A 50-year-old man presents to the rheumatology clinic after experiencing an acute monoarthropathy in his left big toe’s metatarsophalangeal joint. The synovial fluid analysis revealed the presence of negatively birefringent crystals under polarised light. After resolving the inflammation with acute treatment, the rheumatologist decides to start prophylactic treatment with allopurinol to prevent future occurrences. What is the most suitable medication to begin with allopurinol?
A 15-year-old boy presents with a 4-month history of lower back and left heel pain, making walking painful and difficult. He reports experiencing morning stiffness lasting for about an hour, which improves with exercise throughout the day. He denies any prior history of similar symptoms and reports that they suddenly started about 4 months ago.
During examination, the patient exhibits reduced lateral and forward flexion of the spine, tenderness upon palpation of the sacroiliac joints, and decreased chest expansion. What other conditions may be associated with this likely diagnosis?
A 85-year-old woman with a history of dementia is discovered on the floor of her nursing home. She is taken to the Emergency Department and reports experiencing pain in her left hip and is unable to put weight on it. X-rays of the hip and pelvis show no abnormalities. Despite receiving sufficient pain relief, she continues to complain of severe hip pain and remains unable to bear weight. What is the most suitable course of action to take next?
A 25-year-old woman with a history of systemic lupus erythematosus (SLE) visits her primary care physician complaining of wrist pain that has been bothering her for the past week. She also reports feeling stiffness in her wrists, particularly in the morning. Although she typically experiences minor joint aches, this pain is more severe than usual.
During the examination, the physician notes tenderness and pain in both of the patient’s wrists upon passive movement. There is no apparent swelling or deformity. Additionally, a rash across her cheeks is observed, which she says has also developed over the past week.
What would be an appropriate course of action for this patient?
Sarah, a 28-year-old woman, presents to the emergency department with right-sided abdominal pain. The pain radiates to the anterior hip and is relieved by flexing her hips to touch knees to chest. Sarah denies any recent trauma. She has a history of ulcerative colitis and takes regular mesalamine.
On examination, her temperature is 38.0ºC. She mobilises across the room with a limp and has pain on extension and internal rotation of her right hip.
Bloods show:
Lab test Result Reference range
WBC 14.8 * 109/L (4.0 – 11.0)
ESR 18 mm/hr < (15)
CRP 12 mg/L (< 5)
What is the most appropriate investigation at this stage?
A 20-year-old basketball player arrives at the emergency department complaining of a sudden popping sensation in his left heel. During the physical examination, a noticeable dip is palpable on the back of his ankle. The patient reports that he was prescribed ciprofloxacin for a chest infection while on a recent trip to Italy. What is the most suitable test to confirm the suspected diagnosis?
A 23-year-old man comes to your clinic complaining of chronic back pain. He denies any history of trauma but reports experiencing anterior uveitis within the past year. You suspect that he may have ankylosing spondylitis (AS) and decide to perform Schober’s test, which yields a positive result. What is a commonly utilized diagnostic test that could provide further evidence to support this diagnosis?
A 19-year-old male patient complains of sudden onset severe pain in his right hip for the past 10 days. He also experiences high-grade fever with chills that comes and goes despite taking paracetamol. The pain is intense, non-radiating, and worsens with hip movements. He denies any history of trauma. What is the most important diagnostic test for this patient’s likely condition?
Samantha is a 65-year-old with a history of type 2 diabetes who has reported experiencing occasional tingling in her right 4th and 5th fingers. What is the probable diagnosis?
A 55-year-old man visits his GP with complaints of numbness and tingling in his right hand. He works as a computer programmer, is left-handed, and denies any recent injuries. He has never experienced these symptoms before.
Upon further questioning, he reports that the numbness and tingling are most noticeable at night and affect his 1st and 2nd fingers. During the examination, no neurological deficits are observed, but Tinel’s sign is positive.
The GP suggests a splint and refers the patient to physiotherapy.
What is the most probable diagnosis?