A 35-year-old woman presents with increasing early-morning bilateral knee pain and stiffness and generalised fatigue. On examination, she is noted to have flat erythema over the malar eminences with sparing of the nasolabial folds. Multiple painless oral ulcers are also noted. Examination of the knee joints reveals tenderness and suprapatellar effusions bilaterally.
Which of these is most specific for the underlying condition?
A 35-year-old man presents with a 5-day history of pain and swelling affecting the right knee and left ankle. On further questioning, he complained of dysuria and had woken with both eyes ‘stuck together’ for the last three days. He thinks that his urinary symptoms may be linked to the unprotected sex he had three weeks ago. Which of the following is the most likely diagnosis?
A 25-year-old man with inflammatory bowel disease has been experiencing lower back pain, stiffness, and buttock pain for the past six months. He notices that his pain improves after playing squash on Saturdays. He has tested positive for HLA-B27 and his blood tests, including C-reactive protein and erythrocyte sedimentation rate, are normal except for a mild hypochromic microcytic anemia. What is the most likely diagnosis?
A 52-year-old man comes to the clinic complaining of a severely painful, swollen, and red left big toe. He states that it started yesterday and has become so excruciating that he cannot put on shoes. The patient has a medical history of type 2 diabetes and was diagnosed with a stomach ulcer last year. The diagnosis is a first episode of acute gout. What would be the most suitable initial treatment?
A 27-year-old man presents to his primary care physician with complaints of worsening back pain and stiffness over the past 5 months. He denies experiencing leg pain, loss of bladder or bowel control, or weakness in his lower extremities. The patient reports that the stiffness in his back tends to improve throughout the day. Upon examination, the physician notes mild tenderness directly over the lumbar spine and decreased range of motion with hip flexion. The patient has normal muscle strength in his lower extremities and intact sensation. X-ray results reveal sacroiliitis, vertebral squaring, and a ‘bamboo spine’. Which of the following is most likely associated with this patient’s condition?
In which condition is pseudofracture typically observed?
A 40-year-old farmer presents to the clinic with muscle pain in his lower back, calves and neck. He takes regular paracetamol but this has not helped his symptoms. For the past four weeks, he has become increasingly agitated and reports that he can no longer sleep for more than a few hours because the pain wakes him up. He feels increasingly lethargic and helpless. He also reports that as a result of his pain, he feels that his memory has worsened and he reports a low mood. A Kessler Psychological Distress Scale screening questionnaire is performed and he has a score of 30. His laboratory blood tests are unremarkable.
What is the most appropriate treatment for this patient?
A 68-year-old woman presents with a one-month history of non-specific malaise. She experiences stiffness, particularly in the mornings, and has difficulty lifting her arms to comb her hair. She also has constant pain in her arms, shoulders, and jaw when chewing. She has lost 4 kg in weight and has a persistent headache. She smokes 10 cigarettes a day and drinks 10 units of alcohol per week. On examination, she has tenderness with reduced mobility in the proximal muscles of her arms and legs. Her investigations reveal a low Hb, high WCC, and elevated ESR. What is the most likely diagnosis?
An 80-year-old man presents with complaints of stiffness and pain in both shoulders. He has experienced a weight loss of one stone over the past eight weeks and reports feeling lethargic with a decreased appetite. Upon investigation, a positive rheumatoid factor, normochromic normocytic anaemia, and a significantly elevated ESR (100 mm/hr) were found. What is the most probable diagnosis?
A 32-year-old woman fell off her horse while horse-riding and is now experiencing severe foot pain. Her foot was trapped in the stirrup during the fall. An x-ray revealed displacement of her second and third metatarsal from the tarsus. What is the name of this injury?