风湿性疾病.doc

2611~2645
2625 All of the following conditions involve the distal interphalangeal (DIP) joint EXPECT Which of the following statements concerning the antiphospholipid antibody syndrome It could not be associated with the sudden onset of left paresis in a previously healthy It could explain recurrent spontaneous abortion in a 24-year-old woman with an 1:40 titer, Lupus anticoagulant and anticardiolipin antibody are always identical immunoglobulin It could not explain ischemic necrosis of the forefoot in a previously healthy 24-year-old man. E Test for anticardiolipin antibodies have a low degree of variability and excellent reproducibility and should be done in all hospital laboratories. Ankylosing spondylitis is associated with all the following features EXCEPT 2649 A 35-year-old woman presents with a 3-year history of progressive rheumatoid arthritis that has been partially responsive to various nonsteridal anti- inflammatory medications and to low -dose oral corticosteroids. After the examination, you decide to treat her active arthritis with methotrexate, the most widely used and effective agent currently used to treat rheumatoid arthritis. Some of the facts about methotrexate therapy to tell her include A. Therapeutic effects are delayed so that clinical improvement is not generally seen for 3 to 6 B. Adverse effects may include oral ulcers, nausea, vomiting, pneumonitis, bone marrow C. Complete blood count, platelet count, alkaline phosphatase level, and serum glutamic -oxaloacetic transaminase (SGOT) level should be obtained every 4 to 6 weeks to D. Birth control measures must be in use before methotrexate is started. A 17-year-old girl with a diagnosis of systemic lupus erythematosus is referred to you for further evaluation. Among the problems you might expect her to experience would be all the C.Seizures or psychotic episodes or both E.Fever, fatigue, or weight loss or all three A 22-year-old women with systemic lupus erythematosus (SLE) develops worsening arthralgia and is given ibuprofen 800mg three times per day. Two days later, she presents to the emergency room with headache, stiff neck, and fever. Cultures of the cerebrospinal fluid are negative for bacteria and fungi. The most appropriate next step would be to E. Give intravenous corticosteroid and cyclophosphamide A 32-year old woman presents with a 6-week history of fatigue, lymphadenopathy, and low -grade fever. At age 17, she required splenectomy for thrombocytopenia. In her early 20s, she had three miscarriages, one of which was followed by a deep venous thrombosis. Which laboratory tests would be most helpful in establishing a diagnosis? ANA, anti-Sjogren's syndrome (anti-SSA and anti-SS-B) antibodies Rheumatoid factor, ANA, antiscleroderma (anti-SCL-70) antibodies Antineutrophilic antibodies, antihistone antibodies ANA, anticardiolipin antibodies, and anti-DNA antibodies ANA, rheumatoid factor, and Lyme antibodies ∗2672 A 50-year-old man is transferred to your hospital with a presumptive diagnosis of tuberculosis. His chest radiograph shows nodular cavitary lesions in both lung fields. His urinalysis shows 50 red blood cells per high-power field and 3+ proteinuria. He is scheduled for bronchoscopy with transbronchial lung biopsy in the morning. That evening he has a sudden deterioration consisting of massive hemoptysis and progressive renal failure. The most appropriate therapeutic intervention at this point would be supportive management and C. Intravenous cyclophosphamide, 4 mg per kilogram D. Oral cyclophosphamide, 2 mg per kilogram E. Intravenous corticosteroids and intravenous cyclophosphamide, 4 mg per kilogram A 65-year-old man is admitted to the hospital for cholecystitis and undergoes cholecystectomy. Postoperatively, he develops a persistent low-grade fever, intermittent severe crampy abdominal pain, and purpuric lower extremity skin lesions. On the tenth hospital day, he develops a right footdrop and diplopia. The most appropriate next step in his diagnostic evaluation C. Obstain celiac and mesenteric angiography E. Obstain a computed tomographic scan of the brain For each condition select the drug with it is closely associated D.Multiple cholesterol embolization syndrome Match each description with the appropriate disease 2742.Involvement of the upper and lower respiratory tracts; a cause of glomerulonephritis 2743.Ecchymoses and necrosis in extremities in elderly patients 2744.Inflammation of small- to medium-size muscular arteries, which may cause kidney,heart, liver gastrointestinal, and muscular damage 2745. Patients above the age of 55, who may experience fever, weight loss, scalp pain, headache, 2746.Inflammation of the aorta and its branches in young women; also known as "pulseless Match the following clinical syndromes with the most likely associated finding. 2751.Hypopigmented skin lesion with central atrophy and telangiectasia The rheumatoid arthritis patients with gastrointestinal ulcer need administrate analgesic ∗2759 True statem ent regarding the inflammatory joint disease seen in inflammatory bowel A. Axial disease is associated with HLA- B27 positivity B. The activity of peripheral joint disease usually correlates with that of the colitis C. Peripheral arthritis is usually not associated with the presence of rheumatoid factor or D. arthritis is more common in ulcerative colitis than in Crohn's disease ∗2760 Which of the following statements concerning SLE is/are true? A. Although renal glomerular disease is common, renal tubular and interstitial inflammation is B. Anti-SSA antibodies have been associated with the development of congenital heart block in C. Vasculitic lesions of the skin usually portend central nervous system vasculitis. D. Pleural fluid from patients with active SLE is usually exudative, with a low glucose level. E. The chance that a women will develop SLE in her lifetime is approximately 7:1 Which of the following statement concerning ankylosing spondylitis is/are true? A. Monoarthritis or oligoarthritis may precede the onset of back pain. B. The earliest recognizable radisgraphic change in the sacroiliac joints is fusion. C. Back pain and morning stiffness may diminish with activity and may recur after periods of D. Lateral lumbosacral flexion may be assessed with the Schober's test. E. Aortic insufficiency may be an extra-articular manifestation. ∗2762. Correct statements about psoriatic arthritis include which of the following? A. Arthritis occurs in 20-25 percent of patients with psoriasis B. HLA- B27 is strongly associated with sacroiliitis and spondylitis, but not peripheral arthritis, in C. Seventy percent of patients with psoriatic arthritis have seronegative symmetrical polyarthritis D. The flexor tendon sheaths in the fingers are often inflamed and swollen ("sausage" digits) E. Monoarthritis or oligoarthritis may precede the onset of rush. 2763 Which of the following statements regarding the vasculitis syndromes is/are true? A. Wegener's granulomatosis characterized by infiltration of various organs and vessels with cellular in filtrates consisting of atypical lymphoid and plasmacytoid cells. B. Hypersensitivity vasculitis is often confined to the skin and often manifested by palpable C. Temporal arteritis usually involves small intracranial arterioles and venules. D. Takayasu's arteritis may involve the subclavia n arteries. E. Henoch-Schonlein purpura is usually progressive, leading to death or renal failure without

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