A 60-year-old female patient complains of pain in the hands that ...

[savannahhooper]

A 60-year-old female patient complains of pain in the hands that is worse in the morning. On physical examination, the thumb metacarpophalangeal joint is swollen on both hands.
 
  There is swelling of the proximal and distal interphalangeal joints bilaterally. These are typical signs of:
  A. Osteoarthritis
  B. Rheumatoid arthritis
  C. Normal aging
  D. Gouty arthritis

Question 2

Which of the following microorganisms causes Lyme disease?
 
  A. Clostridia
  B. Shigella
  C. Borrelia
  D. Epstein-Barr virus

[xiazhe]

Answer to Question 1

ANS: A
Compared with RA, OA has a higher likelihood of affecting larger joints, such as the hips and knees. Like RA, OA also frequently involves the small joints of the hands, although it tends to occur at the distal interphalangeal joints (Heberden's nodes) and proximal interphalangeal joints (Bouchard's nodes). Most frequently, the second and/or third digits and the base of the thumb are involved. The distribution is asymmetrical. The pain and stiffness associated with OA often improve with moderate use and are worse after extended periods of rest. If three or more metacarpophalangeal joints are swollen, the differential should include RA.

Answer to Question 2

ANS: C
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted by a bite from a deer tick. Whereas the incubation period ranges from 3 to 30 days, the onset of symptoms typically appears in 7 to 14 days. Although the disorder can be asymptomatic, the patient generally develops migratory polyarthralgia, myalgia, and neurological findings, including meningitis and/or neuropathy. An early finding is a solitary target lesion that may be followed by multiple lesions.

[savannahhooper]

Excellent

[alvinum]

TYSM