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A 55-Year-Old Business Executive Comes to the Office Due to Worsening

question 1577

Multiple Choice

A 55-year-old business executive comes to the office due to worsening joint pains for the past several months. He says, "My hands and fingers feel tight on waking up in the morning, and they are painful to move. I can't hold my toothbrush or button up my shirts. It slowly gets better by the time I get to the office in the morning." The patient has also felt excessively tired and has lost 4.5 kg (10 lb) over the past 6 months, which he attributes to extra work for a new business venture. He has no prior medical problems and takes no medications. The patient occasionally drinks alcohol and does not use tobacco or illicit drugs. Temperature is 37.2 C (99 F) , blood pressure is 132/86 mm Hg, and pulse is 72/min. Physical examination shows no scleral icterus or oral lesions. The lungs are clear to auscultation. Heart sounds are normal. The abdomen is soft and nontender with no organomegaly. Metacarpophalangeal and proximal interphalangeal joints of both hands show mild boggy swelling with tenderness on gentle squeezing. There is no increased joint warmth or erythema. No skin rashes are present. Laboratory results are as follows. Which of the following is the most appropriate next step in evaluation of this patient?

Definitions:

Operant Conditioning

An approach to training in which the vigor of a conduct is influenced by offering reinforcements or enforcing sanctions.

Classical Conditioning

A training technique involving the repetitive pairing of two stimuli; a reaction initially caused by the second stimulus is ultimately provoked by just the first stimulus.

Dissociative Disorders

A group of mental disorders characterized by a voluntary disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity.

Consciousness

the state of awareness of one's own existence, sensations, thoughts, surroundings, and experiences.