A 30-year-old male patient complains of occasional discoloration of his fingers, starting with white and then turning blue, which he first noticed 3 years ago. He has no significant medical history. What test would be most effective in determining if his Raynaud’s is associated with vasculitis?
A 32-year-old woman comes to the gastroenterology clinic for follow-up. She was diagnosed with coeliac disease 2 years ago and has been experiencing severe fatigue, muscle aches, and weakness in her proximal muscles for the past few months. During the examination, her blood pressure is 112/70 mmHg, and her pulse is regular at 75 beats per minute. Proximal muscle weakness is confirmed.
Lab results show a calcium level of 2.0 mmol/l and an alkaline phosphatase level of 275 IU/l. What is the most useful next investigation?
A 35-year-old woman visits the Rheumatology Clinic for evaluation. She reports experiencing pain in multiple joints, particularly in her back, wrists, ankles, and feet, with noticeable involvement of the distal interphalangeal joints. During the examination, psoriatic patches are observed on her elbows, and her nails show onycholysis, transverse ridging, and pitting. There is also swelling, pain, and limited movement in her DIP. Despite being prescribed methotrexate, there is no improvement in her condition. You decide to treat her with adalimumab. What is the mechanism of action of adalimumab?
A 38-year-old Turkish man presents with superficial thrombophlebitis in his leg veins.
Upon questioning, he reports experiencing recurrent episodes of oral and genital ulcers over the past year, some of which have resulted in scarring. He also has a history of anterior uveitis.
Recent blood tests indicate a normocytic normochromic anemia, normal liver function tests, urea and electrolytes, and an elevated erythrocyte sedimentation rate (66 mm/hr). A venous Doppler revealed below knee deep venous thrombosis.
Which medication should he be started on?
A 57-year-old man presents to the emergency department with a 2-week history of increasing fatigue and shortness of breath with exertion. He denies any recent infections or fainting episodes. The patient has a medical history of Crohn’s disease, type 2 diabetes, epilepsy, and gout. He was recently started on azathioprine.
During the examination, the patient appears pale. Heart and lung sounds are normal, and the abdomen is soft and non-tender.
Laboratory results show:
– Hb 81 g/L (135 – 180)
– Platelets 66 * 109/L (150 – 400)
– WBC 1.1 * 109/L (4.0 – 11.0)
– Neuts 0.3 * 109/L (2.0 – 7.0)
– Na+ 136 mmol/L (135 – 145)
– K+ 4.1 mmol/L (3.5 – 5.0)
– Urea 3.1 mmol/L (2.0 – 7.0)
– Creatinine 83 µmol/L (55 – 120)
What medication should be discontinued based on this patient’s presentation?
A 45-year-old man with poorly controlled diabetes and a history of social alcohol consumption presents with an acutely swollen and red mid foot that has been bothering him for the past three weeks. He denies any recent foot injuries. Upon examination, the mid foot is warm and pedal pulses are intact. However, there is a glove and stocking distribution of sensory loss bilaterally. Recent blood tests reveal normal FBC, CRP, and UEC, and a foot radiograph appears normal. What should be the next step in managing this patient?
A 42-year-old woman visits her GP with concerns about a scaly patch of skin on her nose. Upon examination, the doctor observes a shiny-bordered, pearly nodule measuring approximately 0.3 cm x 0.3 cm.
The patient has a history of inflammatory bowel disease and is currently taking Azathioprine, but continues to smoke despite advice from her gastroenterologist.
What identifiable risk factor in her medical history is associated with her current presentation?
You are asked to see a 35-year-old man with a three year history of recurrent episodes of asymmetrical joint pains involving his knees, ankles and elbows. Two to four joints tend to be affected at any one time and each joint may be affected from two to four weeks each time.
In the last decade he has also had recurrent painful mouth sores. On this occasion, he also complains of a severe occipital headache, mild abdominal pain and some discomfort on passing urine.
On examination, his temperature is 38°C. His left knee and right ankle joints are painful, swollen and tender. Superficial thrombophlebitis is noted in the right leg.
Investigations show:
Hb 99 g/L (130-180)
WCC 11.6 ×109/L (4-11)
Platelets 420 ×109/L (150-400)
ESR 60 mm/hr (0-15)
Plasma sodium 138 mmol/L (137-144)
Plasma potassium 4.3 mmol/L (3.5-4.9)
Plasma urea 6.9 mmol/L (2.5-7.5)
Plasma creatinine 95 µmol/L (60-110)
Plasma glucose 5.8 mmol/L (3.0-6.0)
What is the most likely diagnosis?
A 65-year-old Caucasian man complains of worsening hearing loss and difficulty with chewing. He reports a family history of similar symptoms that required medication in his father and paternal uncles. Upon examination, frontal bossing is observed. Laboratory tests reveal an elevated alkaline phosphatase and a serum calcium level at the upper limit of normal. All other investigations are unremarkable. What is the initial treatment option for this patient?
A 27-year-old Japanese city banker with a history of irritable bowel disease presents with recurrent mouth ulcers that have been occurring more frequently despite previous treatment with chlorhexidine mouthwashes, oral aciclovir, and prednisolone lozenges. He has also been experiencing pain at the tip of his penis during sexual intercourse and has been feeling increasingly tired, leading him to give up playing football. He denies any weight loss and his appetite is unchanged. On examination, multiple aphthous ulcers are found in the oral cavity, as well as a small aphthous ulcer on the tip of the penis. Abdominal examination reveals mild, diffuse tenderness but no masses, and rectal examination reveals no abnormality. Investigations reveal a low haemoglobin level, elevated white cell count and platelets, and slightly elevated urea and creatinine levels. The erythrocyte sedimentation rate is slightly elevated, but anti-nuclear antibody and anti-dsDNA antibody tests are negative. The patient is currently taking oxytetracycline for acne. What is the most likely diagnosis?