#august2020mccqe1
A 32-year-old woman is evaluated in the emergency department for a 4-day history of pain and swelling of the right wrist and low-grade fever. She has a 7-year history of severe rheumatoid arthritis. She does not recall any specific trauma involving the wrist but has recently been very physically active. Medications are methotrexate, a folic acid supplement, etanercept, prednisone, and ibuprofen. On physical examination, temperature is 37.8°C (100.0°F), blood pressure is 118/68 mm Hg, pulse rate is 90/min, and respiration rate is 18/min. BMI is 22. Cardiopulmonary examination is normal. There is no rash. The right wrist is swollen and tender and has a decreased range of motion. There are a subcutaneous nodule and small flexion deformity on the left elbow but no active synovitis. Mild synovitis is present on the second metacarpophalangeal joints bilaterally. The hips, knees, and feet are not tender or swollen and have full range of motion. Which of the following diagnostic studies of the wrist will be most helpful in establishing this patient's diagnosis?
(A) Arthrocentesis
(B) Arthroscopy
(C) Bone scan
(D) MRI
(E) Radiography
A 32-year-old woman is evaluated in the emergency department for a 4-day history of pain and swelling of the right wrist and low-grade fever. She has a 7-year history of severe rheumatoid arthritis. She does not recall any specific trauma involving the wrist but has recently been very physically active. Medications are methotrexate, a folic acid supplement, etanercept, prednisone, and ibuprofen. On physical examination, temperature is 37.8°C (100.0°F), blood pressure is 118/68 mm Hg, pulse rate is 90/min, and respiration rate is 18/min. BMI is 22. Cardiopulmonary examination is normal. There is no rash. The right wrist is swollen and tender and has a decreased range of motion. There are a subcutaneous nodule and small flexion deformity on the left elbow but no active synovitis. Mild synovitis is present on the second metacarpophalangeal joints bilaterally. The hips, knees, and feet are not tender or swollen and have full range of motion. Which of the following diagnostic studies of the wrist will be most helpful in establishing this patient's diagnosis?
(A) Arthrocentesis
(B) Arthroscopy
(C) Bone scan
(D) MRI
(E) Radiography
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