The Daily PANCE PANRE Question 5

A 34-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? A. progressive systemic sclerosis B. CREST syndrome C. osteoarthritis D. rheumatoid arthritis E. ankylosing spondylitis Answer: D In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine) Note: * This is part of the Daily PANCE and PANRE in your inbox email series: 60 days of PANCE and PANRE Questions and Answers delivered directly to your inbox. It is a great and fun way to learn! If you haven't already you can sign up by clicking Here. The Daily PANCE PANRE Question 5 A 34-year-old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? progressive systemic sclerosis CREST syndrome osteoarthritis rheumatoid arthritis ankylosing spondylitis Answer: D Rheumatoid Arthritis In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine) Know Your Content BlueprintRheumatoid Arthritisis part of the NCCPA Content Blueprint MusculoskeletalSystem (10%). Read more atSmarty PANCE Rheumatoid Arthritis. Note: * This is part of the Daily PANCE and PANRE in your inbox email series: 60 days of PANCE and PANRE Questions and Answers delivered directly to your inbox. It is a great and fun way to learn! If you haven't already, you can sign up for FREE by clicking Here. Help support The PA Life for FREE! This is provided as an opportunity for anyone who appreciates this email series to help support it painlessly. If you are going to be purchasing anything from Amazon.com (books, school supplies, etc.) simply start your next Amazon.com purchase by clicking here... it's a free way for you to help support the cause! Just click over to Amazon.com then, when you make your purchase, Amazon will send a portion of the proceeds to The Physician Assistant Life. The money goes toward paying for one-time and ongoing costs (like equipment, hosting, backup services, etc.). Thank you for supporting the site and keeping this content free! If you are studying for the PANCE or the PANRE I recommend thesereview books Just completed the PANRE and passed quite comfortably. I used your practice exams as part of my preparation. They were quite helpful for question format and content. Thanks for providing such a useful service. Steve Smith, PA- S, Hospitalist at Gerald Champion Regional Medical Center I love your site and think that it is the most enjoyable studying resource that I have use so far. David PA-S Dear Stephen, I wanted to thank you for your excellent website. I have been a physician assistant for 18 years and recently passed my panre again.   I was really nervous this time, as I have been working in the field of hematology oncology for the last four years. Prior to that I had worked in primary care.   Your daily questions, quizzes and websites reassurance was of tremendous help to me!   Keep up the good work. You are a treasure to the PA profession! Sasha CarlislePA – C This is my 4th PANRE, I graduated 25 yrs. ago as a surgeon assistant and physician assistant.   I have spent the last 20 years on a H+P service and I started my medical career as a USMC corpsman.   The USMC uses the accolade OUTSTANDING, your entire program is such , the attention to details to the answers, the 230 plus pages on  PDF, the flash cards, your program built my confidence BIG TIME, Jesus has richly blessed my life BECAUSE of you , I never have to take this brutal exam again and can retire at 66 yrs old you played a prodigious part in me passing amen!!! David Gavin PA-C Stephen, Just wanted to let you know that I am enjoying your site very much and believe it is helping more than any other site Ive used thus-far (I have done HippoPA, not bad, and Brian Wallaces site). Will study some more, dont feel ready yet! Im an older PA, practiced for 18 years, have done the at home board tests the last two. I am nervous about taking the test center exam! Thanks again for your site, and the best to you! Rebecca Lynch, PA-C Im a PA student graduating in December and taking my PANCE about 4 weeks from now. Your website has become one of my favorite study tools, so thanks for all your work in putting that together! Caitlin Anderson, PA-S I graduated from PA school in May and failed my first attempt at the PANCE in July. I was not nearly as prepared as I should have been and in the following 90 days, I developed into a completely different PA. I listened to all of your podcasts, took every practice test (at least once), and got both the daily question emails and the daily eponym emails. My second attempt at the PANCE was earlier in October and I went into it with so much more confidence than I had after receiving the news that I failed the first time. I really appreciate all the work you do to make studying for the PANCE fun well at least tolerable and I will definitely recommend your program to next years graduating class. Thank you! thank you! thank you! Christopher M., PA-C First of all, thank you so much for all of the resources you have made available for those of us studying for the PANRE! This is fabulous and wish Id known about it sooner.   Kristin F. PA-C I want to thank you for everything! I purchased the 3 month membership prior to my PANCE. I just found out I passed! The setup and links to Brian Wallaces podcasts were perfect! Garrett Wilson, PA-C Just want to say- Thank you for your website.   I just passed the recert and it was thank to your recommendations of review material. KennyPA-C