A 19-Year-Old Woman Comes to the Physician with a 1-Week

question 226

Multiple Choice

A 19-year-old woman comes to the physician with a 1-week history of malaise and joint pains.  She also has mild shortness of breath.  The patient initially developed left elbow pain and swelling but now has pain in the right knee and ankle.  She emigrated from Thailand 6 months ago and has resided with family members in New York City, none of whom have been ill.
Her temperature is 38 C (100.4 F) , blood pressure is 104/64 mm Hg, pulse is 92/min, and respirations are 20/min.  Lungs are clear bilaterally.  Cardiac examination reveals a blowing 3/6 holosystolic murmur at the apex.  The right knee and left elbow are mildly swollen and tender.  There are palpable subcutaneous nodules on the extensor surface of both arms.
Erythrocyte sedimentation rate is 100 mm/hr and blood cultures are negative.
Which of the following is most useful in confirming the diagnosis?

• A)Antineutrophil cytoplasmic antibodies
• B)Antinuclear antibody screen
• C)Antistreptolysin O antibody titers
• D)Rheumatoid factor
• E)Right knee aspiration

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Definitions:

Crossing Over

The process during meiosis where two chromosomes pair up and exchange segments of their genetic material to produce new combinations of genes.

Homologous Chromosomes

Pairs of chromosomes that contain the same types of genes but can have different alleles.

Sister Chromatids

They are identical copies of a single chromosome that are connected by a centromere. Sister chromatids are formed during DNA replication and are important for the process of cell division.

Chromosomal DNA

The DNA that constitutes the chromosomes within the nucleus of eukaryotic cells, encoding most of the genetic information of the organism.