A 58- Year- Old Female Had Three Subcutaneous Nodules in Her

question 8

Multiple Choice

A 58- year- old female had three subcutaneous nodules in her finger joints. She complained of extreme morning stiffness and pain in her joints that did improve during the course of the day. On physical exam she had a low grade fever, but was otherwise normal. Fluid withdrawn from the joint was cloudy and white. Immediate Gram stain of the fluid revealed mostly neutrophils but no organisms. Bacterial culture of the fluid was negative for organism growth. Which test below is most appropriate to do next?

• A)Viral culture
• B)C- reactive protein (CRP)
• C)Rheumatoid factor (RF)
• D)Erythrocyte sedimentation rate (ESR)
• E)Antinuclear antibody (ANA)

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Definitions:

Delayed Phase Preference

A shift in sleep patterns characterized by staying up later in the evening and sleeping later in the morning than younger children that has been associated with hormonal changes at puberty.

Sexual Dimorphism

The differences in appearance between males and females of the same species, beyond the differences in their sexual organs.

Heredity

The passing of traits from parents to offspring through genes, affecting an individual's characteristics and predispositions.

Homosexual Orientation

A sexual orientation characterized by a romantic or sexual attraction to individuals of the same gender.