MD Musculoskeletal and Connective Tissue 5

Question 1

A 55-year-old man presents with pain and stiffness in his shoulders and hips that is worse in the morning, elevated ESR, and normal muscle enzymes. He responds dramatically to low-dose prednisone. What is the diagnosis?

Accepted Answer

Polymyalgia rheumatica

Answer

Polymyalgia rheumatica presents with proximal girdle stiffness, markedly elevated ESR/CRP, normal CK, and a dramatic response to low-dose corticosteroids.

Question 2

A 30-year-old woman with SLE develops new hematuria and proteinuria. Renal biopsy shows diffuse proliferative glomerulonephritis with 'wire-loop' lesions. What class of lupus nephritis is this?

Accepted Answer

Class IV (diffuse lupus nephritis)

Answer

Class IV diffuse lupus nephritis is the most severe form, characterized by diffuse glomerular involvement and wire-loop lesions from subendothelial immune complex deposits.

Question 3

A 65-year-old man on aspirin therapy for cardiovascular disease develops a hot, swollen knee. Synovial fluid WBC is 85,000/mm³ with 95% neutrophils. Gram stain is negative. What is the most appropriate next step?

Accepted Answer

Empiric intravenous antibiotics pending culture results

Answer

Synovial WBC >50,000/mm³ with high neutrophilia is presumptive septic arthritis requiring immediate empiric antibiotics while awaiting culture, given the risk of joint destruction.

Question 4

A 14-year-old boy has pain in his right knee that worsens with activity. X-ray shows fragmentation of the tibial tuberosity. What is the diagnosis?

Accepted Answer

Osgood-Schlatter disease

Answer

Osgood-Schlatter disease is a traction apophysitis at the tibial tuberosity insertion of the patellar tendon, common in physically active adolescents during growth spurts.

Question 5

A 50-year-old woman with rheumatoid arthritis develops a vasculitic rash, peripheral neuropathy, and digital gangrene. Which complication of RA does she have?

Accepted Answer

Rheumatoid vasculitis

Answer

Rheumatoid vasculitis is a rare but serious extra-articular complication of severe RA characterized by inflammation of small-to-medium vessels causing neuropathy, skin ulcers, and digital ischemia.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Musculoskeletal and Connective Tissue 5