Day 25
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1.  A 40-year-old female complains of 7 weeks of pain and swelling in both wrists and knees. The patient complained of fatigue and lethargy several weeks before noticing the joint pain. The patient notes that after a period of rest, resistance to movement is more striking. On exam, the metacarpophalangeal joints and wrists are warm and tender. There are no other joint abnormalities. There is no alopecia, photosensitivity, kidney disease, or rash. Which of the following is correct? a. The clinical picture suggests early rheumatoid arthritis, and a rheumatoid factor should be obtained b. The prodrome of lethargy suggests chronic fatigue syndrome c. Lack of systemic symptoms suggests osteoarthritis d. X-rays of the hand are likely to show joint space narrowing and erosion
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2. A 35-year-old construction worker presents with complaints of nocturnal parasthesias of the thumb and the index and middle fingers. There is some atrophy of the thenar eminence. Tinel sign is positive. The most likely diagnosis  . Carpal tunnel syndrome b. De Quervain’s tenosynovitis c. Amyotrophic lateral sclerosis d. Rheumatoid arthritis of the wrist joint
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3. A 25-year-old male cigarette smoker has a history of respiratory infections and has also been found to have hematuria. A high value for diffusing capacity is noted during pulmonary function testing. This finding is consistent with which of the following disorders? a. Anemia b. Cystic fibrosis c. Emphysema d. Intrapulmonary hemorrhage
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4. A middle-aged  man complains of recurrent episodes of sudden-onset dizziness. He notices an abrupt onset of a spinning sensation when sitting up or lying down in bed. The symptoms last for 30 seconds and then resolve completely. He has no hearing change or other neurologic symptoms, and his physical examination is completely normal. A Dix-Hallpike maneuver reproduces his symptoms. Which of the following is the most likely mechanism for his vertigo symptoms? 
(A)  basilar migraine 
(B)  brain stem ischemic events 
(C)  benign cerebellar tumors 
(D)  calcium debris (calcium carbonate crystals) in the semicircular canals 
(E)  Meniere’s disease
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5. A 40-year-old man is injured in a car accident and fractures his left elbow. He now complains of numbness of his fourth and fifth fingers, and weakness in his hand grip. Neurologic findings confirm weakness of handgrip with weakness of finger abduction and adduction, and decreased sensation over the fifth finger and lateral aspect of fourth finger. Which of the following is the most likely diagnosis? 
(A)  ulnar nerve injury 
(B)  radial nerve injury 
(C)  median nerve injury 
(D)  carpal tunnel syndrome 
(E)  axillary nerve injury
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