A 24-year-old man comes to the clinic complaining of back pain that has persisted for two weeks. The pain is situated between the shoulder blades and happens frequently throughout the day. He expresses concern that this might be a severe issue and has been avoiding physical activity as a result.
What aspects of this patient’s medical history are cause for concern?
A 59 year old female visits her GP with complaints of fatigue and body aches. Upon further inquiry, the patient reports feeling increasingly tired for the past several months and experiencing joint and muscle pains. Her medical history indicates chronic heart failure, which is being treated with isosorbide dinitrate and hydralazine. As hydralazine can lead to drug-induced lupus, what investigation would be most helpful in confirming this diagnosis?
Which of the following characteristics is not typically associated with Marfan’s syndrome?
As part of a shared care prescribing agreement, the rheumatology team requests you to prescribe a medication to a 60-year-old woman with rheumatoid arthritis. Upon reviewing her recent notes, you discover that she had been sent to the emergency department for suspected cardiac chest pain, which was later ruled out, and a musculoskeletal cause was diagnosed. During her hospitalization, she was given 300mg of aspirin, which caused a widespread flushing and a maculopapular rash, and aspirin was recorded as a drug adverse reaction on her medical records. Which of the following DMARDs should be prescribed with caution?
A 27-year-old man comes to the GP clinic complaining of new onset of low back pain. The pain is more severe at night and frequently spreads to his hips. It gets better with physical activity. He is also experiencing light sensitivity in both eyes and decreased vision in his left eye. Despite taking oral NSAIDs, his symptoms have not improved. What would be the most suitable medication for the next stage of treatment?
A 45-year-old woman with a history of rheumatoid arthritis visits her GP with complaints of heightened pain and stiffness in her wrists and fatigue for the past week. Upon examination, there is slight swelling and tenderness in both wrists. The patient has been taking sulfasalazine for the past 5 years without any issues. What is the best course of action for management?
A 25-year-old female soccer player presents to the clinic with intense left knee discomfort. She reports that she landed awkwardly on her knee while playing soccer and heard a ‘snapping sound’ followed by significant swelling around the left knee joint. During the physical examination, there was an increase in laxity on anterior drawer of the left tibia compared to the femur. What is the most suitable test to confirm the diagnosis?
An 85-year-old woman is brought to the emergency department via ambulance following a fall in her bedroom. During the examination, it is noted that her left leg is internally rotated and shortened. The patient’s caregiver reports that she had a left total hip arthroplasty four years ago and is currently taking amitriptyline for pain management. What is the probable reason for the patient’s symptoms?
A 25-year-old man presents with a complaint of painful hands. He reports that his fingers turn white and become numb when exposed to cold, and then turn blue upon rewarming. His medical history is unremarkable, and he works in construction. On examination, there is no evidence of digital ulcers, calcinosis, chilblains, rash, or arthralgia. His blood results show a hemoglobin level of 145 g/L, platelet count of 260 * 109/L, WBC count of 6.2 * 109/L, and ESR of 10mm/hr. What is the most likely cause of his symptoms?
A 50-year-old woman reports experiencing painful tingling in her fingers and relief when hanging her arm over the side of the bed. She also has a positive Tinel’s sign. What is the most probable factor contributing to her diagnosis?