(D) "I'd like to refer you to a counselor." (B) "Have you considered moving to an assisted living facility where your quality of life could be much better?" (A) "Do you think you're depressed? I can help with that." I've had it." Which of the following is the most appropriate response?
The patient says, "I cannot continue to live as I am. Physical examination discloses marked joint deformities in the hands, wrists, shoulders, and feet the findings are unchanged from previous visits. She tells you that her husband of 30 years left her 6 months ago. Medications include etanercept, methotrexate, prednisone, and tramadol. Medical history is otherwise unremarkable. She has difficulty bathing and dressing, but she is able to stand and walk independently. Rheumatoid arthritis was diagnosed at age 35 years, and the patient has been unable to work for the past 10 years. Which of the following cell types is most affected by this patient's condition?Ī 54-year-old woman with severe rheumatoid arthritis comes to the office for a routine follow-up examination. Sensation to pain and temperature is decreased at the lower costal margin and below, most pronounced on the right. Proprioception and sensation to vibration are absent over the left lower extremity and decreased over the right lower extremity to the level of the hip. Deep tendon reflexes are normal in the upper extremities but hyperactive in the lower extremities, especially on the left. Examination shows spastic lower extremities and moderate weakness of the left lower extremity, more prominently in the flexor than in the extensor muscles. His temperature is 37☌ (98.6☏), pulse is 55/min, respirations are 10/min, and blood pressure is 110/70 mm Hg. He is 157 cm (5 ft 2 in) tall and weighs 55 kg (121 lb) BMI is 22 kg/m 2. He had an episode of optic neuritis in the right eye 3 years ago. He began to notice some problems with his balance 2 days ago, and his walking has become progressively worse since then. The last eligibility period in which the 2023 fee will apply is OctoDecember 31, 2023.A 27-year-old man is brought to the emergency department by his roommates because of an inability to walk. The first eligibility period in which the 2023 fee will apply is NovemJanuary 31, 2023. Three-month eligibility periods that end in 2023. The last eligibility period in which the 2022 fee will apply is OctoDecember 31, 2022. The first eligibility period in which the 2022 fee will apply is NovemJanuary 31, 2022. Three-month eligibility periods that end in 2022. Your application fee can only be paid by American Express, MasterCard or Visa. The Step 3 application fee is non-refundable and non-transferable from one eligibility period to another or from one application to another. The busiest testing times at Prometric are May through July and November through December.The USMLE is not available the first two weeks in January.Please keep the following in mind when selecting your eligibility period: 2023 eligibility periods are now available.
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