Immunologic And Inflammatory Post-test
Immunology and Inflammatory Post Test. Rosen's Emergency Medicine, 7th Edition. Section Nine: Chapters 114 - 118.
- 1.The distinction between monoarticular and polyartiular arthritis is an important distinction which helps narrow the differential diagnosis. Which of the following pairings below is correct?
- A.
Pseudogout – polyarticular
- B.
Gonocoocal arthritis – monoarticular
- C.
Gout – polyarticular
- D.
Lyme disease – monoarticular
- E.
Rheumatoid arthritis – polyarticular
- 2.Which of the following is the most common cause of bacterial septic arthritis?
- A.
Neisseria gonorrhoeae
- B.
Group A streptococcus
- C.
Staphylococcus aureus
- D.
E. coli
- E.
Salmonella species
- 3.
- A.
She may be discharged home on oral antibiotics after a dose of IV antibiotics
- B.
It is unnecessary to perform a cervical culture on this patient
- C.
This type of arthritis is more commonly oligoarthritis than monoarthritis
- D.
The etiology of this arthritis has a high liklihood of creating long-term joint pathology
- E.
This type of arthritis is most common in children and adults > 55 years old
- 4.
- A.
Absolute cell count can be used to rule out a septic etiology
- B.
Arthrocentesis is contraindicated if infection of any kind covers the joint
- C.
If you obtain a very small amount of synovial fluid, the most important test to be run is cell count and differential
- D.
The most concerning complication of arthrocentesis is a “dry tap”
- E.
Most of the white blood cells in septic arthritis are PMNs, while in inflammatory arthritis, eosinophils predominate.
- 5.In evaluating a patient with acute arthritis, which laboratory study may be of any value in determining the underlying etiology?
- A.
Platelet count
- B.
CPK
- C.
Serum protein level
- D.
Sedimentation rate
- E.
Uric acid level
- 6.Which of the following statements regarding the seronegative spondyloarthropathies is NOT true?
- A.
The most common extra-articular manifestation of ankylosing spondylitis is aortic root disease
- B.
There is a genetic component to theses arthropathies related to the HLA-B27 marker
- C.
Psoariatic arthropathy occurs in up to 20% of patients with psoriasis
- D.
In patients with IBD, the peripheral arthritis tends to correlate with flare-ups of the bowel disease, but the spinal manifestations do not
- E.
Reactive arthritis (Reiter’s syndrome) develops 2-6 weeks after an episode of urethritis or dysentery
- 7.Which of the following statements concerning the treatment of gout is true?
- A.
Colchicine can be safely used in patients with chronic renal insufficiency
- B.
Allopurinol increases uric acid elimination and is useful during an acute gouty attack
- C.
Intramuscular injections of ACTH are useful if NSAIDs are contraindicated
- D.
Treatment with NSAIDs should continue for at least one week after symptoms have abated
- E.
There is a high likelihood that a single administration of IM ACTH may lead to suppression of the hypothalamic-pituitary-adrenomedullary axis
- 8.
- A.
The attacks tend to be more severe
- B.
The typical patient is younger
- C.
The crystals cannot be identified using microscopy
- D.
Treatment with colchicines is contraindicated
- E.
The knee is the most commonly involved joint
- 9.
- A.
Teres minor
- B.
Supraspinatus
- C.
Infraspinatus
- D.
Deltoid
- E.
Subscapularis
- 10.In regards to provocative testing for tendinopathies, which of the following pairings is NOT correct?
- A.
De Quervain’s tenosynovitis – Finkelstein test
- B.
Rotator cuff tendinopathy – Neer test
- C.
Achilles tendon rupture – Thompson test
- D.
Bicipital tendinopathy – Empty can test
- E.
Lateral epicondylitis – Cozen test
- 11.Which are the two most common sites of acute bursitis?
- A.
Subacromial and anserine bursitis
- B.
Olecrenon and trochanteric bursitis
- C.
Iliopsoas and subacromial bursitis
- D.
Prepatellar and subacromial bursitis
- E.
Prepatellar and olecrenon bursitis
- 12.All of the following factors predispose a patient to develop septic bursitis except:
- A.
Diabetes mellitus
- B.
Trauma
- C.
Advanced age
- D.
Alcohol abuse
- E.
Rheumatoid arthritis
- 13.All of the following conditions are part of the criteria used by the American Rheumatism Association for the diagnosis of systemic lupus erythematous except:
- A.
Pericarditis
- B.
Oral ulcers
- C.
Positive antinuclear antibody
- D.
Leukocytosis
- E.
Proteinuria >0.5 g/24 hours
- 14.
- A.
70% of patients develop hitchhiker’s thumb
- B.
Renal biopsy is not useful in the work-up or management of patients with SLE
- C.
Bundle branch block is the most common cardiac manifestation, reported in 30% of patients
- D.
Neurologic presentations, such as seizures, stroke, psychosis, migraines, are frequently the first signs of disease
- E.
Oral ulcerations commonly accompany disease flares
- 15.Drug-induced lupus usually presents with skin and joint manifestations. This condition is usually reversible when the agents are stopped. Which of the following medications is not commonly implicated in a lupus-like syndrome?
- A.
Procainamide
- B.
Acetaminophen
- C.
Sulfonamides
- D.
Phenytoin
- E.
Hydralazine
- 16.
- A.
Absence of temporal artery tenderness would eliminate the possibility of this condition
- B.
Polycythemia is a common finding
- C.
Elevated ESR level may be a helpful diagnostic clue
- D.
Onset of this disease is typically the age 40 years or younger
- E.
Steroids must be withheld until arterial biopsy can be done
- 17.Which of the following statements regarding the small vessel vasculitides is false:
- A.
Goodpasture’s syndrome is characterized by deposition of anti-glomerular basement membrane antibodies and results in alveolar hemorrhage and progressive glomerulonephritis
- B.
The hallmark of Behcet’s disease is oral ulceration, which is required to make the diagnosis
- C.
Approximately 2/3 of cases of HSP follow an upper respiratory tract infection
- D.
Erythema nodosum more commonly affects men than women
- E.
The initial complaints of patients presenting with Wegener’s granulomatosis are typically upper respiratory tract symptoms
- 18.Which of the following is not a commonly sited cause of anaphylaxis?
- A.
Cat hair
- B.
Crustaceans
- C.
Wasp stings
- D.
Penicillin
- E.
Radiocontrast medium
- 19.A healthy 27 year old male presents to the ED after being “stung” by something while apple picking. He complains of throat tightness and shortness of breath. On exam there is no rash and his lungs are clear to auscultation. His initial vitals are HR 119, BP 68/42, RR 26, O2 98% RA. What is the most appropriate initial treatment?
- A.
Methylprednisolone 125 mg IV
- B.
Diphenhydramine 50 mg IV
- C.
Epinephrine 0.3 mg 1:10,000 solution IM
- D.
Nebulized albuterol 2.5 mg diluted to 3 mL of normal saline
- E.
Epinephrine 0.1 mg of 1:10,000 solution IV over 5 minutes
- 20.A 57 year old female presents to the Emergency Department in anaphylactic shock. Since her arrival, she has received epinephrine, methylprednisolone, diphenhydramine and ranitidine. Despite the aggressive treatment, she remains hypotensive. You suspect she is taking which of the following medications?
- A.
Amlodipine
- B.
Aspirin
- C.
Levothyroxine
- D.
Metoprolol
- E.
Amiodarone
- 21.The next therapy that should be administered to the patient in the previous question is:
- A.
Atropine 0.3-0.5 mg IV
- B.
Glucagon 1 mg IV
- C.
Vasopressin 40 units IV
- D.
Isoproterenol 0.05-0.2 g/kg/min
- E.
Dopamine 5 g/kg/min
- 22.A 48 year old male with a history of HTN presents with several hours of swelling of the lips and tongue. On further questioning, you determine that the patient takes an ACE inhibitor. Which of the following statements regarding this condition is incorrect?
- A.
Angioedema involves the deeper dermal and subcutaneous tissue and commonly involves the face, mouth, lips, extremities, and genitalia
- B.
10% of cases are classified as chronic with recurrent episodes persisting longer than 6 weeks
- C.
There is a subset of angioedema which is hereditary due to an autosomal recessive condition caused by C1 esterase inhibitor deficiency or functional deficiency
- D.
ACE inhibitor-induced angioedema may occur as many as 10 years after initiation of therapy
- E.
All types of angioedema result in elevated bradykinin levels
- 23.A 4 year old female presents with several days of yellow crusting lesions only on her face. She is afebrile and nontoxic. The lesions are pruritic, but not painful. Which of the following statements is true?
- A.
These lesions are not contagious
- B.
Systemic antibiotics have been shown to prevent later occurrence of glomerulonephritis
- C.
Group A streptococcus is the most common causative organism
- D.
Without treatment, these lesions will heal in 3-6 weeks
- E.
Systemic antibiotics have a higher cure rate than topical agents
- 24.A 23 year old healthy female presents 4 days after an elective rhinoplasty. She complains of fever and flu-like symptoms and she is now vomiting and somewhat confused. Her vital signs are: temperature 102.9, HR 126, BP 82/53. On exam, you note diffuse erythema. In regards to her diagnosis, which of the following is incorrect?
- A.
This illness has been associated with an exotoxin-producing S. aureus and severe group A beta-hemolytic streptococcal infections
- B.
The diagnosis of this illness requires fever, hypotension, and rash
- C.
You can see pharyngitis, a “strawberry tongue,” conjunctivitis or vaginitis with this illness
- D.
The rash associated with this illness is initially a diffuse, blanching erythroderma followed by full-thickness desquamation
- E.
Antibiotics are not indicated in the treatment of this illness
- 25.A young woman is concerned about some patches on her back and chest that did not tan over the summer. Her diagnosis is likely:
- A.
Seborrheic dermatitis
- B.
Tinea versicolor
- C.
Vitiligo
- D.
Pityriasis rosea
- E.
Erythema multiforme
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