Sjögren's syndrome — MCQs

A 47-year-old woman presents to her physician for difficulty swallowing. She states that she intentionally delayed seeing a physician for this issue. She says her primary issue with swallowing is that her mouth always feels dry so she has difficulty chewing food to the point that it can be swallowed. On physical examination, her oral mucosa appears dry. Both of her eyes also appear dry. Several enlarged lymph nodes are palpated. Which of the following patterns of reactive lymphadenitis is most commonly associated with this patient’s presentation?

A 58-year-old woman presents to the physician with a throbbing headache. She says she had it for the last year and it’s usually located in the right temporal area. There is localized tenderness over the scalp. During the last 2 weeks, she experienced 3 episodes of transient loss of vision on the right side, without ocular pain. On physical examination, her vital signs are normal. Palpation reveals that the pulsations of the superficial temporal artery on the right side are reduced in amplitude. Laboratory studies show: Blood hemoglobin 10.7 g/dL (6.64 mmol/L) Leukocyte count 8,000/mm3 (8.0 x 109/L) Platelet count 470,000/mm3 (470 x 109/L) Erythrocyte sedimentation rate 60 mm/h (60 mm/h) Which of the following conditions is most likely to co-exist with the presenting complaint in this woman?

A 51-year-old man is bitten by a cottonmouth viper and is successfully treated with sheep hyperimmune Fab antivenom. Three days later, the patient develops an abdominal itchy rash and re-presents to the emergency department for medical care. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type II, and multiple basal cell carcinomas on his face and neck. He currently smokes 1 pack of cigarettes per day, drinks a 6-pack of beer per day, and denies any current illicit drug use. His vital signs include: temperature 40.0°C (104.0°F), blood pressure 126/74 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, his gait is limited by diffuse arthralgias, lung sounds are clear bilaterally, and he has normal heart sounds. The patient has a pruritic periumbilical serpiginous macular rash that has spread to involve the back, upper trunk, and extremities. Of the following options, which is the next best step in patient management?

A biology student is studying apoptosis pathways. One of the experiments conducted involves the binding of a ligand to a CD95 receptor. A defect of this pathway will most likely cause which of the conditions listed below?

A 51-year-old woman comes to the physician because of fatigue and progressive pain and stiffness in her hands for 3 months. She used to play tennis but stopped 1 month ago because of difficulties holding the racket and her skin becoming “very sensitive to sunlight.” Her last menstrual period was 1 year ago. She has diabetes mellitus controlled with insulin. She does not smoke or drink alcohol. Vital signs are within normal limits. The patient appears tanned. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. Which of the following is the most appropriate next step in diagnosis?

A previously healthy 30-year-old woman comes to the physician because of a 6-month history of a recurring rash that typically occurs on exposure to the sun and affects only the face. She also has noticed several nonpainful ulcers on the roof of her mouth. She is sexually active with one male partner and they use condoms inconsistently. Her mother has end-stage renal disease. The patient does not smoke or drink alcohol. Her vital signs are within normal limits. Physical examination shows an erythematous rash across the cheeks that spares the nasolabial folds. There are three small ulcers on the hard palate. Laboratory studies show: Leukocyte count 3,000/mm3 Platelet count 70,000/mm3 Erythrocyte sedimentation rate 80 mm/h Serum Antinuclear antibodies 1:320 Anti-Smith antibodies positive Urine Protein 3+ RBC casts negative RBCs none WBCs 10–15/hpf Which of the following is the most appropriate next step in management?

A 42-year-old woman presents complaining of pain in her hands. She reports that the pain is in both hands, and that it is usually worse in the morning. She reports that her hands are also stiff in the morning, but that this gradually improves throughout the morning. She notes, however, that her symptoms seem to be getting worse over the last three months. What is the most likely pathogenesis of her disease process?

A 53-year-old woman presents to her primary care provider complaining of fatigue for the last several months. She reports feeling tired all day, regardless of her quality or quantity of sleep. On further questioning, she has also noted constipation and a 4.5 kg (10 lb) weight gain. She denies shortness of breath, chest pain, lightheadedness, or blood in her stool. At the doctor’s office, the vital signs include: pulse 58/min, blood pressure 104/68 mm Hg, and oxygen saturation 98% on room air. The physical exam shows only slightly dry skin. The complete blood count (CBC) is within normal limits. Which of the following best describes the pathogenesis of this patient's condition?

Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen

A 55-year-old woman presents to the office complaining of leg ulcers for the past 6 months. She has a chronic history of severe rheumatoid arthritis controlled with methotrexate. She does not drink alcohol or smoke cigarettes. Her vitals are normal. Her lungs are clear to auscultation. The abdomen is soft and non-tender with a palpable spleen tip on inspiration. Skin examination shows scattered ulcers on the legs in various stages of healing. Additionally, metacarpophalangeal and proximal interphalangeal joints are tender. Varicose veins are not observed. Laboratory results are as follows: Hemoglobin 10.5 g/dL MCV 74 fl Platelets 226,000/mm3 White blood cells 2500/mm3 Neutrophils 20% Alanine aminotransferase 36 U/L Aspartate aminotransferase 39 U/L Creatinine 1.0 mg/dL HIV test is negative. Which of the following is the most likely cause of this patient's condition?