A 17-year-old rugby player is admitted to the emergency department after a field accident. During the examination, the physician discovers tenderness in the anatomical snuffbox and scaphoid tubercle. Which neurovascular structure is most likely to be affected?
A 49-year-old patient with a history of rheumatoid arthritis complains of abdominal pain, cough with purulent sputum, and shortness of breath. During abdominal palpation, splenomegaly is observed, and crackles are heard in both lung bases on auscultation. The patient’s vital signs are as follows:
Heart rate: 110/min
Respiratory rate: 22/min
Temperature: 38ºC
Blood pressure: 90/65 mmHg
Which of the following blood test results would confirm the diagnosis of Felty’s syndrome?
A 27-year-old man presents to the outpatient clinic with a history of lower back pain and stiffness persisting for six months. The pain and stiffness improve with exercise but worsen at night. Physical examination reveals reduced flexion of the spine. Ankylosing spondylitis is suspected, and the patient is scheduled for blood tests and spinal X-rays. What finding would most strongly support the diagnosis in this case?
Emma is a 26-year-old patient who has been experiencing back pain for the past year. She describes the pain as a dull ache that is mostly located in her lower back and sometimes wakes her up in the early hours of the morning. Emma notes that she generally feels better when she is active throughout the day and is often worse when resting.
What investigation would be most helpful in confirming Emma’s diagnosis?
A 40-year-old man presents to the emergency department complaining of severe back pain and a high fever. The pain began in his lower back three days ago and has progressively worsened, now extending to his left thigh and groin. He finds relief by lying on his back and keeping his left knee slightly bent and hip externally rotated. Hip extension is particularly painful.
The patient has a history of intravenous drug use. On examination, he has a fever of 38.2ºC and a heart rate of 132 beats per minute. A mild systolic murmur is present, and tenderness is noted over L1 to L3.
His urine dip reveals protein 1+ and blood 1+, but is negative for nitrites and leukocytes. What is the most likely cause of his back pain?
A 27-year-old man complains of left knee pain, dysuria, and a painful right eye. He recently returned from a trip to Thailand where he had unprotected sex. Upon examination, his left knee is slightly swollen and painful with limited range of motion. The right conjunctiva is inflamed. His respiratory rate is 18/min, heart rate is 78 bpm, and temperature is 37.6 ºC. Joint aspiration reveals turbid synovial fluid with a white cell count of 35,000 cells/mm3 (<200) and 65% polymorphonuclear cells (<30%). Culture results are negative. What is the most likely diagnosis?
A 32 year old man comes to the Emergency Department complaining of left knee pain that has been bothering him for the past 2 days. He denies any history of injury and reports feeling well, except for a recent episode of food poisoning after eating a kebab 2 weeks ago. He has no personal or family history of rheumatological disorders and has never had any sexually transmitted infections. Upon examination, the knee appears swollen, red, and tender. Aspiration of the joint reveals clear fluid without white blood cells or crystals. What is the most probable diagnosis?
A 35-year-old female presents with pain and stiffness in her left knee, which she’s had for the last 4 months. On further questioning, she also has pain and stiffness in her right wrist and the distal interphalangeal joint of her left index finger. Her symptoms are worse in the morning and seem to improve throughout the day. She reports that her late mother also had joint problems; but does not know the diagnosis, although she recalls that her fingers were completely swollen before she started treatment.
What is the most likely diagnosis?
A 60-year-old man visits his GP complaining of hand pain that worsens with activity and towards the end of the day. He has a medical history of psoriasis and is not currently taking any medications. During the examination, the doctor notes tender bony swellings in three DIP joints on both hands. What is the probable diagnosis?
A 30-year-old woman presents to the rheumatology clinic with a diagnosis of systemic lupus erythematosus. You intend to initiate monotherapy with hydroxychloroquine. What particular monitoring should be considered before starting this medication?