A 56-year-old male presents with complaints of right-sided neck pain with radiation down the right ...

The answer to question 1  ANS: D
In cervical spine trauma, cervical disk herniation can occur. A positive Spurling's sign is noted if this maneuver reproduces neck and radicular pain, suggesting a herniated disk. Spurling's sign is tested for by lightly pressing downward on the top of the patient's head while tilting back and toward the side of pain. Lhermitte's sign may support suspicion of a herniated disk. This test is conducted by having the patient flex the neck in a chin-to-chest motion and is positive if an electric shock-like sensation down the spine results.

The answer to question 2  ANS: A
Compared with RA, OA has a higher likelihood of affecting larger joints, such as the hips and knees. Like RA, OA also frequently involves the small joints of the hands, although it tends to occur at the distal interphalangeal joints (Heberden's nodes) and proximal interphalangeal joints (Bouchard's nodes). Most frequently, the second and/or third digits and the base of the thumb are involved. The distribution is asymmetrical. The pain and stiffness associated with OA often improve with moderate use and are worse after extended periods of rest. If three or more metacarpophalangeal joints are swollen, the differential should include RA.

The answer to question 3  ANS: C
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted by a bite from a deer tick. Whereas the incubation period ranges from 3 to 30 days, the onset of symptoms typically appears in 7 to 14 days. Although the disorder can be asymptomatic, the patient generally develops migratory polyarthralgia, myalgia, and neurological findings, including meningitis and/or neuropathy. An early finding is a solitary target lesion that may be followed by multiple lesions.

The answer to question 4  ANS: A
Gonorrhea is a sexually transmitted infection that often involves reactive arthritis. The polyarthritis is often migratory and affects lower extremities as well as the hands. In addition to the arthritis, the syndrome usually includes a nonpruritic dermatitis and tenosynovitis. Generalized muscle aches and fever are also common.

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