, improves survival, and has a favorable
safety profile. Methotrexate and azathioprine are steroid-sparing agents used in
refractory cases. Prednisone is for acute flares.
4. A 28-year-old male presents with painful, swollen joints in his hands and feet,
morning stiffness lasting 2 hours, and rheumatoid nodules. What is the most
specific diagnostic marker?
A. Rheumatoid factor (RF)
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. C-reactive protein (CRP)
D. Erythrocyte sedimentation rate (ESR)
Correct Answer: B - Anti-CCP has 95-98% specificity for rheumatoid arthritis and
may appear early in disease. RF is less specific (70-80%). CRP and ESR are
inflammatory markers but are not specific to RA.
5. A 55-year-old woman with known Rheumatoid Arthritis develops dry eyes
and dry mouth. Which secondary autoimmune condition is most likely?
A. Systemic Lupus Erythematosus
B. Sjögren's Syndrome
C. Scleroderma
D. Mixed Connective Tissue Disease
,Correct Answer: B - Sjögren's syndrome commonly occurs as a secondary
condition in RA (20-30% of patients). Sicca symptoms (dry eyes, dry mouth) are
hallmark features. SLE, scleroderma, and MCTD can also have sicca but are less
common secondary associations with RA.
6. Which physical examination finding is most characteristic of Systemic Sclerosis
(Scleroderma)?
A. Malar rash
B. Heliotrope rash
C. Sclerodactyly
D. Erythema nodosum
Correct Answer: C - Sclerodactyly (thickening and tightening of skin on fingers) is
pathognomonic for systemic sclerosis. Malar rash is SLE; heliotrope rash is
dermatomyositis; erythema nodosum is associated with sarcoidosis and
inflammatory bowel disease.
7. A 40-year-old patient with Systemic Sclerosis reports progressive dysphagia
and heartburn. What is the most likely underlying mechanism?
A. Achalasia
B. Lower esophageal sphincter dysfunction
C. Esophageal stricture
D. Hiatal hernia
Correct Answer: B - Lower esophageal sphincter dysfunction due to smooth
muscle atrophy and fibrosis causes gastroesophageal reflux and dysphagia in
systemic sclerosis. Achalasia is a separate disorder. Strictures are a complication of
chronic reflux, not the primary mechanism.
, 8. Which autoantibody is most specifically associated with Limited Cutaneous
Systemic Sclerosis (CREST syndrome)?
A. Anti-Scl-70 (anti-topoisomerase I)
B. Anti-centromere antibody
C. Anti-Jo-1
D. Anti-U1-RNP
Correct Answer: B - Anti-centromere antibodies are present in 70-90% of limited
cutaneous systemic sclerosis (CREST). Anti-Scl-70 is associated with diffuse
cutaneous systemic sclerosis. Anti-Jo-1 is associated with polymyositis. Anti-U1-
RNP is associated with mixed connective tissue disease.
9. A 50-year-old male presents with muscle weakness in proximal upper and
lower extremities, heliotrope rash, and Gottron's papules. Which diagnosis is
most likely?
A. Polymyalgia Rheumatica
B. Dermatomyositis
C. Systemic Lupus Erythematosus
D. Inclusion Body Myositis
Correct Answer: B - Dermatomyositis presents with proximal muscle weakness
and classic skin findings: heliotrope rash (purple discoloration of eyelids) and
Gottron's papules (erythematous lesions over knuckles). Polymyalgia rheumatica
has no rash. Inclusion body myositis affects distal muscles asymmetrically.
10. Which enzyme is the most sensitive marker for muscle inflammation in
dermatomyositis and polymyositis?
A. Creatine kinase (CK)
B. Aldolase
C. Aspartate aminotransferase (AST)
D. Lactate dehydrogenase (LDH)
