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Self-Assessment Questions

Rheumatology

Osteoarthritis: Review Questions

Janet F. Burkholder, MD

Dr. Burkholder is Assistant Professor of Medicine, Section of Rheumatology, Temple University School of Medicine, Philadelphia, PA, and Associate Director,
Arthritis Joint Center, Temple University Hospital, Philadelphia.



Choose the single best answer for each question.

1. A 43-year-old teacher presents for evaluation of diffuse joint pain. In addition to arthralgias, the patient describes numbness and tingling in his fingers that is worse at night. His medical history is notable for diabetes and hypertension. On examination his wrists, back, and knees are hyperextensible, and he has marked pronation of the ankles. The patient’s wrists appear thickened without clear evidence of synovitis, and Phalen’s maneuver is positive bilaterally. Radiographs of the hands are consistent with degenerative osteoarthritis, and distal digital tufting is noted. Which of the following is the most likely cause of this patient’s osteoarthritis?
  1. Wilson’s disease
  2. Ehlers-Danlos syndrome, type III
  3. Ochronosis
  4. Primary generalized osteoarthritis
  5. Acromegaly
Click here to compare your answer.


2. Characteristic radiographic findings in osteoarthritis include all of the following EXCEPT:

  1. Osteophytes
  2. Symmetrical joint space narrowing
  3. Subchondral cysts
  4. Subchondral bone sclerosis
  5. Subluxation
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3. A 65-year-old woman reports difficulty walking. She can walk for one block, but pain “in the back of her legs” forces her to stop and sit, which relieves the pain. She can walk for a long time in the grocery store, but the pain returns with carrying groceries into her house. On examination, she has limitation in range of motion in the cervical spine, marked Heberden’s nodes and Bouchard’s nodes, and knee crepitus. Her neurologic examination is unremarkable. Her distal pulses are detected with some effort. Which of the following is the most likely cause of her symptoms?

  1. Spinal stenosis
  2. Vascular claudication
  3. Knee osteoarthritis
  4. Trochanteric bursitis
  5. Lumbar radiculopathy
Click here to compare your answer.
4. After playing 3 years of high-school football, a 17-year-old boy is offered a college scholarship at a Division 1 school. What is the likelihood that he will have significant osteoarthritis if he plays football for an additional 4 years?
  1. 36%
  2. 15%
  3. 100%
  4. 75%
  5. 50%
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5. A 38-year-old male accountant complains of hand pain. A radiograph is notable for degenerative changes in the second and third metacarpal-phalangeal joints. Which of the following is the most helpful diagnostic test?

  1. Erythrocyte sedimentation rate (ESR)
  2. Lyme titer
  3. Ferritin level
  4. Rheumatoid factor
  5. Antinuclear antibody
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6. A 30-year-old woman is morbidly obese. Which joints are most likely to have early degenerative changes?

  1. Hips and ankles
  2. Knees and ankles
  3. Hips and knees
  4. Hands and knees
  5. Lumbar spine and ankles
Click here to compare your answer.
 

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