A 24-year-old male comes to see his doctor complaining of a painful swelling in his left knee, along with dysuria and discharge from both eyes. He is typically healthy but had a bout of diarrhea three weeks ago. He has no medical history or allergies. During the examination, you observe that the patient has a swollen left knee and several waxy, scaly patches on the soles of his feet.
What is the most suitable initial treatment for the probable diagnosis?
A 50-year-old woman presents with a 1-month history of fatigue, aches, constipation, and nausea. She reports increased thirst and waking at night to pass urine, and has been experiencing a low mood that has kept her from leaving the house frequently. The following investigations were performed:
– Hb 140 g/L (115 – 160)
– WBC 5.9 * 109/L (4.0 – 11.0)
– Calcium 2.8 mmol/L (2.1-2.6)
– PTH 75 pg/mL (10 – 55)
– ALP 130 µmol/L (30 – 100)
– Phosphate 0.4 mmol/L (0.8-1.4)
– Urea 5.3 mmol/L (2.0 – 7.0)
– Creatinine 68 µmol/L (55 – 120)
– 25-hydroxycholecalciferol 48 nmol/L (>50)
– eGFR 62 ml/min/1.73 m2
What is the most likely underlying cause of her presentation?
A 5-year-old boy is brought to the emergency department with significant elbow pain, following a fall from a playground swing. He is unable to fully extend or supinate his elbow joint. Upon examination, there are no other alarming findings. X-ray imaging confirms a diagnosis of radial head subluxation. The child has been administered pain relief, which has provided some relief. What is the best course of action for further management?
A 16-year-old girl complains of knee pain. She is an avid hurdler and has been experiencing progressively worsening knee pain after exercising. She reports that her knee locks and she feels a painful popping sensation when extending it. She denies any recent injuries. Upon examination, there is slight swelling, tenderness on the inner side of the knee, and discomfort when flexing or extending the knee. What is the probable diagnosis in this case?
A 28-year-old male patient visits the rheumatology clinic with complaints of a dull ache in his lower back that typically starts in the morning and improves throughout the day. He also reports limited movement of his entire spine, particularly in the lumbar region. Additionally, he has been diagnosed with anterior uveitis. What test would be the most suitable to confirm the probable diagnosis?
A 50-year-old woman comes to the Rheumatology clinic for evaluation. She complains of experiencing arthralgia and swelling in the MCP joints of both hands for the past six months. Upon examination, boggy swelling is observed in the third, fourth, and fifth MCP joints bilaterally, along with erythema and mild tenderness upon palpation. No significant deformities are noted, and she has normal motor function and range of motion in both hands. The following are the results of her investigations:
Anti-cyclic citrullinated peptide (CCP) antibody titre 48U (<20)
What are the most probable X-ray findings for this patient’s hands?
A 38-year-old man has been referred to the rheumatology clinic by his GP due to suspicion of systemic lupus erythematosus (SLE). The patient complains of symmetrical arthralgia affecting the MCP and PIP joints for the past 3 months, along with mouth ulcers and photosensitivity. Which of the following medical histories would support a diagnosis of SLE?
A 50-year-old woman comes to the Emergency Department after coughing up blood this morning. She is a non-smoker and has been feeling fatigued for the past four months, losing 5 kg in weight. She has also experienced joint pains in her wrists and noticed blood in her urine on two separate occasions. Her medical history includes sinusitis and recurrent nosebleeds. The chest X-ray and urinalysis reports reveal bilateral perihilar cavitating nodules and protein +, blood ++, respectively. What is the most appropriate investigation to confirm the diagnosis?
A 50-year-old man visits his GP complaining of increasing pain in one leg over the past 6 months. He also reports mild weakness in the affected leg during any activity. The pain travels down the back of his left leg and worsens when walking, causing him to stop and rest frequently. However, the pain improves when he sits or crouches down. The patient has no history of smoking or cardiovascular issues and has a body mass index of 19.0 kg/m2. There are no abnormalities found during back and neurological examinations. What is the most probable diagnosis?
A 79-year-old woman presents to her GP with complaints of worsening pain in her left knee for the past 6 months. The pain is more pronounced during the day and subsides at night or when she is at rest. She experiences increased stiffness in the morning, which takes around 15 minutes to resolve. She denies any joint problems in the past and is currently taking amlodipine for hypertension, which is well controlled. She has no known drug allergies. What is the most suitable initial management for this patient?