A 50-year-old woman with a history of rheumatoid arthritis is experiencing severe joint pain and synovitis in her hands and wrists. Despite being prescribed methotrexate and sulfasalazine, her symptoms have not improved. Her rheumatologist has recommended switching to adalimumab. Before starting this medication, which test must be performed?
A 67-year-old man has recently undergone a DEXA scan after experiencing back pain.
The results are as follows:
Site T score
Lumbar spine -1.5
Femoral neck -2.0
What does the femoral neck bone density score indicate for this individual?
A 75-year-old man of Brazilian descent is referred for an outpatient DEXA scan by his general practitioner. He has obesity and chronic kidney disease (for which he takes ramipril). He has never smoked and rarely drinks alcohol. What risk factor predisposes him to this condition? His DEXA scan now shows a T-score of -3 and he is started on alendronic acid.
A 67-year-old woman presents with an inability to bear weight on her right thigh after a fall, accompanied by right incomplete atypical femoral fracture and left stress fractures. She had been experiencing vague bilateral thigh and groin pain for a month prior. Despite no metastatic spread to the femurs, she has a history of bony metastatic breast cancer, hypertension, heart failure, and depression. She has been taking spironolactone and furosemide for three years, Herceptin and alendronic acid for six years, and sertraline for ten years. Which medication is likely to have contributed to her condition?
A 28-year-old male patient arrives at the Emergency Department complaining of a painful red eye and blurred vision. Upon further inquiry, he reveals that he is experiencing multiple painful ulcers in his mouth and genital area. Despite being sexually active, he admits to seldom using barrier contraception, and his routine sexually transmitted infection screenings have all been negative. What is the probable diagnosis?
A 55-year-old woman with chronic kidney disease presents with an acutely painful joint. The joint is red and swollen upon examination. The patient reports waking up with the pain, which has worsened to a 9/10 severity throughout the day. Despite taking simple analgesia, the pain has not improved.
The patient’s vital signs are as follows:
– Heart rate: 115 bpm
– Blood pressure: 120/56 mmHg
– Respiratory rate: 21
– Oxygen saturation: 98%
– Temperature: 39.1°C
Based on the symptoms, what is the most likely joint affected?
A 27-year-old male patient arrives at the emergency department complaining of fever, chills, and excruciating joint pain that has been ongoing for a day. Upon examination, the patient seems to be in distress, and the joint is warm and erythematosus to the touch. Additionally, there is a skin abscess located beneath the left axilla. To aid in further diagnosis, a synovial fluid aspiration is performed. Based on this presentation, which joint is most likely affected?
A 93-year-old man is brought into the emergency department after a car accident. He was in the passenger seat and wearing a seatbelt at the time.
His son, who was also in the car, reports hearing a loud ‘thud’ when his father’s knees hit the dashboard. He had a right total hip replacement 12 years ago.
A primary survey shows right-sided dislocation of the hip.
What findings would be anticipated on examination, considering the probable type of dislocation?
A 35-year-old man presents to the rheumatologist with persistent pain, swelling, and soreness in his right knee, lower back, and eyes. He reports feeling generally well and is currently taking ciprofloxacin for a UTI. He was treated for Chlamydia and gonococcus co-infection four weeks ago. Blood tests reveal Hb levels of 132 (115 – 160), WBC count of 10.4 * 109/L (4.0 – 11.0), and CRP levels of 55 mg/L (< 5). On examination, the right knee and ankle are swollen and tender. What auto-antibody is typically associated with this condition?
A 32-year-old man visits his GP with complaints of worsening joint pains and fever over the past 3 weeks. The fever occurs every evening and can reach up to 39.5ºC but subsides by the morning. He experiences pain and swelling in his shoulders, wrists, and metacarpophalangeal joints that aggravates with the fever. Although his girlfriend has noticed a salmon-pink rash on his back, no rash is visible during examination. He also reports a persistent sore throat. He denies any weight loss or night sweats and has no significant medical history. What is the most probable cause of this patient’s symptoms?