Question of the Week # 324

Posted on February 26, 2012 by Archer USMLE Reviews

324)  A 45 year old woman with history of Rheumatoid Arthritis presents to the emergency room increasing pain and swelling in her joints. She reports progressively increasing pain and stiffness of her bilateral wrist joints over the past two weeks. She now developed rapidly increasing pain and swelling in her right knee which prompted this Emergency Room visit. Her medications include Ibuprofen and Methotrexate. On examination, she is afebrile. There is mild swelling and tenderness in bilateral wrist joints. Right knee is warm, swollen and tender. Flexion and extension of the right knee  are severely painful.  Laboratory investigations are as follows:

WBC 9.0k/µl

Differential: Neutrophils 65%, Lymphocytes 24%, Monocytes 7%

Hemoglobin 11.5 g/dL ( Normal = 13.0 to 16.5 gm%),

Mean cell volume (MCV)  84  fL

Platelet count 510k/µl ( Normal 180 to 350k⁄μl )

ESR : 70 mm/hr

Which of the following is the most appropriate next step in management?

A)  Pulse Methyl Prednisolone

B)  Oral Prednsione

C) Arthrocentesis

D) Discontinue Methotrexate and start Infliximab

E) Intra-articular Glucocorticoids

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Question of the Week # 152

Posted on May 18, 2011 by Archer USMLE Reviews

152) A 34 year old woman with history of recently diagnosed Rheumatoid Arthritis presents to your office for follow up. She reports much improvement in her symptoms after starting Ibuprofen for pain. She was also started on Hydroxychloroquine 3 weeks ago. Which of the following is most appropriate in monitoring her therapy?

A)     Liver function tests every month

B)      Complete Blood Count every 3 months

C)      Serum Creatinine every week

D)     Ophthalmologic evaluation every year

E)      Hydroxychloroquine serum levels every month

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