A 74-year-old woman presents to your clinic to discuss the results of recent investigations for her lower back pain. Her blood results show:
– Bilirubin: 16 µmol/L (3 – 17)
– ALP: 220 u/L (30 – 100)
– ALT: 33 u/L (3 – 40)
– γGT: 54 u/L (8 – 60)
– Albumin: 38 g/L (35 – 50)
Following these results, a lumbar spine x-ray was performed, which revealed mixed lytic/sclerotic lesions. Based on this likely diagnosis, what would be your first-line treatment recommendation?
Anna is a 35-year-old woman who has come to her GP complaining of sudden lower back pain. Her medical history does not indicate any alarming symptoms and her neurological examination appears normal.
What initial pain relief medication should the GP suggest?
A 35-year-old Afro-Caribbean woman presents with complaints of cold and painful hands during winter. She reports that her hands change color from pale to blue and red in the morning. Despite using gloves and hand warmers, her symptoms have only slightly improved. She is interested in trying medications to alleviate her symptoms. Based on the probable diagnosis, which medication should be prescribed?
A 63-year-old man visits his doctor complaining of haemoptysis and symmetrical polyarthritis in his hands and feet for the past four weeks. He has also noticed blood in his urine recently. Upon conducting a urine dipstick test, the results show positive for blood and protein, but negative for nitrites, leucocytes, and ketones, with a pH of 7.5. The doctor orders various blood tests to aid in the diagnosis.
What blood test is most likely to assist in the diagnosis?
When speaking with a new parent about the advantages of breastfeeding, they inquire about how breastfeeding can enhance their baby’s immune system. You clarify that certain immunoglobulins are present in breast milk, which can transfer immunity from specific illnesses to the baby.
Which immunoglobulin will this parent be passing on to their child?
A 10-year-old girl arrives at the emergency department following a fall from a swing, landing on her outstretched right hand. She is experiencing wrist pain and has difficulty moving it. The X-ray report shows:
Fracture of the distal radius affecting the growth plate and the distal part of the diaphysis, without involvement of the distal epiphysis.
What Salter-Harris fracture type is this?
A 56-year-old woman visits her GP complaining of experiencing pain on the lateral side of her left thigh for the past two weeks. The pain has been gradually worsening and extends downwards to just above her left knee. She reports that the pain is more intense when she sleeps on her left side and sometimes wakes her up at night. Upon examination, the doctor observes point tenderness on palpation of the lateral aspect of the left hip, which triggers the radiation of the pain down the thigh. The pain is exacerbated when the hip is passively externally rotated. What is the most probable diagnosis for this patient?
A 67-year-old woman comes to the ED complaining of instability and pain in her right hip. She reports that the pain extends to her knee and is exacerbated by weight-bearing, but she is still able to walk and bear weight. She underwent a total hip replacement 19 months ago for an intracapsular femoral neck fracture. What is the probable diagnosis?
A 70-year-old female presents to her primary care physician with a one-month history of bilateral shoulder and hip girdle pain. Polymyalgia rheumatica is diagnosed and the patient is prescribed a daily dose of 15 mg oral prednisolone. Considering the patient’s likelihood of taking prednisolone for more than 3 months, what is the best course of action to address her heightened risk of developing osteoporosis?
An 80-year-old man presents to the emergency department with a headache on the right side of his head. The pain is concentrated in his right temple and worsens when he moves his jaw. He reports no changes in vision or focal neurological symptoms. The patient has a medical history of polymyalgia rheumatica. A temporal artery biopsy is scheduled to confirm the diagnosis. What is the next best course of action in managing this patient?