USMLE-Rx Step 2 Qmax Challenge #21454

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USMLE-Rx Step 2 Qmax Challenge #21454A 24-year-old man presents to his physician because of back pain that has become more severe over the past several months. He describes the pain as dull and localizes it to his lower back and gluteus muscles bilaterally. He notes feeling very stiff in the morning, but the stiffness improves with activity. He also notes the pain often awakens him during the night and does not go away until he gets out of bed and walks around for a while. On physical examination his lungs are clear to auscultation bilaterally, but he seems to have diminished air entry due to impaired chest wall expansion. Palpation of the sacral spine and hip joints causes pain. He cannot fully flex or extend at the hips. He also has limited hip abduction. X-ray of the spine is shown in the image.

Which of the following is the patient at risk for developing?

A. Anterior uveitis
B. Gastroesophageal reflux disease
C. Malar rash
D. Mitral stenosis
E. Pleuritis


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