Musculoskeletal/Rheum - Primary Care
Review
A 75 year-old female presents with complaints of stiffness, aching, and pain in the
muscles of her neck, shoulders, lower back, hips, and thighs. There is no associated
weakness associated with the stiffness and achiness. Laboratory evaluation shows an
elevated C reactive protein and erythrocyte sedimentation rate. Which of the following
medications is used to treat this condition immediately and will also serve to prevent a
known complication from this disorder?
Methotrexate (Rheumatrex)
Azathioprine (Imuran)
Cyclophosphamide (Cytoxan)
Glucocorticoids - answers Glucocorticoids
A 51- year-old man recently underwent a physical examination during which you
obtained a routine chemistry profile. All values were normal except for a serum uric acid
of 7.5 mg /dL. He has no history of gouty arthritis, renal disease, or urolithiasis. The
most appropriate management of this problem would be to:
Begin Probenecid therapy to prevent renal stone formation
Initiate therapy with Allopurinol to prevent urate nephropathy
Follow the patient expectantly without pharmacologic intervention
Treat the patient with prophylactic indomethacin to prevent gout
None of the above - answers Follow the patient expectantly without pharmacologic
intervention
A 52 year-old male presents with a severely painful, swollen right great toe. He denies
recent trauma, but reports several similar episodes of toe pain and swelling over the
past two to three years. He has a history of alcohol abuse and hypertension, for which
he "takes medication" of unknown type. Examination reveals bright erythema and
edema associated with the right first MCP joint. Which of the patient's antihypertensive
medications may be contributing to this condition?
Hydrochlorothiazide (HCTZ)
Lisinopril (Prinivil)
,Metoprolol (Lopressor)
Diltiazem (Cardizem) - answers Hydrochlorothiazide (HCTZ)
Disease-modifying antirheumatic drugs(DMARDS) include all of the following EXCEPT?
Hydroxychloroquine
NSAID's
Methrotrexate
Sulfasalazine
D-penicillamine - answers NSAID's
A 56 year-old white post-menopausal female had a recent surveillance DEXA bone
densitometry. The T-score is -2.7 for her right hip. In counseling this patient, in addition
to medications, which of the following would you recommend?
Weight bearing exercises
Daily red wine consumption
Limit sun exposure
Water aerobics - answers Weight bearing exercises
Which of the following medications is the initial treatment of choice for suppressing the
progression of rheumatoid arthritis (RA)?
Gold salts
Methotrexate (Rheumatrex)
Prednisone
Naproxen sodium (Naprosyn) - answers Methotrexate (Rheumatrex)
A 34 year-old female, with a past medical history of irritable bowel syndrome and
migraines, presents with fatigue, generalized aching and stiffness of the trunk, hip, and
shoulder girdles. She complains of pain and tightness in the neck and across the upper
posterior shoulders. She complains of poor sleep, but denies depression. Physical
examination is unremarkable except for numerous tender points on palpation.
Laboratory evaluation was unremarkable. Which of the following is the best intervention
for this patient?
Corticosteroids
Supervised exercise program
Hydrocodone (Vicodin)
Refer to endocrinologist - answers Supervised exercise program
What is the first DOC for the suppression of inflammation in a patient with RA?
Hydroxychloroquine
Oral prednisone
, NSAID's
D-penicillamine
Methotrexate - answers NSAID's
A 70-year-old man with renal insufficiency and recurrent attacks of proven gouty arthritis
has elevated serum and urine uric acid levels. He is now asymptomatic. The most
appropriate approach is
Chronic allopurinol
Chronic celecoxib
Chronic probenecid
Chronic colchicine
No chronic therapy - answers Chronic allopurinol
An elderly woman slipped in her driveway, injuring her right wrist. Radiographs show a
Colles fracture. Before sending the patient to orthopedics, intervention should include
immobilization with which splint
Volar
Ulnar gutter
Thumb spica
Cock up - answers Volar
An otherwise healthy 12-year-old patient presents for a preparticipation sports PE. On
PE, the patient has a spinal curve abnormality with marked elevation of the right
scapula and a right thoracic hump. Results of spinal films indicate a 25 degree
curvature. Which is the most important plan for treatment?
Monitor the patient every 3 months until menarche
Send the patient for aggressive PT
Refer the patient to a chiropractor for therapy
Refer the patient for evaluation by an orthopedic surgeon - answers Refer the patient
for evaluation by an orthopedic surgeon
A 20 year old female fell off of her mountain bike at Markham Park and presents to your
urgent care center for evaluation later that day. She notes that she fell "over the
handlebars" and tried to "catch" herself with outstretched arms. She has terrible pain in
the left wrist and is in obvious distress. There is swelling and she doesn't let you move it
without a fight. Pain is primarily on the radial aspect of the wrist and she has exquisite
snuff box tenderness on deep palpation. There are no fractures on the A/P and oblique
x-rays of her wrist (and you remember to get comparison of the good right wrist also).
The next step in treatment would be which of the following?
Long arm splint with repeat radiographs in 10-12 days of the left wrist
Arm sling and instructions for early motion physical therapy to avoid stiffness
Review
A 75 year-old female presents with complaints of stiffness, aching, and pain in the
muscles of her neck, shoulders, lower back, hips, and thighs. There is no associated
weakness associated with the stiffness and achiness. Laboratory evaluation shows an
elevated C reactive protein and erythrocyte sedimentation rate. Which of the following
medications is used to treat this condition immediately and will also serve to prevent a
known complication from this disorder?
Methotrexate (Rheumatrex)
Azathioprine (Imuran)
Cyclophosphamide (Cytoxan)
Glucocorticoids - answers Glucocorticoids
A 51- year-old man recently underwent a physical examination during which you
obtained a routine chemistry profile. All values were normal except for a serum uric acid
of 7.5 mg /dL. He has no history of gouty arthritis, renal disease, or urolithiasis. The
most appropriate management of this problem would be to:
Begin Probenecid therapy to prevent renal stone formation
Initiate therapy with Allopurinol to prevent urate nephropathy
Follow the patient expectantly without pharmacologic intervention
Treat the patient with prophylactic indomethacin to prevent gout
None of the above - answers Follow the patient expectantly without pharmacologic
intervention
A 52 year-old male presents with a severely painful, swollen right great toe. He denies
recent trauma, but reports several similar episodes of toe pain and swelling over the
past two to three years. He has a history of alcohol abuse and hypertension, for which
he "takes medication" of unknown type. Examination reveals bright erythema and
edema associated with the right first MCP joint. Which of the patient's antihypertensive
medications may be contributing to this condition?
Hydrochlorothiazide (HCTZ)
Lisinopril (Prinivil)
,Metoprolol (Lopressor)
Diltiazem (Cardizem) - answers Hydrochlorothiazide (HCTZ)
Disease-modifying antirheumatic drugs(DMARDS) include all of the following EXCEPT?
Hydroxychloroquine
NSAID's
Methrotrexate
Sulfasalazine
D-penicillamine - answers NSAID's
A 56 year-old white post-menopausal female had a recent surveillance DEXA bone
densitometry. The T-score is -2.7 for her right hip. In counseling this patient, in addition
to medications, which of the following would you recommend?
Weight bearing exercises
Daily red wine consumption
Limit sun exposure
Water aerobics - answers Weight bearing exercises
Which of the following medications is the initial treatment of choice for suppressing the
progression of rheumatoid arthritis (RA)?
Gold salts
Methotrexate (Rheumatrex)
Prednisone
Naproxen sodium (Naprosyn) - answers Methotrexate (Rheumatrex)
A 34 year-old female, with a past medical history of irritable bowel syndrome and
migraines, presents with fatigue, generalized aching and stiffness of the trunk, hip, and
shoulder girdles. She complains of pain and tightness in the neck and across the upper
posterior shoulders. She complains of poor sleep, but denies depression. Physical
examination is unremarkable except for numerous tender points on palpation.
Laboratory evaluation was unremarkable. Which of the following is the best intervention
for this patient?
Corticosteroids
Supervised exercise program
Hydrocodone (Vicodin)
Refer to endocrinologist - answers Supervised exercise program
What is the first DOC for the suppression of inflammation in a patient with RA?
Hydroxychloroquine
Oral prednisone
, NSAID's
D-penicillamine
Methotrexate - answers NSAID's
A 70-year-old man with renal insufficiency and recurrent attacks of proven gouty arthritis
has elevated serum and urine uric acid levels. He is now asymptomatic. The most
appropriate approach is
Chronic allopurinol
Chronic celecoxib
Chronic probenecid
Chronic colchicine
No chronic therapy - answers Chronic allopurinol
An elderly woman slipped in her driveway, injuring her right wrist. Radiographs show a
Colles fracture. Before sending the patient to orthopedics, intervention should include
immobilization with which splint
Volar
Ulnar gutter
Thumb spica
Cock up - answers Volar
An otherwise healthy 12-year-old patient presents for a preparticipation sports PE. On
PE, the patient has a spinal curve abnormality with marked elevation of the right
scapula and a right thoracic hump. Results of spinal films indicate a 25 degree
curvature. Which is the most important plan for treatment?
Monitor the patient every 3 months until menarche
Send the patient for aggressive PT
Refer the patient to a chiropractor for therapy
Refer the patient for evaluation by an orthopedic surgeon - answers Refer the patient
for evaluation by an orthopedic surgeon
A 20 year old female fell off of her mountain bike at Markham Park and presents to your
urgent care center for evaluation later that day. She notes that she fell "over the
handlebars" and tried to "catch" herself with outstretched arms. She has terrible pain in
the left wrist and is in obvious distress. There is swelling and she doesn't let you move it
without a fight. Pain is primarily on the radial aspect of the wrist and she has exquisite
snuff box tenderness on deep palpation. There are no fractures on the A/P and oblique
x-rays of her wrist (and you remember to get comparison of the good right wrist also).
The next step in treatment would be which of the following?
Long arm splint with repeat radiographs in 10-12 days of the left wrist
Arm sling and instructions for early motion physical therapy to avoid stiffness
