You are working in a busy outpatient clinic and performing assessment on a new patient. The patient reports pain in the left ankle and big toe. You see what looks like a large tophi on the left toe. The patient's BMI is 38, and the patient reports drinking beer several nights a week. What is your patient's MOST LIKELY diagnosis?

Gouty arthritis

Rheumatoid arthritis

Lupus

Osteoarthritis

Answer and Explanation

The Correct Answer is A

A.   Gouty arthritis, or gout, is characterized by the accumulation of uric acid crystals in the joints, leading to sudden and severe pain, especially in the big toe (podagra). The presence of tophi (deposits of uric acid crystals under the skin) on the left toe is a classic sign of chronic gout. The patient's high BMI and frequent beer consumption also increase the risk for elevated uric acid levels, contributing to gout.
B.   Rheumatoid arthritis is an autoimmune condition that typically causes symmetric joint pain and stiffness, often involving the small joints of the hands and feet. It is less likely to present with tophi and is usually not linked to a history of beer consumption or a specific joint (like the big toe) in isolation.
C.   Systemic lupus erythematosus (SLE) can cause joint pain, but it usually involves multiple joints in a symmetrical pattern and is associated with a range of other systemic symptoms. The presence of tophi and the specific pain in the big toe point more toward gout.
D.   Osteoarthritis is a degenerative joint disease that commonly affects weight-bearing joints and can cause pain, especially with movement. However, it does not typically cause the acute attacks or the presence of tophi that are characteristic of gout.

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Correct Answer is D

Explanation

A. Methotrexate (MTX) is a disease-modifying antirheumatic drug (DMARD) that helps slow disease progression but does not provide immediate pain relief. NSAIDs and steroids may be used for symptomatic relief, but MTX alone can manage both pain and disease progression over time.
B. This response is unprofessional and dismissive. It implies that the medication regimen is based solely on the patient's insurance coverage rather than their medical needs. It does not address the patient’s question and could undermine trust in the healthcare team.
C. Methotrexate does not primarily treat nausea; rather, it is used to manage rheumatoid arthritis. While some patients may experience nausea as a side effect of MTX or other medications, this is not its primary purpose.
D. Methotrexate is indeed a DMARD that can take weeks to months to show its full benefits in controlling inflammation and slowing disease progression. Meanwhile, NSAIDs or corticosteroids may be prescribed to provide quicker relief from symptoms such as pain and swelling.

A. Use paper tape on fragile skin B. Provide mouthwash with alcohol for oral care C. Avoid aspirin D. Provide a soft bristle toothbrush or oral sponge E. Teach to use an electric shaver instead of a razor

Correct Answer is ["A","C","D","E"]

Explanation

A. Paper tape is gentler on fragile skin compared to standard adhesive tape. It reduces the risk of skin tears and bleeding, making it a safer option for patients with thrombocytopenia.
B. This option is not advisable. Mouthwash containing alcohol can irritate and dry out the mucous membranes in the mouth, potentially leading to ulcers or bleeding. Instead, an alcohol-free mouthwash should be used for oral care.
C. Aspirin is an antiplatelet agent that can increase the risk of bleeding. Patients on bleeding precautions should avoid aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) to minimize the risk of excessive bleeding.
D. A soft-bristle toothbrush or oral sponge is recommended for oral care to minimize trauma to the gums and mucous membranes. This helps reduce the risk of bleeding in patients with low platelet counts.
E. Using an electric shaver is safer than a traditional razor, as it reduces the risk of cuts and nicks that can lead to bleeding. This precaution is particularly important for patients with thrombocytopenia.

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Naxlex Comprehensive Predictor Exams

Your patient has just received a new diagnosis of Rheumatoid Arthritis. They are confused about their prescriptions, however. They ask you "Why am I receiving so many medications? I thought this 'MTX' drug was the one that would treat my arthritis?". What is your BEST response?

Correct Answer is D

Explanation

Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease processes. Which actions. are needed for patients who must be placed on bleeding precautions? (Select all that apply)

Correct Answer is ["A","C","D","E"]

Explanation

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