27-year-old African American woman comes to the office due to 6 weeks of pain and swelling of her hands and wrists

27-year-old African American woman comes to the office due to 6 weeks of pain and swelling of her hands and wrists. The pain

worsens in the morning and is associated with stiffness for 10-15 minutes. She has also had easy fatigability and muscle aches. The

patient has no significant past medical history and does not take any medications. She has been sexually active with a new partner.

Her temperature is 37.9 C (100 2 F), blood pressure is 140/90 mm Hg, and pulse is 76/min. Physical examination reveals slightly

swollen, tender metacarpophalangeal and proximal interphalangeal joints. There is a nontender ulcer on the buccal mucosa. Mild

cervical and axillary lymphadenopathy is present Cardiopulmonary auscultation is normal. The abdomen is soft and nontender. The

tip of the spleen is palpable with exhalation. Laboratory results are as follows:

Hemoglobin 11.0 g/dl

Platelets 90,000/mm3

Leukocytes 4,500/mm3

An x-ray of the hands and wrists reveals no bony erosions. Urinalysis shows 2+ protein and 20-30 red blood cells/hpf Which of the

following is the most likely diagnosis?

  • QA Beh(;et disease
  • 0 B. Disseminated gonococcal infection
  • 0 C. Felty syndrome
  • 0 D. Hodgkin disease
  • 0 E. Parvovirus B 19 infection
  • 0 F Sarcoidosis
  • 0 G. Systemic lupus erythematosus

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60-year-old woman comes to the clinic due to the persistent feeling of “always having to go to the bathroom.” For the past 3 years,

the patient has had urinary urgency followed by involuntary loss of urine 2 or 3 times per day She has dysuria and nocturia and

sometimes awakens to find her undergarments wet Menopause occurred at age 52 when a total laparoscopic hysterectomy with

bilateral salpingo-oophorectomy was performed for endometrial adenocarcinoma. Medical history is significant for recurrent urinary

tract infections during the past year The patient is not sexually active and takes no medications. On physical examination, the vulvar

skin shows reduced elasticity with labia minora retraction. The vaginal epithelium is smooth and has areas of patchy erythema. There

is no loss of urine with Valsalva maneuver, and a urinalysis and postvoid residual urine test are normal. Which of the following is the

most likely cause of this patient’s urinary symptoms?

  • QA Chronic bladder pain syndrome
  • 0 B. Estrogen deficiency
  • 0 C. Incomplete bladder emptying
  • 0 D. Urethral hypermobility
  • 0 E. Vesicovaginal fistula formation

0 voters