#january2020mccqe1
A 58-year-old woman comes to the physician because of persistent joint aches affecting hands and hips in an asymmetric distribution. The pain is slow in onset and is aggravated by activity. She reports a brief (less than 30 minutes) phase of morning stiffness relieved by heat and movement. She denies fever or weight loss. On the contrary, she has gained approximately 5% of her baseline weight in the past 6 months. Her temperature is 37 C (98.6 F), blood pressure is 130/80 mm Hg, pulse is 74/min, and respirations are 12/min. Examination reveals nodular thickening of the distal interphalangeal joints without redness. Mild limitation in joint motion is appreciated bilaterally in hand joints and in the right hip joint. The patient’s walking is characterized by a slightly shortened length of stride on the right side. Cardiac and respiratory examination reveals no abnormalities. At this time, which of the following is the most appropriate next step in diagnosis?
(A) No further evaluation necessary
(B) Complete blood count and erythrocyte sedimentation rate
(C) Blood test for rheumatoid factor
(D) Blood test for antinuclear antibodies
(E) X-ray studies
(F) Bone densitometry
(G) Diagnostic arthrocentesis
A 58-year-old woman comes to the physician because of persistent joint aches affecting hands and hips in an asymmetric distribution. The pain is slow in onset and is aggravated by activity. She reports a brief (less than 30 minutes) phase of morning stiffness relieved by heat and movement. She denies fever or weight loss. On the contrary, she has gained approximately 5% of her baseline weight in the past 6 months. Her temperature is 37 C (98.6 F), blood pressure is 130/80 mm Hg, pulse is 74/min, and respirations are 12/min. Examination reveals nodular thickening of the distal interphalangeal joints without redness. Mild limitation in joint motion is appreciated bilaterally in hand joints and in the right hip joint. The patient’s walking is characterized by a slightly shortened length of stride on the right side. Cardiac and respiratory examination reveals no abnormalities. At this time, which of the following is the most appropriate next step in diagnosis?
(A) No further evaluation necessary
(B) Complete blood count and erythrocyte sedimentation rate
(C) Blood test for rheumatoid factor
(D) Blood test for antinuclear antibodies
(E) X-ray studies
(F) Bone densitometry
(G) Diagnostic arthrocentesis
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