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  #1  
Old 09-27-2012
billy's Avatar
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Arrow Billy Step 1 Questions #2

A 30-year-old man sees his physician because he has had cramping abdominal pain and bloody diarrhea for the past 4
days. On physical examination, there is diffuse tenderness on palpation of the abdomen. Bowel sounds are present. There
are no masses and no organomegaly. A stool culture is positive for Shigella flexneri. The episode resolves spontaneously
within 1 week after onset. Six weeks later, the patient sees his physician because of increasingly severe lower back pain.
Physical examination now shows stiffness of the lumbar joints and tenderness affecting the sacroiliac joints. He is treated
with ibuprofen. Several months later, the back pain recurs, and he complains of redness of the right eye and blurred
vision. Serologic testing for which of the following is most likely to be positive in this patient?

□ (A) Rheumatoid factor
□ (B) Chlamydia trachomatis
□ (C) Epstein-Barr virus
□ (D) HLA-B27
□ (E) Borrelia burgdorferi
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  #2  
Old 09-27-2012
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A 30-year-old man sees his physician because he has had cramping abdominal pain and bloody diarrhea for the past 4
days. On physical examination, there is diffuse tenderness on palpation of the abdomen. Bowel sounds are present. There
are no masses and no organomegaly. A stool culture is positive for Shigella flexneri. The episode resolves spontaneously
within 1 week after onset. Six weeks later, the patient sees his physician because of increasingly severe lower back pain.
Physical examination now shows stiffness of the lumbar joints and tenderness affecting the sacroiliac joints. He is treated
with ibuprofen. Several months later, the back pain recurs, and he complains of redness of the right eye and blurred
vision. Serologic testing for which of the following is most likely to be positive in this patient?

□ (A) Rheumatoid factor
□ (B) Chlamydia trachomatis
□ (C) Epstein-Barr virus
□ (D) HLA-B27
□ (E) Borrelia burgdorferi
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Step 1 - 244 [✔] Step 2 CK - 246 [✔] Step 2 CS [✔] Step 3 - 228 [✔] Match [EMORY SOM] YOG: 2013, 4 Months of USCE University Hospital
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  #3  
Old 09-27-2012
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Arrow Hla b27

Looks like ankylosing spondylitis hence HLA B27 +
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Old 09-27-2012
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Default my answer :)

□ (d) hla-b27
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Old 09-27-2012
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D. HLA B27



Reiter's syndrome is "Can't see, can't pee, can't climb a tree."

A mnemonic of the triad: inflammation of the eyes in the form of conjunctivitis or uveitis, and urethritis in men or cervicitis in women and inflammatory arthritis of large joints.

Maily follows these organisms infection:
The most common of which would be a genital infection with Chlamydia trachomatis in the US. Other bacteria known to cause reactive arthritis which are more common worldwide are Ureaplasma urealyticum, Salmonella spp., Shigella spp., Yersinia spp., and Campylobacter.
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  #6  
Old 09-28-2012
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Correct Answer Correct

This patient developed arthritis affecting the lumbar and sacroiliac joints several weeks after Shigella dysentery.
He subsequently developed conjunctivitis and, most likely, uveitis. This symptom complex is a classic representation of a
cluster of related disorders called seronegative spondyloarthropathies. This cluster includes ankylosing spondylitis, Reiter
syndrome, psoriatic arthritis, and enteropathic arthritis (as in this case). A common feature is a very strong association with
the HLA-B27 genotype. Despite some similarities with rheumatoid arthritis, these patients are invariably negative for
rheumatoid factor. Urethritis caused by Chlamydia trachomatis can trigger Reiter syndrome, another form of seronegative
spondyloarthropathy. Such infection precedes the onset of arthritis, however. There is no relationship between infection
with Borrelia burgdorferi, the causative agent of Lyme disease, and reactive arthritis in HLA-B27-positive individuals.
Similarly, Epstein-Barr virus infection is not a trigger for these disorders
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