08-23-2008, 11:40 PM
A 52-year-old woman is admitted to the hospital with fever up to 102 F, shortness of breath, and a cough with production of yellowish sputum for the past three days. She has a history of severe arthritis for the past twenty years. Over the past two years, she has lost about thirty pounds. She has a history of frequent admissions to the hospital with recurrent pneumonias and skin abscesses. Her medications include celecoxib, omeprazole, and methotrexate.
Physical examination reveals a pale, thin, ill-looking woman. Her temperature is 101.6 F, blood pressure is 110/68 mm Hg, and respiratory rate is 24/min. Submandibular and cervical lymph nodes are two centimeters is size and are mobile, soft, and painless on palpation. The wrists, elbows, knees, ankles, metacarpophalangeal joints, and proximal interphalangeal joints are severely deformed bilaterally and have restriction in the range of motion. Palpation of elbows and Achilles tendons reveals small, subcutaneous nodules. There are multiple ulcerations, ecchymoses, and skin hyperpigmentation of both lower extremities. Lung auscultation reveals rales and dullness on percussion over the right lung base. The chest x-ray reveals right lower lobe pneumonia. The spleen is palpable, and the liver has a span of 15 cm. Her white cell count is 2,500/mm 3 with a hemoglobin of 6.8 mg/dL, a hematocrit of 20.6%, and platelets of 80,000/mm3.
Which test would be most helpful to determine the right initial mode of treatment?
(A) Bone-marrow biopsy
(B) Peripheral smear examination
© Lymph node needle biopsy
(D) Synovial fluid analysis
(E) Skin biopsy
also what is the Dx??
Physical examination reveals a pale, thin, ill-looking woman. Her temperature is 101.6 F, blood pressure is 110/68 mm Hg, and respiratory rate is 24/min. Submandibular and cervical lymph nodes are two centimeters is size and are mobile, soft, and painless on palpation. The wrists, elbows, knees, ankles, metacarpophalangeal joints, and proximal interphalangeal joints are severely deformed bilaterally and have restriction in the range of motion. Palpation of elbows and Achilles tendons reveals small, subcutaneous nodules. There are multiple ulcerations, ecchymoses, and skin hyperpigmentation of both lower extremities. Lung auscultation reveals rales and dullness on percussion over the right lung base. The chest x-ray reveals right lower lobe pneumonia. The spleen is palpable, and the liver has a span of 15 cm. Her white cell count is 2,500/mm 3 with a hemoglobin of 6.8 mg/dL, a hematocrit of 20.6%, and platelets of 80,000/mm3.
Which test would be most helpful to determine the right initial mode of treatment?
(A) Bone-marrow biopsy
(B) Peripheral smear examination
© Lymph node needle biopsy
(D) Synovial fluid analysis
(E) Skin biopsy
also what is the Dx??