A 53-Year-Old Seamstress Comes to the Physician with Pain and Intermittent

question 278

Multiple Choice

A 53-year-old seamstress comes to the physician with pain and intermittent swelling in her fingers for the past 3 years.  Symptoms involve primarily the distal interphalangeal joints and occur after she sews.  A year ago, she was hospitalized with upper gastrointestinal bleeding and was found to have erosive gastritis and a duodenal ulcer.  Her other medical problems include hypertension, type 2 diabetes mellitus, and fatty liver.  Her current medications are glipizide, sitagliptin, lisinopril, and amlodipine.
Her blood pressure is 133/70 mm Hg and pulse is 78/min.  Her BMI is 26 kg/m².  Her hands appear as shown below.  There is bony swelling and tenderness of several distal interphalangeal joints.  The remainder of the examination is within normal limits.

Laboratory results are as follows:

Liver function tests are within normal limits.
Which of the following is the most appropriate treatment for this patient?

• A)Acetaminophen
• B)Adalimumab
• C)Celecoxib
• D)Methotrexate
• E)Naproxen

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Definitions:

Open Door Policies

Policies adopted by employers to encourage employees to communicate openly with management about concerns, grievances, or suggestions without fear of reprisal.

Due Process

A judicial principle that guarantees equitable treatment within the regular legal system, particularly as a right of citizens.

Guarantee of Equity

An assurance or policy aimed at providing fair treatment and opportunities for all individuals, often focusing on employment, education, and access to resources.

Nonunion Dispute Resolution

Mechanisms for resolving employment-related conflicts outside of union involvement, often through mediation, arbitration, or internal grievance procedures.