A 37-Year-Old Woman Comes to the Physician with Pain in Her

question 414

Multiple Choice

A 37-year-old woman comes to the physician with pain in her hand joints lasting several months.  She feels she is clumsy in the morning because her hands are stiff and tender.  Four weeks ago the patient was treated for knee pain and swelling with naproxen.  Her past medical history is otherwise unremarkable.
Joint examination shows warmth, swelling, and tenderness in the proximal interphalangeal and metacarpophalangeal joints and both wrists.  X-rays show periarticular osteopenia and erosions of the proximal interphalangeal and metacarpophalangeal joints.
Laboratory results are as follows:

The patient is treated with nonsteroidal anti-inflammatory therapy with significant symptomatic relief.
Which of the following is the most appropriate next step in management of this patient?

• A)Etanercept
• B)Low-dose maintenance prednisone
• C)Methotrexate
• D)Rituximab
• E)Sulfasalazine

---

Definitions:

Brainstorming

A creative group technique aimed at generating ideas or finding solutions to problems through spontaneous participation.

Freewriting

A writing technique where the writer writes continuously for a set period without concern for spelling, grammar, or topic coherence, to unlock creativity or solve writing blockages.

Clustering

A method of organizing similar or related items, ideas, or information into groups for analysis or understanding.

Writing Process

The sequence of steps that writers follow to create a text, including prewriting, drafting, revising, and editing.