A 55-year-old patient with rheumatoid arthritis is being evaluated for disease progression. Which of the following laboratory findings is most indicative of increased disease activity?

Presence of anti-cyclic citrullinated peptide (anti-CCP) antibodies

Elevated rheumatoid factor (RF) levels

Decreased erythrocyte sedimentation rate (ESR)

Elevated C-reactive protein (CRP) levels

Answer and Explanation

The Correct Answer is D

A.   Anti-cyclic citrullinated peptide (anti-CCP) antibodies are specific for rheumatoid arthritis but are not necessarily linked to disease activity.
B.   Elevated rheumatoid factor (RF) levels are common in rheumatoid arthritis but not always indicative of disease activity.
C.   A decreased erythrocyte sedimentation rate (ESR) is typically a sign of less inflammation, not more.
D.   Elevated C-reactive protein (CRP) levels are a direct marker of inflammation and are often correlated with increased disease activity in rheumatoid arthritis.

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Correct Answer is B

Explanation

A. Encouraging the patient to take deep breaths and cough would not address the underlying cause of the symptoms, which may indicate a more serious condition.
B. Administering oxygen to maintain adequate oxygenation is the most appropriate initial action, as the patient’s symptoms suggest a potentially life-threatening condition like a cardiac tamponade or pulmonary embolism.
C. Positioning the patient flat in bed is not recommended, as it may exacerbate breathing difficulties and
the patient’s distress.
D. A warm compress is unlikely to be beneficial in this acute situation and could delay appropriate intervention.

A. Klebsiella pneumoniae B. Streptococcus pneumoniae C. Escherichia coli D. Staphylococcus aureus

Correct Answer is D

Explanation

A. Klebsiella pneumoniae is a Gram-negative bacterium and is typically associated with more severe pneumonia, particularly in patients with underlying lung disease, but it does not form clusters.
B. Streptococcus pneumoniae is a common cause of pneumonia but typically appears as Gram-positive cocci in pairs or chains, not clusters.
C. Escherichia coli is a Gram-negative bacterium that generally causes urinary tract infections and is not a common cause of pneumonia with Gram-positive cocci in clusters.
D. Staphylococcus aureus is a Gram-positive bacterium that forms clusters and is a common cause of pneumonia, particularly in young, otherwise healthy individuals, and can present with fever, chills, and productive cough. This fits the presentation and sputum findings in this patient.

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A 55-year-old patient with rheumatoid arthritis is being evaluated for disease progression. Which of the following laboratory findings is most indicative of increased disease activity?

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Explanation

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