For reference, it’s question #162, with QID: SCBR4797MBZ5658
Full question for reference as well:
A 42-year-old woman with rheumatoid arthritis is admitted to the hospital because of a 3-day history of
fever, intermittent severe chest pain, mild abdominal pain, and malaise. She also has a 1-week history of
increasing fatigue. The chest pain worsens with inspiration, and she says she now sleeps most comfortably
while leaning over her kitchen table. During the past week, she has had increased joint pain and decreased
appetite. She has not had vomiting or changes in bowel function. Her medications are methotrexate,
prednisone, and acetaminophen with codeine. She does not smoke cigarettes, drink alcohol, or use illicit
drugs. She is in moderate distress. She is 165 cm (5 ft 5 in) tall and weighs 59 kg (130 lb); BMI is 22 kg/m .
Her temperature is 38.6°C (101.4°F), pulse is 90/min, respirations are 22/min and shallow, and blood
pressure is 140/88 mm Hg. On examination, a pleural friction rub is heard over the lower lobe of the right
lung, and a pericardial friction rub is heard over the anterior aspect of the left hemithorax. The spleen tip is
palpated 2 cm below the left costal margin. There is no peripheral edema. There is thickening of the synovial
membranes and tenderness to palpation of the hands and feet. Laboratory studies show:
Hemoglobin 11.1 g/dL
Hematocrit 33%
Mean corpuscular volume 88 μm
Leukocyte count 1800/mm
Segmented neutrophils 65%
Eosinophils 2%
Basophils 1%
Lymphocytes 30%
Monocytes 2%
Platelet count 155,000/mm
Serum
Urea nitrogen 24 mg/dL
Creatinine 1.2 mg/dL
AST 12 U/L
ALT 24 U/
Which of the following is the most likely diagnosis?
Answer: Felty Syndrome