Medicine question 44 - misshyd

[ArchivalUser]

the explanation is saying we need baseline imaging before starting treatment.

[ArchivalUser]

anti ccp is more sensitive for RA and also shows severity
so going with c

[ArchivalUser]

dr_cks answer is D
This question is from archer lectures. Please see the following explanation. though CCP indicates severe disease, it says you need baseline x-rays to compare with post treatment

Ans. D ...from dr.red rheum lecture

The patient has the criteria for the diagnosis of Rheumatoid Arthritis. Once Rheumatoid arthritis is diagnosed, some baseline imaging study to evaluate the hands and the wrists must be performed. This will help to assess the severity of the disease at the time of initiation of therapy and also, for comparision with post treatment radiographs to evaluate response to the therapy . Plain radiographs of the hands and wrists are appropriate. Further managements depends upon the baseline severity of the disease at the time of diagnosis.

Mild RA : less than 6 inflamed joints, no extra-articular manifestations, no bony erosions or joint cartilage loss.
Moderate RA : Elevated ESR, Positive RA or positive Anti - CCP antibodies, radiographic changes such as osteopenia or small peripheral erosions and minimal joint space narrowing, no extra-articular disease.
Severe RA : imaging studies showing bony erosions and loss of cartilage, high titers of RF or Anti-CCP, presence of extra-articular manifestations, Anemia of chronic disease, Hypoalbuminemia.


Ans. A is incorrect. It is inappropriate to start therapy with out asessing baseline bone disease with an imaging study.

Ans. B is incorrect. It is inappropriate to start therapy with out asessing baseline bone disease with an imaging study. This option is appropriate if the patient is determined to have early, mild RA. Imaging must be performed to assess if this is mild or severe RA.

Ans. C is incorrect. It is inappropriate to start therapy with out asessing baseline bone disease with an imaging study. This option is correct if the patient is determined to have early, severe RA. Imaging must be performed to assess if this is mild or severe RA.

Ans. E is incorrect. The clinical criteria and positive anti-ccp suggest rheumatoid arthritis in this patient. There is no reason to obtain ANA.

[ArchivalUser]

NSIM or most appropriate next step in management means the same thing.

with USMLE MCQ. the answer to this type of question does not have to be treatment, it could be a test, procedure or treatment.

Some conditions by default u go to treatment without test or investigation eg. uncomplicated cystitis, next step in mx is antibiotic no need 4 urine culture .

[ArchivalUser]

B. Start Ibuprofen and follow-up in one month

[ArchivalUser]

sjsmmd i have already posted answer and explanation . Answer is D
breeder you are so very correct. Thanks

[ArchivalUser]

up..medicine_king...people still post different answers after i quoted reference.
so references are important...

[ArchivalUser]

The q mentions joint swollen & tender which indicates there might be joint erosions

So Xray is next step followed by NSAID then DMARD

My ans D X Ray

[ArchivalUser]

hi can u snd me archer lectures my exam z next month snd at mirha123 thanks

[ArchivalUser]

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