A 27-year-old construction worker complains of worsening pain in his feet over the past two weeks, describing it as feeling like he is walking on gravel. He also reports experiencing lower back pain.
The patient recently returned from a trip to Spain two months ago and recalls having a brief episode of urethral discharge, but did not seek medical attention for it.
What is a possible diagnosis?
A 30-year-old Afro-Caribbean woman presents with bilateral ankle and wrist pain that has been gradually worsening over the past 5 days. She complains of fatigue and feelings of lack of energy. She mentions a dry cough and shortness of breath on exertion, lasting for more than a year. On examination, her vital signs are within normal limits, except for the presence of a mild fever. There are several reddish, painful, and tender lumps on the anterior of the lower legs. A chest X-ray shows bilateral hilar masses of ,1 cm in diameter.
Which of the following test results is most likely to be found in this patient?
A 35-year-old woman presented with fever and joint pain. During her consultation with the doctor, the doctor observed a rash on both cheeks. A kidney biopsy sample showed deposits of immunoglobulin, C3, and fibrinogen in the basement membrane. Her serum analysis revealed elevated levels of anti-dsDNA antibody. What is the most probable diagnosis?
A 20-year-old student midwife presents with increasing pain and swelling of the ring finger of her left hand. The pain and swelling started two days ago and is now extremely uncomfortable to the point the patient has been avoiding using the left hand altogether. She cannot remember injuring the affected area, and is usually fit and well, without medical conditions to note except an allergy to peanuts.
On examination, the affected finger is markedly swollen and erythematosus, with tenderness to touch – especially along the flexor aspect of the finger. The patient is holding the finger in slight flexion; attempts at straightening the finger passively causes the patient extreme pain. The patient is diagnosed with tenosynovitis.
About which one of the following conditions should the presence of acute migratory tenosynovitis in young adults, particularly women aged 20, alert the doctor?
A 35-year-old married man was on a business trip in Thailand when he developed diarrhoea that lasted for 1 week. He returned to the United States and, a few weeks later, visited his primary care physician (PCP) complaining of pain in his knee and both heels. His eyes have become red and he has developed some painless, red, confluent plaques on his hands and feet, which his PCP has diagnosed as psoriasis.
What is the most probable diagnosis?
Which joint is usually spared from osteoarthritis?
A 20-year-old patient presents with purpura on his back, buttocks and extensor surface of his lower limbs. He has dipstick haematuria.
Which one of the following is the most likely diagnosis?
A 33-year-old paediatric nurse presents with complaints of fatigue, joint discomfort throughout her body, and a rash on her face that has worsened since returning from a recent trip to Portugal. On examination, there is no evidence of small joint synovitis, but the facial rash is prominent. Blood tests reveal a haemoglobin level of 103 g/l, MCV of 88.8 fl, platelet count of 99 × 109/l, and a WCC of 2.8 × 109/l. What is the most appropriate treatment option at this stage?
A 40-year-old teacher presents with complaints of lethargy and widespread aches and pains, particularly in the shoulders and hands. She has been absent from work for the past 5 months due to her symptoms. Her medical history includes a diagnosis of irritable bowel syndrome. Despite a brief course of steroids and anti-inflammatory medication, she has not experienced any improvement. Physical examination reveals multiple tender points in different muscle groups, but no evidence of joint disease. What is the probable diagnosis?
A 72-year-old man presents for review, complaining of pain in his knees. There is also stiffness in his fingers and he finds it difficult to use his computer. There is a history of hypertension, for which he takes amlodipine 10 mg, and type II diabetes, for which he takes metformin. He had been given a diagnosis of ulcerative colitis some years ago but has had no recent symptoms. On examination, he has a body mass index (BMI) of 34; blood pressure is 150/90 mmHg, and he has swelling and bony deformity of both knees. There is crepitus and anterior knee pain on flexion. Examination of the hands reveals Heberden’s nodes.
Investigations:
Investigation Result Normal value
Haemoglobin 120 g/dl 115–155 g/l
White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
Platelets 240 × 109/l 150–400 × 109/l
Erythrocyte sedimentation rate 12 mm/h 0–10mm in the 1st hour
Rheumatoid factor Negative
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.7 mmol/l 3.5–5.0 mmol/l
Creatinine 130 μmol/l 50–120 µmol/l
X-ray of both knees reveals reduced joint space, subchondral sclerosis and cyst formation and osteophytes within the joint space.
Which of the following fits best with the diagnosis?