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Q.ld: 4382 ( Previous Ne><t Lab Values Notes Calculator

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A 29-year-old woman presents to your office complaining of fatigue for the last several months. She says that
she tires easily after walking short distances and has difficulty combing her hair due to an inability to hold her
hands over her head for a long time. She reports anxiety, irritability, and a weight loss of eight pounds over the
last two months. She denies fever or loss of appetite. She does not smoke or consume alcohol. Her father
died of a stroke when he was 54 years old and her mother has diabetes mellitus. On examination. she is
afebrile with a pulse of 125/min. Cardiac exam reveals a regular rhythm with no murmur. Her lungs are clear
to auscultation. Her gait is normal, but when asked to sit down slowly she drops into the chair. A fine finger
tremor is evident when she extends her arms. Her muscles are non-tender to palpation. She appears to
have decreased muscle mass in her shoulders. Deep tendon reflexes are normal. Which of the following is
the most likely cause of this patient's symptoms?

r A. Basal ganglia lesion

r B. Cerebellar dysfunction
r C.lnflammatory muscle disease
r D. Neuromuscular junction disorder
r E. Polyneuropathy
r F. Thyroid disease
r G. Upper motor neuron disease
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Item: 2 of 4
Q. ld: 3574 (
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A 33-year-old tennis player comes to you with a complaint of pain in his right shoulder. He says that the pain
is absent at rest but present when he lifts his arm over his head. The pain is compromising his play. On
examination. active motion at right shoulder is limited due to pain. Pain is most severe on passive internal
rotation and flexion at the right shoulder. No atrophy of the shoulder muscle is seen. Which of the following is
the most likely diagnosis in this patient?

r A. Tear of long head of bicep tendon

r B. Tennis elbow
r C. Subacromial bursitis
r D. Anterior dislocation of shoulder
r E. Axillary nerve palsy
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2 Item: 3 of 4 11 PMark <:1 t>- I

Q.ld: 3059 ( Previous Ne><t Lab Values Notes Calculator

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A 45-year-old woman presents to your office complaining of one week of fatigue and weakness in her
shoulders and hips. She reports difficulty performing household tasks. climbing the stairs. or rising from a
chair. She denies any facial weakness or blurry vision. She has a history of gastroesophageal reflux disease
and takes over the counter ranitidine. Her family history is positive for breast cancer in her mother. Her vital
signs are within normal limits and examination shows normal sensation and deep tendon reflexes. Strength is
4 out of 5 in the proximal muscles groups of the arms and legs. and there is no limitation in the range of
motion. Other physical examination is within normal limits. The ESR is 80 mm/hour and her serum creatine
kinase is elevated. The TSH is within normal limits. Which of the following is the best initial treatment for this
patient?

r A. Indomethacin
r B. Corticosteroids
r C. Colchicine
r D. Riluzole
r E. Amitriptyline
r F. Oxycodone
r G. Pyridostigmine
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Q.ld: 3149 ( Previous Ne><t Lab Values Notes Calculator

3

A 54-year-old man presents to the emergency room with acute pain. swelling and redness of his right knee.
He had one episode of gouty arthritis a year ago that resolved quickly with indomethacin. He also has type 2
diabetes. hypertension and chronic renal disease. He does not use any illicit drugs. His temperature is
38.3•c (1 00.9.F). blood pressure is 110/65 mmHg, and pulse is 11 0/min. Examination reveals a tender,
erythematous effusion of the right knee with decreased range of motion. Which of the following is the most
appropriate next step in management?

r A. Serum uric acid level

r B. Indomethacin
r C. X-ray of the knee
r D. MRI of the knee
r E. Synovial fluid analysis
r F. Bone scan