A 56-year-old woman comes to the clinic complaining of an itchy rash. She reports observing a bluish-purple patchy rash mainly on areas exposed to the sun. During the examination, she displays purple eyelids and rough raised purple patches on her knuckles. Her nails exhibit ragged cuticles, and blood vessels are visible on the nail fold. A poorly defined purple rash is present on both her arms extending up to her shoulders. What is the probable diagnosis?
A 56-year-old woman comes to her primary care physician complaining of right shoulder pain and stiffness for the past three days. She has a medical history of type 2 diabetes and is currently taking metformin and gliclazide. She is a non-smoker and does not consume alcohol. Her profession is a screenwriter.
During the examination, the patient displays restricted active and passive movements of the right shoulder, with external rotation being the most affected. No crepitus is observed.
What is the most effective way to confirm the diagnosis, considering the probable cause of the patient’s symptoms?
A 70-year-old woman presents to rheumatology clinic for follow-up of her osteoporosis treatment. She was diagnosed with osteoporosis five years ago based on a DEXA scan due to a strong family history of osteoporosis and multiple courses of corticosteroids for asthma. The patient has never had a hip, wrist, or vertebral fracture. She has been taking alendronic acid 70 mg weekly without any adverse effects, but finds the need to drink a lot of water with her dose burdensome. Her medical history is significant for asthma, which is now well-controlled, and she denies any thyroid disease or rheumatoid arthritis. She is a non-smoker and rarely drinks alcohol. Her height is 160 cm, weight is 65 kg, and her current femoral neck BMD is T -1.9 g / cm2. Her FRAX 10-year probability of major osteoporotic fracture is 18% and hip fracture is 6.8%. What is the most appropriate management for her osteoporosis?
A 45-year-old woman has been diagnosed with fibromyalgia and has been experiencing severe widespread body pain, severe fatigue, and difficulty concentrating on daily activities. She had previously been prescribed pregabalin but did not feel any improvement in her symptoms. Her symptoms have been causing more problems and she has been unable to attend work as a teaching assistant. What is the next appropriate pharmacological treatment for her fibromyalgia?
A 30-year-old woman presents to the hospital with recurrent fevers and joint pain. She denies any recent foreign travel or recreational drug use. On examination, she has a salmon-pink rash on her trunk and mild cervical lymphadenopathy. Blood results show elevated WBC count, ESR, and ferritin levels. What is the recommended initial treatment for the likely diagnosis?
A 23-year-old woman presents to the emergency department with a two-week history of sore throat, fever, rash, and joint pains. She has no medical history and does not take any regular medications. She denies smoking or drinking alcohol but has a family history of rheumatoid arthritis.
Observations:
Heart rate: 89 beats per minute
Respiratory rate: 19/minute
Oxygen saturations: 96% on room air
Temperature: 39.1°C
Blood pressure: 124/77 mmHg
On examination, there is synovitis affecting both wrists. A salmon-pink rash is present on her chest, and there is evidence of pharyngitis. The rest of the examination is unremarkable.
Blood tests:
Hb: 138 g/L (Female: 115-160)
Platelets: 422 * 109/L (150-400)
WBC: 17.1 * 109/L (4.0-11.0)
Na+: 136 mmol/L (135-145)
K+: 4.2 mmol/L (3.5-5.0)
Urea: 5.4 mmol/L (2.0-7.0)
Creatinine: 101 µmol/L (55-120)
Bilirubin: 12 µmol/L (3-17)
ALP: 89 u/L (30-100)
ALT: 64 u/L (3-40)
γGT: 82 u/L (8-60)
Albumin: 36 g/L (35-50)
CRP: 52 mg/L (<5)
Ferritin: 2240 ng/mL (20-250)
Further testing:
Rheumatoid factor negative
Antinuclear antibody negative
Blood cultures negative
Plain radiography of the chest is unremarkable.
What is the most appropriate management for this 23-year-old woman?
A 79-year-old man presents to the emergency department with a fall. He slipped on a wet surface in his bathroom while getting ready for bed and sustained an injury to his ankle. He has a past medical history of diabetes and takes metformin. He does not smoke or drink alcohol. He enjoys gardening in his spare time.
Examination reveals tenderness and swelling at the left ankle and is otherwise unremarkable.
Plain radiography of the left ankle demonstrates a fracture.
Blood tests:
Hb 130 g/L Male: (135-180)
Female: (115 – 160)
Platelets 200 * 109/L (150 – 400)
WBC 5.0 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 4.0 mmol/L (3.5 – 5.0)
Urea 5.0 mmol/L (2.0 – 7.0)
Creatinine 95 µmol/L (55 – 120)
CRP 3 mg/L (< 5)
Calcium 2.30 mmol/L (2.20-2.6)
Vitamin D 80 nmol/L (>50)
ALP 150 IU/L (44-147)
He is managed conservatively without the need for an operation.
What is the most appropriate next step in management?
A 75-year-old man is admitted after a fall resulting in distal ulnar and radial fractures in his left wrist. He has a medical history of diet-controlled diabetes and hypertension. The patient is concerned about preventing future fractures and wants to know what can be done.
What investigation and treatment options would be most appropriate for this patient?
A 57-year-old woman received a call from an out of hours GP, advising her to attend the emergency department due to abnormalities found on her blood tests during her annual well woman check-up. She has a medical history of systemic sclerosis and uses topical emollients on her hands. She denies alcohol consumption, is an ex-smoker, and works as a receptionist. Her blood results are as follows:
– Hb 110 g/L (115 – 160)
– Platelets 151 * 109/L (150 – 400)
– WBC 4.5 * 109/L (4.0 – 11.0)
– Na+ 137 mmol/L (135 – 145)
– K+ 4.2 mmol/L (3.5 – 5.0)
– Urea 11.5 mmol/L (2.0 – 7.0)
– Creatinine 164 µmol/L (55 – 120)
– eGFR 30 ml/min (>90)
Upon observation, the nurse notes that the patient’s blood pressure is high. In the right arm, it is 187/95 mmHg and in the left arm is 191/94 mmHg.
What is the most appropriate treatment to initiate for this patient?
A 17-year-old girl presents with a 6-month history of fatigue, joint pain and a recurring macular rash. Prior to this, she was healthy. She has no previous medical history or recent illnesses and has not traveled recently.
On examination, her temperature is 37.5 °C, blood pressure is 120/80 mmHg, and pulse is 90 bpm. A non-blanching macular rash is seen on her arms and legs. There is swelling and tenderness in her wrists and ankles. Lymph nodes are palpable in her neck and groin.
Investigations reveal the following:
– Hb: 130 g/l (normal range: 120-160 g/l)
– WCC: 12.0 × 109/l (normal range: 4.0-11.0 × 109/l)
– PLT: 350 × 109/l (normal range: 150-400 × 109/l)
– Na+: 142 mmol/l (normal range: 135-145 mmol/l)
– K+: 4.5 mmol/l (normal range: 3.5-5.0 mmol/l)
– Cr: 80 μmol/l (normal range: 50-120 μmol/l)
– RF: Negative
– ANA: Negative
– Anti-dsDNA: Negative
– ASO titre: Not detected
– ECG: Normal sinus rhythm
What is the most likely underlying diagnosis from the choices listed below?