Quiz on SBM Exam 4, created by Brianna Pickering on 02/09/2019.
You next patient is a 26 y/o woman with new onset symmetric, polyarticular inflammatory joint pain, photosensitive facial rash, and a history of thrombocytopenia. Which of the following lab tests would be the most useful in confirming your working diagnosis?
erythrocyte sedimentation rate
Systemic lupus erythematosus is a multisystem inflammatory autoimmune disease. Which of the following accurately describes patients with systemic lupus erythematosus?
they are more likely to be male than female
they will have depressed antibody production
they often have a positive ANA which is highly specific for systemic lupus
they will likely have significant fatigue, malaise, and non-specific aches and pains
What is the key reason we see organ boundaries on imaging studies?
differences in density/contrast
presence of calcium
age of the patient
Your patient is an 85 y/o woman who presents with a unilateral headache and pain in her jaw when chewing meat. On examination, you note her temporal artery is tortuous and tender. This is an example of which of the following?
large vessel vasculitis
medium vessel vasculitis
smal vessel vasculitis
You are seeing a middle aged man with a history of asthma who presents with cough and shortness of breath. He has no abdominal pain, nausea, or diarrhea. His CBC shows a larger than normal percent of eosinophils. He has a (+) ANCA (p-ANCA). This is an example of which of the following diseases?
eosinophilic granulomatosis with polyangiitis (eGPA)
A new agent to control psoriasis is being compared to placebo in a randomized trial. Patients are carefully screened to exclude any patients who are under 45, over 65, have comorbid conditions, prior treatment with antipsoriatic medications, alcohol use above CDC "at risk" levels, or a positive score on a sensitive screening instrument for mental health disorders. Adherence is assured with case management and social support, and measured using pill counts at clinic visits. After one year, the new agent is demonstrated to reduce the frequency, extent, and discomfort of skin eruptions. This is an example of which type of study?
comparative effectiveness study
A new anti-rheumatic medication showed great promise in early trials, so local physicians became interested in studying its benefits in a clinical trial. Half of the physicians in the department practice at a single location, while the other half of the department practices in outlying clinics. So, they decided to perform a 'natural experiment.' After obtaining consent, patients attending outlying clinics will receive usual treatments, while patients attending the central clinic will receive the new medication. Patients will be followed for one year, with regular assessment of serum markers of inflammation, involvement by physical exam, and symptoms scores on a validated instrument. In this study, the outcome "symptom scores on a validated instrument" is an example of which type of outcome?
You are seeing a 26 y/o woman with systemic lupus erythematous. On her follow up appointment, she reports that several months ago she had a miscarriage at 20 weeks of pregnancy. Which of the following labs should you check on this patient because of this new information?
rheumatoid factor and anti-CCP
ESR and CRP
A 30 y/o patient on hemodialysis (CKD Stage V) was admitted for convulsions and seizure. After a recent injury, he was started on a new opioid medication. Which of the following opioids has been associated with seizures in patients with CKD?
You are seeing a child who presents with fever, swollen lymph nodes, a peeling rash on the palms and soles, and a tongue that looks like a ripe red strawberry. You remember that this can be associated with some form of vasculitis. You decide to order an ultrasound. Which arteries should be visualized on the ultrasound?
his extracranial carotid arteries
his renal arteries
his coronary arteries
his pulmonary arteries
Bisphosphonates are often used in the treatment of osteoporosis. Which of the following describes their mechanism of action?
they increase osteoblast apoptosis
they decrease osteoblast apoptosis
they increase osteoclast apoptosis
they decrease osteoclast apoptosis
Which of the following are common adverse effects of NSAIDs?
gastritis and peptic ulceration
hepatotoxicity with bleeding
central nervous system depression
respiratory depression and coma
You are seeing a new patient who reports he has a long history of arthritis that has been treated continuously with prednisone in doses ranging form 10-30 mg daily for years, prescribed by his former provider and has never been monitored for side effects. He is at risk for which of the following adverse effects due to long term use of prednisone?
chronic renal failure
induction of lymphoma
A patient with prostate cancer with metastases to the brain has just completed a month-long course of chemotherapy, followed by radiation therapy to the skull. One week ago he was started on dexamethasone 4mg QID, to reduce brain swelling. His other medical problems include hypertension and diabetes mellitus. Which side effect of dexamethasone would most likely be observed in this patient?
hypotension from sodium retention
Rituximab is one of the "biologics" that is used to treat rheumatoid arthritis and vasculitis. The mechanism of action to Rituximab is which of the following?
it binds both soluble and membrane bound TNF-alpha, inhibiting its further activity
it blocks the p40 subunit of IL-12 and IL-23, decreasing T cell activation
it binds to the surface of mature, CD19 and CD20+ B cells and causes their depletion
it binds to a costimulatory molecule on antigen presenting cells, blocking T cell activation
Patients who are taking allopurinol can exhibit extreme bone marrow suppression and other forms of drug toxicity when exposed to which of the following medications?
Which of the following is a potential adverse effect of anti-TNF therapy?
reactivation of tuberculosis
reactivation of peptic ulcer disease
worsening of peripheral neuropathy
Which of the following situations is a relative contraindication to the use of hydroxychloroquine?
patient with a history of liver disease
patient with a history of renal disease
patient with diabetes mellitus
patient with retinal disease
A 46 y/o woman has been taking acetaminophen 1000 mg every 3-4 hrs for a recent onset headache. Her past medical history was significant for alcohol use, fatty liver, and hepatitis C. She has been nauseated and vomited several times, but she waited 5 days before presenting to an emergency room while continuing to take acetaminophen. Which of the following side effects associated with acetaminophen use do you suspect this patient may be experiencing?
nausea related to acute kidney injury
Which of the following is a defining characteristic of the epidermis?
loose connective tissue
a non-keratinized stratified squamous epithelium (does not have a stratum corneum)
a keratinized stratified squamous epithelium (does have a stratum corneum)
dense irregular connective tissue
Which of the following is a defining characteristic of the dermis?
it is not technically part of the skin
it has abundant adipose tissue
it is directly adjacent to skeletal muscle
it contains hair follicles, sweat glands and nerves
You are seeing a patient with systemic lupus erythematosus (SLE) who has a photosensitive skin eruption, fatigue and arthralgias as her only manifestations. She is otherwise feeling well, with no evidence of internal organ involvement on exam or by laboratory evaluation. Which of the following medications would be appropriate for this patient?
You are seeing a new patient who has a diagnosis of diffuse scleroderma. Her first symptoms began about 6 months ago and included Raynaud's phenomenon, shortness of breath and skin tightening. On exam, her blood pressure is 110/65, she has thickened, shiny skin over the fingers, hands, forearms and face, and there are multiple telangiectasias over her hands and face. Which of the following would be the most appropriate advice to give her?
she should monitor her blood pressure and call you if it is over 150/100
this is primarily a skin disease for which there are multiple effective therapies
reassure her that the shortness of breath is likely unrelated to her disease
she is very likely to develop seizures as part of this new disease
Your patient is a 75 y/o woman who comes to the office to report 4 episodes of transient vision loss in her left eye over the last week; right now her vision is normal. In addition, she notes difficulty lifting her arms overhead to brush her hair, and pain in her jaw which prevents her from getting through a meal. You obtain labs showing an ESR of 90 (normal >30). Which of the following is your initial step in her care?
physical therapy for her arm pain
start high dose prednisone
temporal artery biopsy
Which of the following features are most consistent with small vessel vasculitis?
fatigue, high blood pressure, tender nodules of the lower extremities
weight loss, headache, vision loss
fatigue, abnormal chest x-ray, active urinary sediment
high inflammatory markers, livedo reticularis on skin, foot drop
A 60 y/o man presents with 6 months of fatigue, 10 pound weight loss, and recurrent episodes of sinusitis and nose bleeds. He also reports one week of increasing shortness of breath and small amounts of blood when he coughs. On exam, you discover blood in both of his nasal passages, tender sinuses, redness of the right eye, and red raised lesions on his legs. His chest x-ray shows diffuse patchy infiltrates in both lungs. You admit him to the hospital and start high dose corticosteroids. Which of the following tests will most likely be abnormal?
anti-nuclear antibody (ANA)
Hepatitis C testing
While seeing a patient with rheumatoid arthritis (RA) in the clinic with your preceptor, you mention that you read of a medication for RA that reduces the number of disabling symptom flares per year in patients with RA. Your preceptor asks what was the number needed to treat (NNT) that was reported in the trial. Looking up the study, you find that this is not reported in the paper. Instead, raw report data is given: there were 200 patients, 100 in the control group experienced 15 symptom flares while 100 in the treatment group experienced 10 symptom flares. You report to the preceptor that the NNT for this trial was which of the following?
There are 3 phases of wound healing: inflammatory, proliferative (migratory), and remodeling. Which of the following accurately describes features of the proliferative phase of wound healing?
its main function is cleaning of the wound
its main function is scar revision and maturation
the key cells involved in this phase are keratinocytes, fibroblasts and endothelial cells
the key cells involved in this phase are neutrophils, macrophages and platelets
Multiple cell types and cytokines are involved in wound healing. TGF-beta is important in this process. Which of the following cell types is a major storage site for transforming growth factor beta? (TGF-b1)
What is the most important x-ray feature to suggest benign vs malignant bone tumors?