A 53-year-old textiles worker is referred for nerve conduction studies after a trial of conservative management fails to improve symptoms of sensory loss over the palmar aspect of her right thumb, index, middle and ring fingers. Examination reveals thenar wasting of the right hand.
What would be the common findings in nerve conduction evaluation of this patient’s symptoms?
A 56-year-old man comes to the clinic complaining of severe pain and redness in his big toe. He appears to be in good health and there are no signs of infection or fever. He has a history of gout and suspects that it has returned. He is currently on a regular dose of allopurinol. What would be the most suitable course of action?
A 56-year-old man presents to the clinic with complaints of back pain. He describes experiencing poorly localised lower back pain for the past 2 weeks, which began after doing some yard work. The patient works as a carpenter and reports that the pain has not improved with the use of a heating pad or over-the-counter pain medication. He denies any fever or neurological symptoms. During the examination, paraspinal tenderness is noted, and the straight-leg test is negative. The patient reports intentional weight loss of 5kg over the past 3 months, and his body mass index is 30 kg/m².
What is the most appropriate next step in managing this patient’s condition?
You see a 60-year-old man who fractured his left ankle 6 weeks ago when he slipped on a wet floor. The orthopaedic team recommended a dual-energy X-ray absorptiometry (DEXA) scan and the results have just been received by you.
His T score is -2.5 and his Z score is -1.8. You inform the patient that his Z score is adjusted for age, gender, and ethnicity, and it indicates a lower bone density than expected for someone of his age and demographic.
A 62-year-old man visits the outpatient department for a review of his osteoporosis, where he is booked in for a DEXA scan. His T-score from his scan is recorded as -2.0, indicating decreased bone mineral density. What patient factors are necessary to calculate his Z-score?
A 55-year-old male has been treated for 3 flares of gout over the last year and would like some medication to prevent this from reoccurring. His past medical history includes: gout, Crohn’s disease, hypertension and depression. His regular medications are: paracetamol, omeprazole, ramipril, azathioprine and sertraline.
Which medication would pose a risk of bone marrow suppression for this patient?
A 35-year-old woman complains of dull lower back pain after relocating. She has no significant medical history and her physical examination is unremarkable. What is the initial treatment option for her pain?
A 26-year-old male comes to the emergency department (ED) after twisting his ankle while playing soccer. Upon arrival at the ED, he is unable to take more than two steps and experiences bony tenderness at the lateral malleolus. An x-ray is conducted, revealing an undisplaced fracture of the fibula, located just distal to the syndesmosis.
What is the appropriate course of treatment for this patient?
A 51-year-old male presents with painful colour changes of his hands precipitated by cold. He also reports difficulty swallowing and has noticed tightness of his skin especially on his face and his fingers.
What is the most appropriate test from the options below?
A 65-year-old man presents with weakness and a skin rash on his upper eyelids. He also complains of a cough which has been present for 3 months. He has a 50 pack-year smoking history. On examination he is noted to have symmetrical proximal muscle weakness.
What is the most appropriate test from the options below?