A 7 year-old boy from Sierra Leone presents with a 1 week history of painful left leg. He is homozygous for sickle cell disease. On examination the child is febrile at 40.2ºC and there is bony tenderness over the left tibial shaft. Investigations are:
Hb 7.1 g/dL
Blood culture Gram negative rods
X-ray left tibia: Osteomyelitis – destruction of bony cortex with periosteal reaction.
Which pathogen is most likely responsible for the osteomyelitis in this case?
A 24-year-old teacher with ankylosing spondylitis comes to the clinic complaining of a headache. She mentions having a painful right eye and cloudy vision. During the examination, her eye appears red and photophobic, and her pupils are small with a sluggish pupillary reflex. Although her visual fields are normal, she still reports cloudy vision. Her recent FBC, UEC, and liver function tests all came back normal. What is the diagnosis?
A 32-year-old, previously healthy Turkish man presents with a history of painful oral and genital ulcers. He has also developed gritty eyes and a sore ankle. Upon examination, areas of mucosal ulceration and scarring are found, along with ankle synovitis and eye erythema. After repeated blood tests, he develops blistering at the sites of venipuncture. What is the most probable diagnosis?
A 67-year-old man experiences sudden and severe sharp pain in the middle of his back while lifting a heavy object. Upon examination, he displays tenderness over the thoracic spine. Further investigations reveal a compression fracture of the T10 vertebral body. His lab results show normal levels of plasma sodium, potassium, urea, creatinine, and phosphate, but his plasma calcium and alkaline phosphatase levels are low while his serum parathyroid hormone level is elevated. Based on these findings, what is the most likely diagnosis?
A 32-year-old woman presents to the clinic with complaints of increasing fatigue over the past three months. She denies any other symptoms such as pain, bleeding, weight loss, or mood changes. Her medical history includes asthma, which has been well-controlled for over a year, and she has no known allergies. She is currently taking oral contraceptive pills. Laboratory tests reveal normal FBC, U&Es, calcium, and parathyroid hormone levels, but her vitamin D level is low at 32 nmol/L. What is the most appropriate treatment for her vitamin D deficiency?
A 42-year-old Hispanic man presents for evaluation with a history of two episodes of transient ischaemic attacks in the past 24 months. Additionally, he reports experiencing cramping in his legs when walking for extended periods. He has also been feeling significantly fatigued lately.
He has a history of smoking 1 pack of cigarettes per day for the past 20 years. Arteriography reveals diffuse stenoses of the femoral and popliteal arteries.
The following investigations were conducted:
Haemoglobin (Hb) 140 g/l 115–155 g/l
White cell count (WCC) 6.2 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 300 × 109/l 150–400 × 109/l
Neutrophils 4.0 × 109/l 2.5–7.58 × 109/l
Lymphocytes 1.8 × 109/l 1.5–3.5 × 109/l
Erythrocyte sedimentation rate (ESR) 45 mm/hour 1–20 mm/hour
C-Reactive Protein (CRP) 15 mg/l < 10 mg/l
Aspartate aminotransferase (AST) 35 IU/l 10–40 IU/l
Alkaline phosphatase (ALP) 80 IU/l 30–130 IU/l
Alanine aminotransferase (ALT) 20 IU/l 5–30 IU/l
Anti-nuclear antibody (ANA) Negative
What is the most likely diagnosis based on this clinical presentation?
A 63-year-old man with a diagnosis of Paget’s disease presents to the clinic with a two-month history of worsening bone pain, mainly in his right leg. He is currently taking paracetamol, ibuprofen, and alendronate.
Upon examination, there is significant deformity of the long bones, particularly the right tibia.
The following blood tests were obtained:
– Calcium: 2.40 mmol/L (2.25-2.5)
– Albumin: 37g/L (34-54)
– Corrected calcium: 2.50 mmol/L (2.25-2.5)
– Alkaline phosphatase: 484 U/L (45-105)
– Alanine transaminase: 27 U/L (5-35)
What is the next step in managing this patient’s condition?
A 27-year-old female presents with lethargy, intermittent low grade fever, bilateral wrist pain, pleuritic type chest pain and an erythematous scaly rash perinasally. She has no significant medical history but her family history is significant for an aunt with autoimmune hepatitis and a brother with type 1 diabetes and pernicious anaemia.
On examination, she appears well with a blood pressure of 110/78 mmHg and pulse of 76/min. Abdominal and cardiovascular examination were normal. Dullness to percussion over both lung bases was noted. She had swelling and tenderness of her wrists. A malar rash on a background of moderate facial acne with some scarring was also observed. She reports a history of acne which has improved since she started taking minocycline prescribed by her GP 3 months ago. She is also on oral contraceptives for irregular periods.
Investigations reveal a Hb of 10.3 g/dl, MCV of 79 fl, platelets of 256 * 109/l, WBC of 7 * 109/l, creatinine of 88 umol/L, Na+ of 140 mmol/L, K+ of 3.6 mmol/L, ANA positive, anti dsDNA negative, and normal C3 & C4 complements. Chest X-ray shows blunting of costophrenic angles bilaterally.
What is the most appropriate investigation to confirm the suspected diagnosis?
A 20 year-old female with neuropsychiatric Wilson’s disease starts chelation therapy. After one month, she complains of fatigue, widespread joint pain, and a red rash on her face, neck, shoulders, and arms. What is the most specific test for the suspected diagnosis?
A 54-year-old man presents with reduced sensation in both feet and lethargy. He reports a 2-month history of fevers and a weight loss of 4kg. Additionally, he reports experiencing intermittent testicular pain.
Upon examination, there is livedo reticularis on both legs and reduced light touch and pain sensation on both feet.
Blood tests reveal:
Hb 116 g/l
Platelets 487 * 109/l
WBC 8.3 * 109/l
Neuts 6.3 * 109/l
MCV 89 fL
Na+ 137 mmol/l
K+ 4.8 mmol/l
Urea 12.8 mmol/l
Creatinine 182 µmol/l
Bilirubin 18 µmol/l
ALP 92 u/l
ALT 102 u/l
γGT 16 u/l
ESR 78mm/hr
Albumin 35 g/l
What is the most likely diagnosis?