cms IM form 4 help

[stargazin580]

A 72-year-old man has had burning, aching pain in the distal extremities for 3 weeks; the
pain is exacerbated by lowering the extremities and relieved by elevation. Examination
shows tenderness and swelling of the fingers and wrist, knee, ankle, and toe joints; the
overlying skin is warm and erythematous. There is clubbing of the fingers and toes. Which of
the following is most likely to be abnormal?
A) Serum creatinine concentration
B) Serum ferritin concentration
C) Serum protein electrophoresis
D) X-ray of the abdomen
E) X-ray of the chest

the presentation in this patient is really wired, can't think of any disease would present like this.

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[stargazin580]

An asymptomatic 24-year-old man who is HIV positive comes to the physician for a follow-up
examination. He has been seen by a physician regularly since he was diagnosed 3 years
ago and has been following all recommendations. He currently takes no medications.
Examination shows no abnormalities. Laboratory studies show:
Hematocrit 42%
Leukocyte count 4000/mm3
CD4+ T-lymphocyte count 550/mm3 (Normal~ 500)
Plasma HIV viral load 2000 copies/mL
Which of the following is the most appropriate recommendation for this patient?
A) Follow-up examination in 6 months
B) Two-drug antiretroviral therapy only
C) Two-drug antiretroviral therapy and Pneumocystis jiroveci (formerly P. carinit)
prophylaxis
D) Three-drug antiretroviral therapy only
E) Three-drug antiretroviral therapy and P. jiroveci prophylaxis

the answer for this one seems to be A? I chose D and it was incorrect. but in UpToDate it says any HIV+ pt w/ detectable viral load should be treated. really confused.

 

[BlueJay25]

A 72-year-old man has had burning, aching pain in the distal extremities for 3 weeks; the
pain is exacerbated by lowering the extremities and relieved by elevation. Examination
shows tenderness and swelling of the fingers and wrist, knee, ankle, and toe joints; the
overlying skin is warm and erythematous. There is clubbing of the fingers and toes. Which of
the following is most likely to be abnormal?
A) Serum creatinine concentration
B) Serum ferritin concentration
C) Serum protein electrophoresis
D) X-ray of the abdomen
E) X-ray of the chest

the presentation in this patient is really wired, can't think of any disease would present like this.

Okay, so from this whole vignette the one thing that I took away as the *big clue* was the clubbing of the fingers and toes. Clubbing of the fingers and toes should usually make you consider cancer (especially of the lung) and as such usually CXR would be the best test in that situation. Not 100% sure if this is the right answer, but this is what I would've probably picked - I'm studying for CK right now

Hope this helps, good luck!

 

[BlueJay25]

An asymptomatic 24-year-old man who is HIV positive comes to the physician for a follow-up
examination. He has been seen by a physician regularly since he was diagnosed 3 years
ago and has been following all recommendations. He currently takes no medications.
Examination shows no abnormalities. Laboratory studies show:
Hematocrit 42%
Leukocyte count 4000/mm3
CD4+ T-lymphocyte count 550/mm3 (Normal~ 500)
Plasma HIV viral load 2000 copies/mL
Which of the following is the most appropriate recommendation for this patient?
A) Follow-up examination in 6 months
B) Two-drug antiretroviral therapy only
C) Two-drug antiretroviral therapy and Pneumocystis jiroveci (formerly P. carinit)
prophylaxis
D) Three-drug antiretroviral therapy only
E) Three-drug antiretroviral therapy and P. jiroveci prophylaxis

the answer for this one seems to be A? I chose D and it was incorrect. but in UpToDate it says any HIV+ pt w/ detectable viral load should be treated. really confused.

Honestly, I would've picked D as well. Confused as to why A would be the answer, is this an old nbme form or?

 

[1badvette]

A 72-year-old man has had burning, aching pain in the distal extremities for 3 weeks; the
pain is exacerbated by lowering the extremities and relieved by elevation. Examination
shows tenderness and swelling of the fingers and wrist, knee, ankle, and toe joints; the
overlying skin is warm and erythematous. There is clubbing of the fingers and toes. Which of
the following is most likely to be abnormal?
A) Serum creatinine concentration
B) Serum ferritin concentration
C) Serum protein electrophoresis
D) X-ray of the abdomen
E) X-ray of the chest

the presentation in this patient is really wired, can't think of any disease would present like this.

Could possible be Buerger's disease .. ?