A 42-year-old woman complains of pain in her ring finger. She mentions being bitten by an insect on the same hand a few days ago. Upon examination, her entire digit is swollen, but the swelling stops at the distal palmar crease, and she keeps her finger strictly flexed. Palpation and passive extension of the digit cause pain. What is the probable diagnosis?
A 17-year-old male complains of lower back pain that has been bothering him for 5 months. The pain is worse at night and he experiences morning stiffness. However, he feels better after exercising. He denies any history of injury. Based on his symptoms, the clinical diagnosis is ankylosing spondylitis. What is the most common finding on examination associated with this diagnosis?
A 40-year-old woman presents with a 4-day history of left shoulder pain. The pain is confined to the shoulder and has not spread to other areas. She reports injuring her shoulder while attempting shoulder exercises at the gym recently. The patient has a medical history of type 2 diabetes mellitus and hypercholesterolemia. Upon examination, the shoulder appears normal in temperature and color, without signs of swelling. Active and passive external rotation are significantly limited by pain. Flexion, extension, abduction, and adduction are also limited by pain, but to a lesser extent. What is the most probable diagnosis?
As an FY2 in the Emergency Department, you have assessed a 65-year-old female patient who is experiencing urticaria and breathing difficulties following a recent change in medication. The patient has a medical history of hypertension, osteoporosis, gastro-oesophageal reflux disease, and refractory rheumatoid arthritis. She is also known to have allergies to pollen, aspirin, and plaster adhesives. Which medication is the most likely cause of her current presentation?
A fifty-six-year-old, known alcoholic, presents to his general practitioner (GP) with complaints of swelling in his right foot. The patient is unsure when the swelling started, but it has been gradually worsening for the past four months. The swelling is constant and not painful, and he is still able to bear weight on both limbs. He sleeps with two pillows at night but denies being short of breath or experiencing paroxysmal nocturnal dyspnoea. The patient has been smoking 10 cigarettes a day for 30 years and consuming 15 units of alcohol per day for 20 years.
During examination, the patient’s heart rate is 84/minute, respiratory rate is 12/minute, blood pressure is 135/74 mmHg, oxygen saturations are 98%, and temperature is 36.5ºC. The right foot is visibly swollen and erythematosus, and it is hot to the touch. There is no tenderness on palpation, but there is reduced range of movement due to stiffness from swelling. Pulses are present, but there is reduced sensation in all dermatomes below the knee. The left foot is mildly swollen, but not hot or erythematosus. There is no tenderness on palpation of the joint or tarsal bones, and there is a normal range of movement. Pulses are present, but there is reduced sensation in all dermatomes below the knee.
The GP sends the patient for X-rays of both feet. The X-ray of the right foot shows evidence of osteolysis of the distal metatarsals and widespread joint dislocation in the forefoot. The X-ray of the left foot is normal. What is the most likely diagnosis for this patient?
As a doctor in the emergency department, you are asked to assess a 37-year-old man who is experiencing worsening pain in his left knee. He is unable to bear weight on the affected leg and reports no injury or trauma. The patient is a known IV drug user and has no known drug allergies or regular medications. On examination, the knee is swollen and hot to touch. His vital signs are heart rate 107 bpm, respiratory rate 18 breaths/minute, oxygen saturations 95%, blood pressure 106/65mmHg, and temperature 38.9ºC. Blood tests reveal elevated levels of Hb, WBC, CRP, and ESR. The synovial fluid culture grows Staphylococcus aureus. What is the most appropriate first-line IV antibiotic therapy for this likely diagnosis?
A 58-year-old woman has presented to the hospital with a five-hour history of intermittent retrosternal chest pain radiating into the shoulder and jaw with associated diaphoresis, dyspnoea, and dizziness.
She has a past medical history of Crohn’s disease and takes azathioprine 150 mg daily. She was previously started on sulfasalazine but developed facial swelling.
ECG shows normal sinus rhythm at 78 bpm but demonstrates 3mm of ST depression in leads II, III, and aVF.
Blood results are:
Urea 5.6 mmol/L (2.0 – 7.0)
Creatinine 132 µmol/L (55 – 120)
Initial Troponin T 17 ng/L (5-14)
5 hour Troponin T 326 ng/L (5-14)
A diagnosis of an inferior non-ST elevation myocardial infarction is made.
Which medication should be avoided?
A 28-year-old man visits his GP complaining of painful knee and ankle joints. He reports feeling unwell, fatigued, and feverish after returning from a trip to Thailand three weeks ago, during which he experienced severe diarrhea. The doctor suspects reactive arthritis. What other physical indication during the examination may support this suspected diagnosis?
A 72-year-old man presents to the emergency department with a severely painful and red great toe. He reports experiencing similar episodes before, but none as intense as this one. The pain started suddenly upon waking up this morning, and he has found little relief from taking ibuprofen at home. The doctor suspects gout and decides to confirm the diagnosis by performing a joint aspiration and analyzing the synovial fluid. What are the usual findings on joint aspiration in gout?
A 42-year-old female complains of fatigue and widespread pain for the past six months, which worsens with stress or exposure to cold. Physical examination reveals multiple tender points throughout her body, but all other findings are normal. Despite normal results from autoimmune, inflammatory, and thyroid function tests, what treatment is most likely to be effective for her probable diagnosis?