Joints ache all the time. But what happens when they’re acutely painful???? Gosh …
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acute joint pain
Stem 1 of 4
A 57 year old male presents with 8hr onset “incredible” pain at the first right metatarsophalangeal joint. The joint is stiff and warm to the touch. He denies any history, or family history, of this occurring before. The patient is on therapy for hypertension, but states it has “taken a few pills to get it right”.
Of the medications below, which are more likely taken by this patient if we assume it has exacerbated this presentation?
Stem 2 of 4Which test should be requested first?
CT foot and ankle
Serum uric acid
XR foot and ankle
Stem 3 of 4Joint aspiration reveals mildly elevated white cells and negatively birefringent needle-shaped crystals. What is the most likely diagnosis?
Calcium pyrophosphate arthritis
Monosodium urate arthritis
Stem 4 of 4Which would be the least appropriate therapy for this patient?
Stem 1 of 4
A 52 year old female presents with swelling of all her metacarpophalangeal, proximal interphalangeal joints and bilateral wrists for several years. She reports stiffness in the fingers in the morning that lasts about two hours.
What is the most likely diagnosis?
Stem 2 of 4The hand is examined with deformities present. Which of the following is most likely in this patient?
Stem 3 of 4Of the following tests, which is most specific for most likely diagnosis?
Anti-cyclic citrullinated peptide antibody
Anti-tumour necrosis factor alpha
Interleukin six and seven elevation
Stem 4 of 4Study the radiograph below:
Which of the following features, on this radiograph, support the most likely diagnosis? Select all that may apply.
Loss of joint space
Soft tissue swelling
Stem 1 of 4This is a classic presentation. Which condition should this be “assumed to be until proven otherwise”?
Acute flare of gout
Stem 2 of 4Given the diagnosis, what is the most likely causative organism?
Coagulase-negative staphylococcal species
Stem 3 of 4Select all of the following investigations you may order first line
Liver function test
Synovial gram stain
White cell count
Stem 4 of 4Whilst you are speaking to the patient, his observations are recorded and a deterioration occurs. The following is noted:
HR105, RR24, SBP 110, temp 39.3ºC, sats 98% air. The patient appears to be increasingly drowsy during the history.
What is the patient’s qSOFA score?