A 29-Year-Old Woman Comes to the Office Due to Severe

question 95

Multiple Choice

A 29-year-old woman comes to the office due to severe joint pain in her hands, wrists, and ankles for a week.  The pain is so severe that she is unable to perform her daily activities, and taking ibuprofen provides only partial relief.  She has no prior medical conditions but developed high fever and diffuse rash during a trip to Puerto Rico 2 weeks ago.  Evaluation at a local medical facility was negative for malaria, and her symptoms improved spontaneously after several days.  She does not use tobacco, alcohol, or illicit drugs and is in a monogamous relationship with her husband.  Temperature is 37 C (98.6 F) , blood pressure is 122/70 mm Hg, and pulse is 86/min.  Physical examination shows pink, moist oropharyngeal mucosa; no rash; clear lungs; normal heart sounds; and no abdominal organomegaly.  There is periarticular swelling and tenderness of the wrists, ankles, and interphalangeal joints of her hands.  Range of motion in these joints is decreased due to pain.  Laboratory testing reveals lymphopenia.  Which of the following is the most likely cause of this patient's joint pain?

• A)Acute joint inflammation from crystal deposition
• B)Immune-mediated inflammatory arthritis
• C)Spondyloarthritis triggered by bacterial infection
• D)Tick bite-borne spirochetal joint infection
• E)Viral infection transmitted by mosquito bite

---

Definitions:

Minimum Wage

The legally mandated lowest amount that employers can pay their employees per hour of labor.

Employment Opportunities

Job openings available in the market that people can apply for and get employed.

Training Opportunities

Programs or initiatives designed to enhance the skills and knowledge of individuals, often provided by employers, education institutions, or government organizations.

Labor Market

The supply of available workers in relation to the demand for their services by employers.