A 60-year-old African American male presents with widespread bone pain and muscle weakness. Upon conducting investigations, the following results were obtained:
Calcium 2.05 mmol/l
Phosphate 0.68 mmol/l
ALP 270 U/l
What is the probable diagnosis?
A 40-year-old woman with a 2 year history of rheumatoid arthritis presents to your clinic with an acute flare up of her symptoms. The patient reports increased pain in her joints, general fatigue, and difficulty performing her usual daily activities due to swelling and stiffness in her hands. She mentions experiencing high levels of stress at work and concerns about her financial stability. However, she is otherwise healthy and has normal physical observations. Currently, she is receiving methotrexate 7.5mg intramuscularly weekly. What is the most effective treatment option for managing this presentation?
A 28-year-old man presents to his doctor with left knee pain that has been bothering him for a week. He reports pain when bearing weight and swelling around the joint. He denies experiencing pain in any other joints, but does mention discomfort while urinating.
During the physical exam, the patient has a temperature of 37.9ºC and his left knee is warm and swollen. Additionally, he has inflamed conjunctivae.
Lab results show a hemoglobin level of 151 g/L (135-180), platelets at 333 * 109/L (150 – 400), white blood cell count at 7.6 * 109/L (4.0 – 11.0), and a CRP level of 99 mg/L (< 5). The doctor decides to perform a knee joint aspiration. What would be the expected findings from the joint aspirate?
A 26-year-old male presents to the emergency department with feverish symptoms and a painful right knee. He had a Chlamydia trachomatis infection two weeks ago. His vital signs are as follows:
Respiratory rate 17 breath/min
Heart rate 84 beats/min
Blood pressure 122/76 mmHg
Temperature 37.3ºC
Oxygen saturations 97% on room air
What is the most likely finding in a synovial fluid sample taken from this patient’s knee?
A 29-year-old man comes to the emergency department complaining of a fever and intense pain in his knee. Upon examination, the right knee is visibly swollen and red, with limited range of motion in both flexion and extension. The joint is warm to the touch. His vital signs are as follows: heart rate 94/min, respiratory rate 18/min, blood pressure 130/72 mmHg, and temperature 39.2 ºC. He has no medical history and does not take any regular medications. He is sexually active and lives with his girlfriend. What is the most likely causative organism for his condition?
A 25-year-old woman presents to the emergency department with an acutely painful and swollen right knee.
On examination, the knee is tender and has a reduced range of motion. She is unable to weight bear on her right leg.
Her observations are as follows, heart rate 98 beats/min, respiratory rate 18/min, blood pressure 110/76 mmHg, oxygen saturation 98%, temperature 38.2ºC.
An aspiration of the joint is performed, producing a sample of yellow-looking synovial fluid from the knee joint.
She has no other past medical history but admits that she missed a gynecology appointment recently.
What is the most likely organism to be cultured from the synovial fluid?
A 5-year-old girl is brought to the hospital with a suspected fracture of her left femur. Her parents are unsure how this happened and deny any injury. During the examination, you observe extensive dental decay, a bluish hue to the whites of her eyes, and on X-ray, multiple fractures at different stages of healing are noted.
What is the probable diagnosis in this scenario?
A 79-year-old woman with a history of rheumatoid arthritis presents with recurrent chest infections over the past 6 months. During examination, splenomegaly is observed. She is currently taking methotrexate and sulphasalazine. Blood tests reveal:
– Hb: 96 g/l
– WBC: 3.6 * 109/l
– Neuts: 0.8 * 109/l
– Lymphs: 1.6 * 109/l
– Eosin: 0.6 * 109/l
What is the probable cause of the neutropenia?
A 40-year-old woman presents to her GP with intermittent mild pain and pins and needles sensation in her thumb and index finger. The pain is triggered by flexing her wrist or accidental hits and has been ongoing for a few weeks despite taking over the counter pain relief. She is worried about its persistence as it is affecting her work as a typist. What is the initial management strategy recommended for this patient?
Sophie is a 16-year-old who has been brought to the emergency department by her father after a fall. An X-ray of her left ankle shows a Weber A fracture. What is the most suitable course of action for treating this injury?