A 42-Year-Old Woman with Rheumatoid Arthritis Returns to the Clinic

question 565

Multiple Choice

A 42-year-old woman with rheumatoid arthritis returns to the clinic for follow-up.  The patient reports improvement in joint pain after methotrexate therapy was begun 6 months ago.  Over the past 2 months, she has felt increasingly winded, causing her to stop jogging.  She has a nonproductive cough and low-grade fevers.  She has no other medical conditions and is a lifelong nonsmoker.  Temperature is 37.5 C (99.5 F) , blood pressure is 120/70 mm Hg, pulse is 88/min, and respirations are 18/min.  Oxygen saturation is 89% on room air at rest.  Jugular venous pressure is normal.  Lung auscultation reveals fine bibasilar inspiratory crackles.  Heart sounds are normal.  Musculoskeletal examination shows mild interphalangeal synovitis.  High-resolution CT scan of the chest reveals patchy areas of consolidation and reticular thickening.  A respiratory sample obtained by bronchoscopy yields lymphocyte-predominant fluid negative for bacterial, viral, and fungal pathogens.  Which of the following is the best next step in management of this patient?

• A)Discontinue methotrexate
• B)Measure serum ACE levels
• C)Measure serum IgE levels
• D)Obtain lung biopsy
• E)Start antifibrotic therapy

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Definitions:

Null Hypothesis

A hypothesis in statistical testing that suggests there is no statistical significance between the specified sets of observations, effectively stating that any observed difference is the result of random chance.

Level of Significance

A threshold in hypothesis testing that determines whether an observed effect is statistically significant.

Diverse Individuals

People who exhibit differences in various attributes such as cultural background, race, religion, gender identity, and life experiences.

Sample Size

The number of individuals or observations included in a study, which can significantly impact the statistical power and conclusions drawn.