A 55-year-old female patient complains of dry eyes, dry mouth, an erythematous rash, and polyarthralgia. Upon investigation, the patient’s anti-nuclear antibody is strongly positive (1:1600), anti-Ro/SSA antibodies are strongly positive, rheumatoid factor is positive, and IgG is 45 g/L (<15), while IgM and IgA are normal, and the kappa/lambda ratio is normal. What is the probable diagnosis?
A 42 year old woman presents to her GP with complaints of dysuria, increased urinary frequency, and lower abdominal pain for the past three days. She denies any signs of systemic sepsis. On examination, she has mild suprapubic pain but is otherwise normal. A urine dip test shows positive nitrites, leukocytes, blood, and protein, indicating a urinary tract infection. The sample is sent for culture. The patient has a medical history of rheumatoid arthritis and takes methotrexate, folic acid, ibuprofen, and omeprazole. Which antibiotic should be avoided in this patient?
A 50-year-old woman who has been living with diabetes for a long time comes to the clinic complaining of a painful and stiff left shoulder that has been bothering her for three weeks. The pain is dull and aching, and it persists even when she is at rest. She denies any history of trauma, fever, or night pain.
Upon examination, the patient’s shoulder movements are significantly limited. There are no signs of shoulder effusion, and her cervical spine movements are normal. Recent blood tests, including FBC, UEC, LFT, and bone profile, all came back normal.
What is the most probable cause of this patient’s shoulder symptoms?
A 67-year-old man complains of increasing lower back and buttock pain over the last 6 months. He describes a burning sensation that is unresponsive to paracetamol. The pain has become so severe that he frequently needs to sit down when walking downhill to catch the bus. However, he has no difficulty walking home from the bus stop and no issues with bladder or bowel function. What is the probable diagnosis?
A 24-year-old Caucasian farmer presents to the outpatient department with a complaint of lower back pain that has been bothering him for the past two months. He reports that the pain is at its worst in the morning. He also experiences intermittent pain and swelling in his right ankle, which he injured while running a year ago. Two weeks ago, he visited the Emergency department with a painful red eye, which was treated with eye drops. He is a heavy smoker, consuming 45 cigarettes a day, and drinks five pints of beer every weekend. He denies any skin rashes or mucosal ulceration. His mother had rheumatoid arthritis, and his father had severe gout. On direct questioning, he admits to being diagnosed with chlamydia four months ago. During the examination, his right ankle was swollen at the site of Achilles’ tendon insertion, but all other joints were unremarkable. Flexion of the lumbar spine was reduced. What is the most likely diagnosis for this man?
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?
A 29-year-old woman who is 20 weeks pregnant is referred to you by her GP. She has a 2-month history of arthralgia, myalgia, and fatigue. She had initially put this down to pregnancy but was finding it increasingly difficult to do her job as a health care assistant in a local nursing home. She denied any shortness of breath, swallowing difficulties or alopecia.
She had asthma since childhood but was relatively well controlled on inhaled salbutamol as required and beclomethasone 400 micrograms twice daily.
She was a smoker of 10 cigarettes per day and had not drunk any alcohol since learning she was pregnant. She lives with her husband and 2-year-old son. Her mother has a history of rheumatoid arthritis.
Her observations show a blood pressure of 138/86 mmHg and a heart rate of 92 beats per minute. Urinalysis showed a trace of protein.
On examination there was tenderness of the 2nd and 3rd metacarpophalangeal (MCP) joints bilaterally and both wrists but no evidence of active synovitis. There are several painless mouth ulcers. You notice a few bruises on her arms but no other evidence of a rash. Her chest was clear and heart sounds were normal. Neurological examination was normal including full visual fields and eye movements.
Her bloods showed the following:
Haemoglobin 108 g/L
White Cell Count 9.2 x 109/L
Platelets 103 x 109/L
Neutrophils 6.02 x 109/L
Lymphocytes 0.80 x 109/L
Eosinophils 0.90 x 109/L
ESR 29 mm/h
Urea 6.9 mmol/L
Creatinine 118 micromol/L
CRP 11 mg/L
Alkaline Phosphatase 87 iu/L
ALT 42 iu/L
Albumin 32 g/L
ANA 1: 320
dsDNA 24
Anti -Ro Positive
Anti -La Positive
Rheumatoid Factor Positive
Anti CCP Negative
Antiphospholipid antibody negative
What is the most likely diagnosis and what complication should be discussed with her?