Day 23
Diagnose the case, Give the investigations, suggest the management and select the rubrics

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1.  A 31-year-old woman presents to your clinic complaining of painful arthritis that is worse in the mornings when she wakes up. She was recently evaluated by an ophthalmologist for uveitis in her right eye. A recent laboratory report shows an erythrocyte sedimentation rate of 48 mm/h. Which of the following will be helpful in distinguishing relapsing polychondritis from rheumatoid arthritis (RA)? A. Arthritis associated with RA is non-erosive. B. Eye inflammation is absent in relapsing polychondritis. C. Relapsing polychondritis will not present with vasculitis. D. Relapsing polychondritis will present with high-titer rheumatoid factor. E. The arthritis of relapsing polychondritis is asymmetric.
 Justify your answer
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2. A 72-year-old male comes to the clinic with intermittent symptoms of dyspnea on exertion, palpitations, and cough occasionally productive of blood. On cardiac auscultation, a low-pitched diastolic rumbling murmur is faintly heard toward the apex. The origin of the patient’s problem probably relates to a. Rheumatic fever as a youth b. Long-standing hypertension c. Silent MI within the past year d. Congenital origin. Explain
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3. A 50-year-old woman presents with a complaint of “the worst headache in my life.” This was followed by a loss of consciousness, after which the patient recovers. What is the most likely cause? A. Middle meningeal artery occlusion 
B. Trauma of bridging meningeal veins 
C. Vertebrobasilar artery occlusion D. Rupture of a berry aneurysm E. Rupture of the posterior cerebral artery. Explain
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4. An elderly woman is examined because she has been getting lost on her way home in her neighborhood during the past several weeks. A Mini- Mental Status examination is administered to screen for cognitive deficits. She answers all of the questions correctly, but she has difficulty copying intersecting pentagons. In which of the following regions of the brain has this woman most likely experienced a stroke? A. Left occipital lobe B. Left frontal lobe C. Left parietal lobe D. Right parietal lobe E. Right temporal lobe. Give reason
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5. A 51-year-old male presents to your clinic complaining of lower back pain. When he exerts himself or lifts items, he describes worsening of the pain and also pain in the left buttock that radiates down the posterior left thigh. The patient denies pain at rest and any history of trauma. You examine his lower back. Which examination maneuver is the most specific for lumbar disk herniation? A. Right straight leg raise B. Left straight leg raise C. Right crossed straight leg raise D. Left crossed straight leg raise E. Reverse straight leg raise

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