TABLE IV-114 Risk Factors for Active Tuberculosis Among Persons Who Have Been Infected With Tubercle Bacilli 24 page

C. Nonrecognition of benign foreign molecules or microbes.

D. Recognition by germ line–encoded host molecules.

E. Recognition of key microbe virulence factors but not recognition of self molecules.

IX-2. A 29-year-old male with episodic abdominal pain and stress-induced edema of the lips, the tongue, and occasionally the larynx is likely to have low functional or absolute levels of which of the following proteins?

A. C1 esterase inhibitor

B. C5A (complement cascade)

C. Cyclooxygenase

D. IgE

E. T-cell receptor, α chain

IX-3. Which of the following statements best describes the function of proteins encoded by the human major histo-compatibility complex (MHC) I and II genes?

A. Activation of the complement system

B. Binding to cell surface receptors on granulocytes and macrophages to initiate phagocytosis

C. Nonspecific binding of antigen for presentation to T cells

D. Specific antigen binding in response to B-cell activation to promote neutralization and
precipitation

IX-4. A 37-year-old man has recently been diagnosed with systemic hypertension. He is prescribed lisinopril as initial monotherapy. He takes this medication as prescribed for 3 days and on the third day notes that his right hand is swollen, mildly itchy, and tingling. Later that evening his lips become swollen and he has difficulty breathing. Which of the following statements accurately describes this condition?

A. His symptoms are due to direct activation of mast cells by lisinopril.

B. His symptoms are due to impaired bradykinin degradation by lisinopril.

C. His symptoms are unlikely to recur if he is switched to enalapril.

D. Peripheral blood analysis will show deficiency of C1 inhibitor.

E. Plasma IgE levels are likely to be elevated.

IX-5. A 35-year-old female comes to the local health clinic for recurrent urticarial lesions that occasionally leave a residual discoloration for the last 6 months. She also has had arthralgias. The sedimentation rate now is 85 mm/h. The procedure most likely to yield the correct diagnosis in this case would be:

A. A battery of wheal-and-flare allergy skin tests

B. Measurement of total serum IgE concentration

C. Measurement of C1 esterase inhibitor activity

D. Skin biopsy

E. Patch testing

IX-6. A 28-year-old woman seeks evaluation from her primary care doctor for recurrent episodes of hives and states that she is “allergic to cold weather.” She reports that for more than 10 years she has developed areas of hives when exposed to cold temperatures, usually on her arms and legs. She has not sought evaluation previously and states that over the past several years the occurrence of the hives has become more frequent. Other than cold exposure, she can identify no other triggers for the development of hives. She has no history of asthma or atopy. She denies food intolerance. Her only medication is oral contraceptive pills, which she has taken for 5 years. She lives in a single-family home that was built 2 years ago. On examination, she develops a linear wheal after being stroked along her forearm with a tongue depressor. Upon placing her hand in cold water, her hand becomes red and swollen. In addition, there are several areas with a wheal and flare reaction on the arm above the area of cold exposure. What is the next step in the management of this patient?

A. Assess for the presence of antithyroglobulin and anti-microsomal antibodies.

B. Check C1 inhibitor levels.

C. Discontinue the oral contraceptive pills.

D. Treat with cetirizine, 10 mg daily.

E. Treat with cyproheptadine, 8 mg daily.

IX-7. A 23-year-old woman seeks evaluation for seasonal rhinitis. She reports that she develops symptoms yearly in the spring and fall. During this time, she develops rhinitis with postnasal drip and cough that disrupts her sleep. In addition, she will also have itchy and watery eyes. When the symptoms occur, she takes nonprescription loratadine, 10 mg daily, with significant improvement in her symptoms. What is the most likely allergen(s) that is/are causing this patient’s symptoms?

A. Grass

B. Ragweed

C. Trees

D. A and B

E. B and C

F. All of the above

IX-8. Which of the following autoantibodies is most likely to be present in a patient with systemic lupus

erythematosus?

A. Anti-dsDNA

B. Anti-RNP

C. Anti-Ro

D. Antiphospholipid

E. Antiribosomal P

IX-9. A 23-year-old woman is evaluated by her primary care physician because she is concerned that she may have systemic lupus erythematosus after hearing a public health announcement on the radio. She has no significant past medical history, and her only medication is occasional ibuprofen. She is not sexually active and works in a grocery store. She reports that she has had intermittent oral ulcers and right knee pain. Physical examination shows no evidence of alopecia, skin rash, or joint swelling/inflammation. Her blood work shows that she has a positive antinuclear antibody (ANA) at a titer of 1:40, but no other abnormalities. Which of the following statements is true?

A. Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus; this
patient has three.

B. Four diagnostic criteria are required to be diagnosed with systemic lupus erythematosus; this
patient has two.

C. If a urinalysis shows proteinuria, she will meet the criteria for systemic lupus erythematosus.

D. She meets the criteria for systemic lupus erythematosus because she has three criteria for the
disease.

E. The demonstration of a positive ANA alone is adequate to diagnose systemic lupus
erythematosus.

IX-10. A 32-year-old woman with a long-standing diagnosis of systemic lupus erythematosus is evaluated by her rheumatologist as routine follow-up. A new cardiac murmur is heard and an echocardiogram is ordered. She is feeling well, and has no fevers, weight loss, or preexisting cardiac disease. A vegetation on the mitral valve is demonstrated. Which of the following statements is true?

A. Blood cultures are unlikely to be positive.

B. Glucocorticoid therapy has been proven to lead to improvement in this condition.

C. Pericarditis is frequently present concomitantly.

D. The lesion has a low risk of embolization.

E. The patient has been surreptitiously using injection drugs.

IX-11. A 24-year-old woman is newly diagnosed with systemic lupus erythematosus. Which of the following organ system complications is she most likely to have over the course of her lifetime?

A. Cardiopulmonary

B. Cutaneous

C. Hematologic

D. Musculoskeletal

E. Renal

IX-12. A 27-year-old female with systemic lupus erythematosus (SLE) is in remission; current treatment consists of azathioprine 75 mg/d and prednisone 5 mg/d. Last year she had a life-threatening exacerbation of her disease. She now strongly desires to become pregnant. Which of the following is the least appropriate action to take?

A. Advise her that the risk of spontaneous abortion is high.

B. Warn her that exacerbations can occur in the first trimester and in the postpartum period.

C. Tell her it is unlikely that a newborn will have lupus.

D. Advise her that fetal loss rates are higher if anticardiolipin antibodies are detected in her serum.

E. Stop the prednisone just before she attempts to become pregnant.

IX-13. A 45-year-old African-American woman with systemic lupus erythematosus (SLE) presents to the emergency department with complaints of headache and fatigue. Her prior manifestations of SLE have been arthralgias, hemolytic anemia, malar rash, and mouth ulcers, and she is known to have high titers of antibodies to double-stranded DNA. She currently is taking prednisone, 5 mg daily, and hydroxychloroquine, 200 mg daily. On presentation, she is found to have a blood pressure of 190/110 mmHg with a heart rate of 98 beats/min. A urinalysis shows 25 red blood cells (RBCs) per high-power field with 2+ proteinuria. No RBC casts are identified. Her blood urea nitrogen is 88 mg/dL, and creatinine is 2.6 mg/dL (baseline 0.8 mg/dL). She has not previously had renal disease related to SLE and is not taking nonsteroidal anti-inflammatory drugs. She denies any recent illness, decreased oral intake, or diarrhea. What is the most appropriate next step in the management of this patient?

A. Initiate cyclophosphamide, 500 mg/m² body surface area I V, and plan to repeat monthly for 3–6
months.

B. Initiate hemodialysis.

C. Initiate high-dose steroid therapy (IV methylprednisolone, 1000 mg daily for 3 doses, followed
by oral prednisone, 1 mg/kg daily) and mycophenolate mofetil, 2 g daily.

D. Initiate plasmapheresis.

E. Withhold all therapy until renal biopsy is performed.

IX-14. A 25-year-old African-American woman was has been followed in SLE clinic since her diagnosis 6 months ago. At that time she had evidence of mild joint disease, photosensitivity, malar rash, positive ANA, and anti-dsDNA. Her renal function and urinalysis were normal. She has been maintained on acetaminophen and hydroxychloroquine. She comes to the emergency department after a recent outing to the beach with friends. Over the past 2 days she’s noticed a marked increase in her fatigue and morning stiffness. She also has red-tinged urine. Physical examination is notable for a skin rash in sun-exposed areas, and diffuse wrist, knee, and ankle synovial thickening. Her platelet count has fallen from normal values to 45,000 and she has new leukopenia. In addition, her serum creatinine is 2.5 and there are RBC casts on urine analysis. An emergent renal biopsy is consistent with active diffuse lupus nephritis. After receiving methylprednisolone 1 g IV for 3 days, all of the following are appropriate treatment regimens EXCEPT:

A. Prednisone 60 mg/d

B. Prednisone 60 mg/d plus azathioprine

C. Prednisone 60 mg/d plus cyclophosphamide

D. Prednisone 60 mg/d plus mycophenolate mofetil

E. Rituximab

IX-15. A 27-year-old woman is admitted to the intensive care unit after delivery of a full-term infant 3 days prior. The patient was found to have right hemiparesis and a blue left hand. Physical examination is also notable for livedo reticularis. Her laboratories were notable for a white blood cell count of 10.2/μL, hematocrit 35%, and platelet count of 13,000/μL. Her BUN is 36 mg/dL and her creatinine is 2.3 mg/dL. Although this pregnancy was uneventful, the three prior pregnancies resulted in early losses. A peripheral smear shows no evidence of schistocytes. Which of the following laboratory studies will best confirm the underlying etiology of her presentation?

A. Anticardiolipin antibody panel

B. Antinuclear antibody

C. Doppler examination of her left arm arterial tree

D. Echocardiography

E. MRI of her brain

IX-16. A 28-year-old woman comes to the emergency department complaining of 1 day of worsening right leg pain and swelling. She drove in a car for 8 hours returning from a hiking trip 2 days ago then noticed some pain in the leg. At first she thought it was due to exertion but it has worsened over the day. Her only past medical history is related to difficulty getting pregnant with 2 prior spontaneous abortions. Her physical examination is notable for normal vital signs and heart and lung examination. Her right leg is swollen from the mid-thigh down and is tender. Doppler studies demonstrate a large deep venous thrombosis in the femoral and ileac veins extending into the pelvis. Laboratory studies on admission prior to therapy show normal electrolytes, normal white blood cell (WBC) and platelet counts, normal prothrombin time, and an activated partial thromboplastin time 3× normal. Her pregnancy test is negative. Low-molecular-weight heparin therapy is initiated in the emergency department. Subsequent therapy should include:

A. Rituximab 375 mg/m² per week for 4 weeks

B. Warfarin with INR goal of 2.0–3.0 for 3 months

C. Warfarin with INR goal of 2.0–3.0 for 12 months

D. Warfarin with INR goal of 2.5–3.5 for life

E. Warfarin with an INR goal of 2.5–3.5 for 12 months followed by daily aspirin for life

IX-17. Which of the following is the most frequent site of joint involvement in established rheumatoid arthritis (RA)?

A. Distal interphalangeal joint

B. Hip

C. Knee

D. Spine

E. Wrist

IX-18. In patients with established rheumatoid arthritis, all of the following pulmonary radiographic findings may be explained by their rheumatologic condition EXCEPT:

A. Bilateral interstitial infiltrates

B. Bronchiectasis

C. Lobar infiltrate

D. Solitary pulmonary nodule

E. Unilateral pleural effusion

IX-19. Which of the following is the earliest plain radiographic finding of rheumatoid arthritis?

A. Juxtaarticular osteopenia

B. No abnormality

C. Soft-tissue swelling

D. Subchondral erosions

E. Symmetric joint space loss

IX-20. Which of the following statements regarding rheumatoid arthritis is true?

A. Africans and African Americans most commonly have the class II major histocompatibility
complex allele HLA-DR4.

B. Females are affected three times more often than are males, and this difference is maintained
throughout life.

C. The earliest lesion in rheumatoid arthritis is an increase in the number of synovial lining cells
with microvascular injury.

D. There is an association with the class II major histocompatibility complex allele HLA-B27.

E. Titers of rheumatoid factor are not predictive of the severity of rheumatoid arthritis or its
extraarticular manifestations.

IX-21. A 46-year-old woman presents to your clinic with multiple complaints. She describes fatigue and general malaise over 2–3 months. Her appetite has decreased. She thinks she has unintentionally lost approximately 5.5 kg. Lately, she notes pain and stiffness in her fingers on both hands that is worse in the morning and with repetitive movement. She has a grandmother and a sister who have rheumatoid arthritis, and she is very concerned that she now has it as well. Which of her complaints represents the most common manifestation of established rheumatoid arthritis?

A. Fatigue and anorexia for more than 2 months with concomitant joint pain

B. Morning joint stiffness lasting for more than 1 hour

C. Pain in symmetric joints that is worsened with movement

D. Positive family history with two relatives with RA

E. Weight loss of more than 4.5 kg during period of active disease

IX-22. All of the following are characteristic extraarticular manifestations of rheumatoid arthritis EXCEPT:

A. Anemia

B. Cutaneous vasculitis

C. Pericarditis

D. Secondary Sjögren’s syndrome

E. Thrombocytopenia

IX-23. All of the following agents have been shown to have disease-modifying antirheumatic drug (DMARD) efficacy in patients with rheumatoid arthritis EXCEPT:

A. Infliximab

B. Leflunomide

C. Methotrexate

D. Naproxen

E. Rituximab

IX-24. Which of the following is the most common clinical presentation of acute rheumatic fever (ARF)?

A. Carditis

B. Chorea

C. Erythema marginatum

D. Polyarthritis

E. Subcutaneous nodules

IX-25. A 19-year-old recent immigrant from Ethiopia comes to your clinic to establish primary care. She currently feels well. Her past medical history is notable for a recent admission to the hospital for new-onset atrial fibrillation. As a child in Ethiopia, she developed an illness that caused uncontrolled flailing of her limbs and tongue lasting approximately 1 month. She also has had three episodes of migratory large-joint arthritis during her adolescence that resolved with pills that she received from the pharmacy. She is currently taking metoprolol and warfarin and has no known drug allergies. Physical examination reveals an irregularly irregular heart beat with normal blood pressure. Her point of maximal impulse (PMI) is most prominent at the midclavicular line and is normal in size. An early diastolic rumble and a 3/6 holosystolic murmur are heard at the apex. A soft early diastolic murmur is also heard at the left third intercostal space. You refer her to a cardiologist for evaluation of valve replacement and echocardiography. What other intervention might you consider at this time?

A. Glucocorticoids

B. Daily aspirin

C. Daily doxycycline

D. Monthly penicillin G injections

E. Penicillin G injections as needed for all sore throats

IX-26. A patient with a diagnosis of scleroderma who has diffuse cutaneous involvement presents with malignant hypertension, oliguria, edema, hemolytic anemia, and renal failure. You make a diagnosis of scleroderma renal crisis (SRC). What is the recommended treatment?

A. Captopril

B. Carvedilol

C. Clonidine

D. Diltiazem

E. Nitroprusside

IX-27. A 57-year-old woman with depression and chronic migraine headaches reports several years of dry mouth and dry eyes. Her primary complaint is that she can no longer eat her favorite crackers, though she does report photosensitivity and eye burning on further questioning. She has no other associated symptoms. Examination shows dry, erythematous, sticky oral mucosa. All of the following tests are likely to be positive in this patient EXCEPT:

A. La/SS-B antibody

B. Ro/SS-A antibody

C. Schirmer’s I test

D. Scl-70 antibody

E. Sialometry

IX-28. Which of the following is the most common extra-glandular manifestation of primary Sjögren’s syndrome?

A. Arthralgias/arthritis

B. Lymphoma

C. Peripheral neuropathy

D. Raynaud’s phenomenon

E. Vasculitis

IX-29. A 44-year-old woman presents for evaluation of dry eyes and mouth. She first noticed these symptoms more than 5 years ago and the symptoms have worsened over time. She describes her eyes as gritty feeling, as if there were sand in her eyes. Sometimes her eyes burn, and she states that it is difficult to be outside in bright sunlight. In addition, her mouth is quite dry. In her job, she is frequently asked to give business presentations and finds it increasingly difficult to complete a 30- to 60-minute presentation. She has water with her at all times. Although she reports good dental hygiene without any recent changes, her dentist has had to place fillings twice in the past 3 years for dental caries. Her only other past medical history is treated tuberculosis that she contracted while in the Peace Corps in Southeast Asia when in her 20s. She takes no medication regularly and does not smoke. Ocular examination reveals punctuate corneal ulcerations on Rose Bengal stain, and the Schirmer’s test shows greater than 5 mm of wetness after 5 minutes. Her oral mucosa is dry with thick mucous secretions, and the parotid glands are enlarged bilaterally. Laboratory examination reveals positive antibodies to Ro and La (SS-A and SS-B). In addition, her chemistries reveal a sodium of 142 meq/L, potassium 2.6 meq/L, chloride 115 meq/L, and bicarbonate of 15 meq/L. What is the most likely cause of the hypokalemia and acidemia in this patient?

A. Diarrhea

B. Distal (type I) renal tubular acidosis

C. Hypoaldosteronism

D. Purging with underlying anorexia nervosa

E. Renal compensation for chronic respiratory alkalosis

IX-30. A patient with primary Sjögren’s syndrome that was diagnosed 6 years ago and treated with tear replacement for symptomatic relief notes continued parotid swelling for the last 3 months. She has also noted enlarging posterior cervical lymph nodes. Evaluation shows leukopenia and low C4 complement

levels. What is the most likely diagnosis?

A. Amyloidosis

B. Chronic pancreatitis

C. HIV infection

D. Lymphoma

E. Secondary Sjögren’s syndrome

IX-31. The histocompatibility antigen HLA-B27 is present in what percentage of patients with ankylosing spondylitis?

A. 10%

B. 30%

C. 50%

D. 90%

E. 100%

IX-32. Which of the following is the most common extra-articular manifestation of ankylosing spondylitis?

A. Anterior uveitis

B. Aortic insufficiency

C. Inflammatory bowel disease

D. Pulmonary fibrosis

E. Third-degree heart block

IX-33. A 25-year-old man sees his primary care physician for evaluation of low back pain. The pain is severe, is worse in the morning, and is relieved with exercise and is worse with rest; in particular, nighttime sleeping is difficult. He does feel quite stiff in the morning for at least 30 minutes. An MRI of his lower back is obtained and shows active inflammation in the sacroiliac joint. On further questioning, he reports a history of unilateral eye redness treated with corticosteroids about 2 years ago. A test for HLA-B27 is positive. Which of the following is first-line therapy for his condition?

A. Infliximab

B. Naproxen

C. Prednisone

D. Rituximab

E. Tramadol

IX-34. A 27-year-old man is seen at his primary care physician’s office for evaluation of painful arthritis involving the right knee that is associated with finger welling diffusely. He is otherwise healthy, but does recall a severe bout of diarrheal illness about 3–4 weeks prior that spontaneously resolved. He takes no medications and reports rare marijuana use. On review of systems, he reports painful urination. Examination shows inflammatory arthritis of the right knee, dactylitis, and normal genitourinary examination. He is diagnosed with reactive arthritis. Which of the following is the most likely etiologic agent of his diarrhea?

A. Campylobacter jejuni

B. Clostridium difficile

C. Escherichia coli

D. Helicobacter pylori

E. Shigella flexneri

IX-35. A 28-year-old woman undergoes evaluation for weight loss and bloody diarrhea that is ultimately diagnosed as Crohn’s disease. She has been diagnosed with dactylitis and bilateral sacroiliitis within the past 6 months. She is scheduled to begin treatment with infliximab in 2 weeks for her Crohn’s disease. Which of the following statements is true regarding the effect of infliximab on her arthritis?

A. Although infliximab is likely to improve her arthritic symptoms, NSAIDs should be tried first.

B. Although infliximab is very effective therapy for Crohn’s disease, it will have no effect on her
arthritis.

C. Her arthritis is unrelated to Crohn’s disease, and because of this she should undergo a thorough
evaluation for infectious causes before undergoing immunosuppressive therapy.

D. Infliximab is very effective therapy for this type of arthritis.

E. None of the above.

IX-36. Which of the following statements regarding the arthritis of Whipple’s disease is true?

A. Arthritis is a rare finding in Whipple’s disease.

B. Joint manifestations are usually concurrent with gastrointestinal symptoms and malabsorption.

C. Radiography frequently shows joint erosions.

D. Synovial fluid examination is unlikely to show polymorphonuclear cells.

E. None of the above.

IX-37. A 35-year-old man has severe ankylosing spondylitis that is unresponsive to NSAID therapy. Therapy with infliximab has been recommended and he is wondering about potential side effects. All of the following are common potential side effects from this medication EXCEPT:

A. Demyelinating disorders

B. Disseminated tuberculosis

C. Exacerbation of congestive heart failure

D. Hypersensitivity pneumonitis

E. Pancytopenia

IX-38. Which of the following definitions best fits the term enthesitis?

A. Alteration of joint alignment so that articulating surfaces incompletely approximate each other

B. Inflammation at the site of tendinous or ligamentous insertion into bone

C. Inflammation of the periarticular membrane lining the joint capsule

D. Inflammation of a saclike cavity near a joint that decreases friction

E. A palpable vibratory or crackling sensation elicited with joint motion

IX-39. A 35-year-old female presents to her primary care doctor complaining of diffuse body and joint pain. When asked to describe which of her joints are most affected, she answers, “All of them.” There is no associated stiffness, redness, or swelling of the joints. No Raynaud’s phenomenon has been appreciated. Occasionally she notes numbness in the fingers and toes. The patient complains of chronic pain and poor sleep quality that she feels is due to her pain. She previously was seen in the clinic for chronic headaches that were felt to be tension related. She has tried taking over-the-counter ibuprofen twice daily without relief of pain. She has no other medical problems. On physical examination, the patient appears comfortable. Her joints exhibit full range of motion without evidence of inflammatory arthritis. She does have pain with palpation at bilateral suboccipital muscle insertions, at C5, at the lateral epicondyle, in the upper outer quadrant of the buttock, at the medial fat pad of the knee proximal to the joint line, and unilaterally on the second right rib. The erythrocyte sedimentation rate is 12 seconds. Antinuclear antibodies are positive at a titer of 1:40 in a speckled pattern. The patient is HLA-B27 positive. Rheumatoid factor is negative. Radiograms of the cervical spine, hips, and elbows are normal. What is the most likely diagnosis?

A. Ankylosing spondylitis

B. Disseminated gonococcal infection

C. Fibromyalgia

D. Rheumatoid arthritis

E. Systemic lupus erythematosus

IX-40. A 42-year-old male presents with complaints of a rash and joint pain. He first noticed the rash 6 months ago. It is primarily on the hands (Figure IX-40), the extensor surfaces of the elbows, and the knees, low back, and scalp. Although he complains of the appearance of these lesions, they do not itch or hurt. He has not been previously evaluated for them and has recently noticed changes in the nail beds. For the last 2 weeks, the patient has had increasingly severe pain in the distal joints of the hands and feet. His hands are so painful that he is having trouble writing and holding utensils. He denies fevers, weight loss, fatigue, cough, shortness of breath, or changes in bowel or bladder habits. Which of the following is the most likely diagnosis?

C. Osteoarthritis

D. Psoriatic arthritis

E. Rheumatoid arthritis

IX-41. All of the following vasculitic syndromes are thought to be due to immune complex deposition EXCEPT:

A. Cryoglobulinemic vasculitis

B. Henoch-Schönlein purpura

C. Polyarteritis nodosa associated with hepatitis B

D. Serum sickness

E. Granulomatosis with polyangiitis (Wegener’s)

IX-42. A 53-year-old man presents with a vasculitis syndrome. His cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) is positive. Which of the following syndromes is he most likely to have?

A. Churg-Strauss syndrome

B. Henoch-Schönlein purpura

C. Microscopic polyangiitis

D. Ulcerative colitis

E. Granulomatosis with polyangiitis (Wegener’s)

IX-43. A 40-year-old male presents to the emergency department with 2 days of low-volume hemoptysis. He reports that he has been coughing up 2–5 tablespoons of blood each day. He reports mild chest pain, low-grade fevers, and weight loss. In addition, he has had about 1 year of severe upper respiratory symptoms including frequent epistaxis and purulent discharge treated with several courses of antibiotics. Aside from mild hyperlipidemia, he is otherwise healthy. His only medications are daily aspirin and lovastatin. On physical examination he has normal vital signs, and the upper airway is notable for saddle nose deformity and clear lungs. A CT of the chest shows multiple cavitating nodules, and urinalysis shows red blood cells. Which of the following tests offers the highest diagnostic yield to make the appropriate diagnosis?

A. Deep skin biopsy

B. Percutaneous kidney biopsy

C. Pulmonary angiogram

D. Surgical lung biopsy

E. Upper airway biopsy

IX-44. An 84-year-old woman sees her primary care physician for evaluation of severe headaches. She noted these several weeks ago and they have been getting worse. Although she has not had any visual aura, she is concerned that she has been intermittently losing vision in her left eye for the last few days. She denies new weakness or numbness, but she does report jaw pain with eating. Her past medical history includes coronary artery disease requiring a bypass grafting 10 years prior, diabetes mellitus, hyperlipidemia, and mild depression. Full review of symptoms is notable for night sweats and mild low back pain that is particularly prominent in the morning. Which of the following is the next most

Date: 2016-04-22; view: 1057