Step 2

Rheumatology 2

A 53-year-old woman with no known medical history presents to her primary care physician’s office to establish care. The patient reports she has not seen a doctor since her teenager years because hospitals make her nervous. She reports experiencing intermittent chest pain that is exacerbated by exertion and is alleviated by rest. She reports her mother died of MI at age 74, and her father is receiving dialysis for renal failure. She also mentions both of her hands have been very stiff in the morning for a couple hours which improves as the day goes on, and she has been somewhat fatigued. She has been taking over the counter ibuprofen daily for pain and discomfort. Otherwise, she denies hair loss, headache, oral ulcers, dyspnea, abdominal pain, rash, joint swelling, fever. An ECG was obtained in office which showed no significant ST/T wave changes and a stress test is scheduled for the patient.

What is the next best immediate step in management?

  • A) Order troponin as an outpatien
  • B) Obtain bilateral hand x-ray
  • C) Order ANA
  • D) Discontinue ibuprofen
  • E) Refer to physical therapy


Yunjia Shen


Dr. Raj Dasgupta