A 62-year-old female with rheumatoid arthritis has enrolled in a clinical study to assess the effectiveness of several medications. Which of the following inhibits tumor necrosis factor by binding to its receptor?”

A patient with symmetrical polyarthritis has a positive rheumatoid factor at 1:320, an erythrocyte sedimentation rate of 58 mm/hour, a C-reactive protein of 1.3 mg/dL, anti-CCP at 58 units (40 to 59 units are considered strongly positive), and subcutaneous nodules at the Achilles tendon. Which of the following would not be an appropriate test?

What is NOT a contributing factor to the development of Osteoporosis?

What is the recommended dose of vitamin D in order to prevent osteoporosis?

Vitamin D deficiency leads to softening of bone, which is known as:

65-year-old female complains of upper and lower extremity pain and weakness. She has difficult arising from low chairs and climbing stairs. She also notes a facial rash. Exam shows proximal muscle weakness, reddish-purple skin discoloration around the eyes, purple nodules over the knees and elbows, and erythema over the joints of the fingers. What is the most probable diagnosis?

A 58-year-old female with no prior history presents with a complaint of bilateral hand pain for several weeks that is worse in the morning and improves with activity. She has warmth and mild tenderness of both hand proximal interphalangeal joints. The remainder of her exam is normal. What is the most likely diagnosis?

A 78-year-old male with a history of congestive heart failure, hyperlipidemia, myelodysplasia, and chronic kidney disease presents with an acute gout attack of his first metatarsal phalangeal joint. His medications include furosemide, lisinopril, aspirin, simvastatin, and atenolol. His last creatinine was 2.6 mg/dL and his uric acid was 8.5 mg/dL. Complete blood count shows white cell count of 5,200 cells/microliter, hemoglobin 8.5 g/dL, hematocrit 25.5%, and platelets of 72,000/microliter. What is the best treatment?

A 65-year-old patient presents with low back pain that is exacerbated by standing, improved by walking, and not changed with sitting. What is the most probable diagnosis?

28-year-old male military diver presents complaining of shin pain when ambulating for the past 4 months. Plain x-ray reveals a large, circumscribed region of bone loss in the tibial shaft involving both cortices. What should be involved in the next phase of this patient's care?

During the screening of a 72-year-old male, it is discovered that he has moderate bone thinning and is at risk for bone fracture. What is the current first-line treatment for such patients?

A middle-aged female was diagnosed with rheumatoid arthritis 2 years ago. She has been closely followed up and found to have low-level disease activity. At present, she has been managed on NSAIDs and has never been received disease-modifying antirheumatic drugs (DMARDs). In such patients with established disease, the American College of Rheumatology recommends what type of treatment?

A 28-year old male presents with 12 weeks of low back and sacral pain worse in the morning. He denies any injury or any recent illness. Exam reveals marked tenderness in the axial and peripheral joints. He also appears to have marked swelling of the tendons on his feet. On x-ray, he has subchondral sclerosis and erosions of the sacroiliac joints. What other feature on plain x-ray may be typical of his disease?

A 25-year-old male presents complaining of back pain that has been present for 2 months. He denies any trauma but says that he has a family history of joint problems. He says the pain is worse in the morning. On physical exam, he is tender to palpation over the lumbar spine and has limited chest expansion. He also is unable to touch his toes with his fingers while standing. Bloodwork reveals an elevated erythrocyte sedimentation rate and mild anemia. X-rays reveal that there is "squaring" of the lumbar vertebrae and symmetrical syndesmophyte formation ("bamboo spine"). Which of the following is not true regarding this condition?

Which of the following laboratory values is most consistent with osteoporosis in a 69-year-old female?

A 65-year-old female has a hip fracture and is diagnosed with osteoporosis. Laboratories show a calcium of 8.6 mg/dL, phosphate 2.9 mg/dL, creatinine 0.9 mg/dL, and 25-hydroxyvitamin D levels of 20 ng/mL (normal >30 ng/mL). A dual x-ray absorptiometry scan shows a t-score of negative 3. Which of the following is the best initial therapy for this patient

A patient with rheumatoid arthritis has had unsatisfactory treatment results from NSAIDs and, in fact, suffered significant gastrointestinal side effects from their use. His provider decides to try etanercept. Which of the following correctly gives the mechanism for the effectiveness of etanercept in rheumatoid arthritis treatment?

Which of the following is the anti-inflammatory agent with the least gastrointestinal upset?

In an otherwise healthy adult patient with no history of trauma which of the following is the most important tool to evaluate an acutely swollen knee

What are negatively birefringent, needle shaped crystals in synovial fluid?

Select the indication for starting therapy for Paget disease.

Which of the following laboratory findings is most consistent with osteoporosis?

Which of the following differentiates gout from pseudogout?

Bouchard nodes are most likely to be seen in a patient with which of the following conditions?

A 44 year old patient has been taking steroids for years for sarcoidosis. Recently the dosage was increased due to worsening of symptoms. He has noticed recently weakness in using his shoulder muscles and walking. What is the most likely diagnosis?

What is the most important cause of renal osteodystophy in patients with chronic renal failure?

How is interleukin 6 best described?

What is the primary medication in the treatment of rheumatoid arthritis?

Which one of the following is a side effect of bisphosphonates?

Which of the following presents with cotton wool skull?”

A 34-year-old female presents with a shawl rash. What is the most likely diagnosis?

What is the best indicator of disease activity in rheumatoid arthritis (RA)?

What percent of patients with gout develop nephrolithiasis?

A 72-year-old male patient presents with mild pain with activity in his left wrist and knee. The pain has been worsening over the past four years. He notices a "crunching" sensation when he flexes his knee. Which of the following diseases is probably causing his symptoms?

Which of the following about NSAIDS is FALSE?

A 60-year-old patient has monoarthritis of the right knee with effusion. Synovial fluid examination shows 6,000 white blood cells/mm3, negative Gram stain, and needle-shaped, negatively birefringent crystals. Which of the following is the most likely diagnosis?

By which of the following methods do bisphosphonates alter bone metabolism?

Which of the following differentiates osteomyelitis from bone infarction in patients with sickle cell anemia?

Who should be screened for osteoporosis with a DEXA scan to determine bone mineral density?