EMQs in Clinical Medicine.pdf - Peshawar Medical College

Joint pain 113
43 Joint pain
A
B
C
D
E
F
G
psoriatic arthritis
polymyositis
rheumatoid arthritis
polymyalgia rheumatica
systemic lupus erythematosus
haemarthrosis
lumbar spondylosis
H
I
J
K
L
M
N
Reiter’s syndrome
osteosarcoma
pseudogout
septic arthritis
gout
osteoporosis
osteoarthritis
For each clinical scenario below, give the most likely cause for the clinical findings.
Each option may be used only once.
1 A 64-year-old patient who has recently been started on medication for hypertension
presents with a very painful, hot, swollen metatarsophalangeal joint.
2 A 12-year-old haemophiliac presents to A&E with severe pain after falling over
and banging his right knee.
3 A 55-year-old man presents to A&E with fever and an exquisitely painful right
knee. On examination his right knee is red, hot and swollen. Purulent fluid is
aspirated from the joint.
4 A 60-year-old woman presents with a painful swollen knee. Her radiograph
shows chondrocalcinosis and joint aspiration reveals presence of weakly positive
birefringent crystals.
5 A 65-year-old woman presents with a 1-month history of pain and stiffness in
her shoulders, worse in the mornings. She says that she was treated in hospital
last year for headache and jaw pain.
Answers: see page 125.