Q67) A 44 year old woman presents to your office with pain and swelling of the small joints in his hands and wrists. The symptoms have been progressing over the past 4 months. She denies any fever or weightloss. She reports stiffness in his both hands that occurs every morning and lasts for 2 hours. On examination, she has symmetrical involvement of both the wrists and two of her left proximal interphalangeal joints. The involved joints are swollen and tender. Laboratory tests shows normal ESR, negative rheumatoid factor, and a negative anti-CCP antibody. X-ray of the wrist and hands reveal mild joint space narrowing with only very small peripheral erosions. The most appropriate next step in management :
A. Prednisone
B. Start NSAID and follow-up in one month.
C. Start NSAID and Methotrexate
D. Start Infliximab
E. Start NSAID and Hydroxychloroquine
Q68) The patient in the above question is started on appropriate therapy. He returns to your clinic in 1 month for regular follow up and his disease is well controlled with near complete remission. The most important next step in follow up of this patient :
A. DEXA scan in 1 year
B. PPD placement
C. Check hepatitis B serology
D. Ophthalmology referral at 3 months
E. Liver function tests
e and d
c ande.methotrexate .lft has be done in 4 to 6 weeks
e
d
c and d
i meant, c and e
C
E
e. b’cos its modrate RA as RA and anti CCP -ve.
d. b’cos to check HCQ s/e
picked nsaid and check up in one month but then the follow up question made no sense so I looked up the answer and i wasn’t sure why they didn’t begin simple nsaids first since there was no elevated esr
no weight loss
I was just thinking that the DMARD was giving too soon …
i guess that means I have to go read LOL
C and E
its E and D… E because it is moderate RA (small peripheral erosions, negative lab work, normal ESR).. because u are starting on Hydroxychloroquine u want to follow up opthalmology.. thats my reasoning
C. Start NSAID and Methotrexate
E. Liver function tests
E, D