A 43-year-old woman presents with right-sided elbow pain. This has been present for the past month and she reports no obvious trigger. On examination she reports pain when the wrist is extended whilst the elbow is extended.
What is the most likely diagnosis?
Correct Answer B:
Lateral epicondylitis:
Lateral epicondylitis typically follows unaccustomed activity such as house painting or playing tennis ('tennis elbow'). It is most common in people aged 45-55 years and typically affects the dominant arm.
Features:
Management options:
A 57-year-old man presents with pain in his right knee. An x-ray shows osteoarthritis. He has no past medical history of note.
What is the most suitable treatment option for the management of his pain?
Correct Answer E: Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line.
Oral NSAIDs should be used second line in osteoarthritis due to their adverse effect profile.
Osteoarthritis: management: NICE published guidelines on the management of osteoarthritis (OA) in 2008:
These drugs should be avoided if the patient takes aspirin:
What is the role of glucosamine?
A 31-year-old woman presents as her fingers intermittently turn white and become painful. She describes the fingers first turning white, then blue and finally red. This is generally worse in the winter months but it is present all year round. Wearing gloves does not help. Clinical examination of her hands, other joints and skin is unremarkable.
Which one of the following treatments may be beneficial?
Correct Answer E: This lady has Raynaud's disease.
Raynaud's:
Raynaud's phenomena may be primary (Raynaud's disease) or secondary (Raynaud's phenomenon) Raynaud's disease typically presents in young women (e.g. 30 years old) with symmetrical attacks.
Factors suggesting underlying connective tissue disease:
Secondary causes:
Management:x
A 79-year-old man presents with a history of lower back pain and right hip pain. Blood tests reveal the following:
Correct Answer E: Paget's disease - old man, bone pain, raised ALP.
The normal calcium and phosphate combined with a raised alkaline phosphate points to a diagnosis of Paget's.
Paget's disease of the bone:
Paget's disease is a disease of increased but uncontrolled bone turnover. It is thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity. Paget's disease is common (UK prevalence 5%) but symptomatic in only 1 in 20 patients.
Predisposing factors:
Clinical features - only 5% of patients are symptomatic:
Indications for treatment include bone pain, skull or long bone deformity, fracture, periarticular Paget's:
Complications:
*Usually normal in this condition but hypercalcaemia may occur with prolonged immobilization.
A 25-year-old man presents with back pain. Which one of the following may suggest a diagnosis of ankylosing spondylitis?
Correct Answer D:
Ankylosing spondylitis: features:
Ankylosing spondylitis is a HLA-B27 associated spondyloarthropathy. It typically presents in males (sex ratio 5:1) aged 20-30 years old.
Clinical examination:
Other features - the 'A's:
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