PANCE Exam Practice Questions: Quiz 858

A 38-year-old female present to your office with complaints of fatigue and generalized weakness for 6 weeks. She experiences stiffness in her hands and wrists for an hour after waking, and has taken nonsteroidal anti-inflammatory medication with some relief. Two weeks ago, she noticed that her knuckles were red and tender. Her past medical history is unremarkable, and she takes no medications. On examination, her temperature is 100°F. Erythema with edema is present at most MCP joints. She has minimally decreased muscle strength. Her labs include WBC: 12,000Hemoglobin: 10.6 g/dL Rheumatoid factor: negative Antibodies to citrulline-containing proteins (anti-CCP): positive ESR: 62 Hand x-ray: juxtaarticular osteopenia of the MCP joints Scheduled nonsteroidal anti-inflammatories are started with appropriate monitoring. After one month her pain is unchanged. What is the most appropriate next step in her treatment?
- a. Physical therapy.
- b. Referral to a rheumatologist.
- c. Begin IV TNF monoclonal antibodies.
- d. Begin allopurinol.

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