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* q4 from Archer qbank
 #836013  
  aravindk - 01/07/17 16:05
 
  A 32-year-old man comes in regularly because his back hurts. You suspect malingering because he continually requests narcotic pain relievers and imaging studies of his spine. He has come 5 times in the last 6 months with the same problem, typically stating that the pain improves with exercise and leaning forward but is worse at night; pain also occurs at times in his buttocks and does not improve with rest. On physical examination you find no abnormalities of the spine besides inflexibility of the lower spine when he leans forward. Neurological examination is normal, including the absence of pain on a straight-leg raise test. X-ray of the spine and sacroiliac joint is normal. All blood tests including rheumatoid factor, ESR, and C-reactive protein are normal. Today, he again claims to have only minimal improvement with ibuprofen. He is requesting narcotics and a “doctor’s note to get out of work.” What is the next best step in management?
A. MRI of the sacroiliac joint
B. Anti-cyclic citrullinated peptide (anti-CCP)
C. HLA-B27 testing
D. Methotrexate
E. Report to employer for malingering
 
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* Re:q4 from Archer qbank
#3323488
  dermat - 01/09/17 16:37
 
  may be its C) as it is only 90% specific  
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* Re:q4 from Archer qbank
#3323640
  hesslid - 01/10/17 16:27
 
  Answer please?  
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* Re:q4 from Archer qbank
#3323927
  aravindk - 01/12/17 23:59
 
  MRI i believe
some ppl answered on blog say MRI
https://archerusmleblog.com/2016/03/02/question-of-the-week-480/
 
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* Re:q4 from Archer qbank
#3324140
  dermat - 01/14/17 13:27
 
  I too wasn't sure btwn MRI n HLA testing...
so picked up the best amongst two considering on if the findings don't come out on MRI as well!
as X rays delineates the lesions on sacroiliac joints well.
Thanks for sharing :)
 
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* Re:q4 from Archer qbank
#3324155
  lamonti - 01/14/17 18:46
 
  C
http://www.passpaces.com/MRCP/issue20.html
 
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