A 27-year-old male presents with lower back pain and painful feet that feel like walking on pebbles. He has been generally healthy, but he recently returned from a trip to Corfu where he had a diarrheal illness. He admits to infrequently taking ecstasy but takes no other medication. On examination, he has limited movement and pain in the sacroiliac joints and soreness in the soles of his feet upon deep palpation. What is the most probable diagnosis?
A middle-aged man without prior medical history is experiencing increasing back pain and right hip pain for the past decade. The pain worsens towards the end of the day. He has bony enlargement of the distal interphalangeal joints. Radiographs reveal prominent osteophytes involving the vertebral bodies and sclerosis with narrowing of the joint space at the right acetabulum. What is the most likely pathologic process occurring in this patient?
A 24-year-old Caucasian farmer presents to the outpatient department with a complaint of lower back pain that has been bothering him for the past two months. He reports that the pain is at its worst in the morning. He also experiences intermittent pain and swelling in his right ankle, which he injured while running a year ago. Two weeks ago, he visited the Emergency department with a painful red eye, which was treated with eye drops. He is a heavy smoker, consuming 45 cigarettes a day, and drinks five pints of beer every weekend. He denies any skin rashes or mucosal ulceration. His mother had rheumatoid arthritis, and his father had severe gout. On direct questioning, he admits to being diagnosed with chlamydia four months ago. During the examination, his right ankle was swollen at the site of Achilles’ tendon insertion, but all other joints were unremarkable. Flexion of the lumbar spine was reduced. What is the most likely diagnosis for this man?
A 65-year-old woman presents to the Emergency department with increasing breathlessness and coughing up of small amounts of blood over the past one week. She also complains of frequent nosebleeds and headaches over the past two months. She feels generally lethargic and has lost a stone in weight.
She is noted to have a purpuric rash over her feet. Chest expansion moderate and on auscultation there are inspiratory crackles at the left lung base.
Investigations show:
Haemoglobin 100 g/L (115-165)
White cell count 19.9 ×109/L (4-11)
Platelets 540 ×109/L (150-400)
Plasma sodium 139 mmol/L (137-144)
Plasma potassium 5.3 mmol/L (3.5-4.9)
Plasma urea 30.6 mmol/L (2.5-7.5)
Plasma creatinine 760 µmol/L (60-110)
Plasma glucose 5.8 mmol/L (3.0-6.0)
Plasma bicarbonate 8 mmol/L (20-28)
Plasma calcium 2.23 mmol/L (2.2-2.6)
Plasma phosphate 1.7 mmol/L (0.8-1.4)
Plasma albumin 33 g/L (37-49)
Bilirubin 8 µmol/L (1-22)
Plasma alkaline phosphatase 380 U/L (45-105)
Plasma aspartate transaminase 65 U/L (1-31)
Arterial blood gases on air:
pH 7.2 (7.36-7.44)
pCO2 4.0 kPa (4.7-6.0)
pO2 9.5 kPa (11.3-12.6)
ECG Sinus tachycardia
Chest x ray Shadow in left lower lobe
Urinalysis:
Blood +++
Protein ++
What is the most likely diagnosis?
A 30-year-old woman had chronic inflammatory disease that affected her spine, sacroiliac joints and large peripheral joints. X-rays confirmed a diagnosis of ankylosing spondylitis.
The majority of patients with this disease are positive for which one of the following molecules?
A 30-year-old white man comes to his general practitioner complaining of progressive low back pain over the past four years. The pain is worse at night when he lies down and improves as he moves around during the day, but it does not go away with rest. Upon further questioning, he reports having experienced three episodes of acute eye pain with sensitivity to light and blurry vision in the past two years. He sought treatment from an ophthalmologist, and the symptoms resolved with steroids and eye drops. X-rays reveal some inflammatory and arthritic changes in the sacroiliac joints. Despite treatment, the disease has continued to progress, and ten years later, x-rays show calcification of the anterior spinal ligament. What is the most likely positive finding in this patient?
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 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 patient in their mid-40s wakes up experiencing severe pain, redness, and swelling at the base of their big toe.
What is the most suitable course of treatment for this patient?
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?