25-year-old man comes to the clinic due to a 3-month history of right shoulder pain

25-year-old man comes to the clinic due to a 3-month history of right shoulder pain. He also has swelling and pain at his heels. The

patient has tried using a topical “arthritis cream” without improvement, although over-the-counter analgesics have provided some

relief. Medical history includes influenza pneumonia at age 12, but he has otherwise been healthy and takes no regular medications.

The patient does not use tobacco, alcohol, or illicit drugs His temperature is 37.3 C (99.2 F), blood pressure is 115/75 mm Hg, pulse

is 56/min and regular, and respirations are 12/min. On examination, there is pain with resisted abduction at the shoulder and

tenderness at the acromioclavicular junction Palpation over the heels, iliac crests, and tibial tuberosities also elicits tenderness.

Which of the fo llowing additional findings is most likely in this patient?

  • QA Hand joint deformities
  • 0 B. Limited spine mobility
  • 0 C. Positive rheumatoid factor
  • 0 D. Proteinuria
  • 0 E. Subcutaneous nodules

0 voters

3-year-old girl is brought to the physician for intermittent “eye crossing.” The parents say her right eye

intermittently “turned in” during her first few months of life. The symptoms have returned in the past month,

especially around bedtime. She has no headaches or pain. The girl was born full-term, has no medical conditions,

and has met all developmental milestones. Vital signs and growth are normal. Examination shows asymmetric

corneal light reflection. When the left eye is covered, the right eye moves midline. Vision screening is normal.

The rest of the examination is normal. What is the most appropriate rtfXt step in management of this patient?

  • Q A. Brain MRI
  • 0 B. Immediate surgery
  • 0 C. Measurement of intraocular pressure
  • 0 D. Patch on the right eye
  • 0 E. Patch on the left eye
  • 0 F. Watchful waiting

0 voters

31-year-old Caucasian male complains of joint pains He describes right knee pain, right heel pain and low-back pain. He was

recently treated for urethral discharge at an outside clinic. He has no history of trauma or illicit drug use. He is afebrile, and his vital

signs are stable. His right knee is swollen, tender and warm to touch; tenderness is also present over the Achilles tendon. Oral

examination shows mouth ulcers. Synovial fluid analysis from the right knee shows a white blood cell count of 1 0,000/mm3 with many

polymorphonuclear leukocytes but a negative Gram stain. Which of the following is the most appropriate initial pharmacotherapy for

this patient?

  • QA Antihistamines
  • 0 B. NSAIDs
  • 0 C. Antibiotics
  • 0 D. Colchicine
  • 0 E. Allopurinol
  • 0 F Chondroitin sulfate

0 voters