A 68-year-old woman comes to her primary care doctor for evaluation of left knee pain. The symptoms began about half-a-year ago. She works as a supermarket cashier and reports that the pain is worse in the evening. Past medical history is notable for hypertension and atherosclerosis. Temperature is 37.2°C (99.0°F), blood pressure is 137/85 mmHg, and body mass index is 30 kg/m2. Physical examination is notable for crepitus and reduced range of motion in the left knee. No erythema or warmth is noted at the affected joint. Cardiac, pulmonary, and abdominal examinations are noncontributory. Which of the following is the next best step in the management of this patient?

A 48-year-old woman presented with a 2-month history of increasingly painful swelling behind her right knee, associated with intermittent low-grade fevers and fatigue. Over the past year, she has had occasional pain in her hands and wrists bilaterally. Examination shows a 3-cm nontender mass in the right popliteal fossa that becomes prominent when the knee is extended. There is mild swelling and redness of her right knee joint. Which of the following is the most likely diagnosis?

Most specific antibody for rheumatoid arthritis is

A 42-year-old woman comes to the physician because of stiffness and pain in multiple joints. The patient says that the fingers on both of her hands have become increasingly stiff and difficult to move over the past 8 months. During this time, she has also noticed that her nails break easily and look spotty. One year ago, she had a urinary tract infection that was treated with antibiotics. Her only medication is occasional ibuprofen for chronic back pain. She is sexually active with 2 male partners and uses condoms inconsistently. Her vitals are within normal limits. There are multiple, well-demarcated red plaques with silvery-white scales over the shins and back. Serum studies show a negative rheumatoid factor and ANA. Which of the following is the most likely diagnosis?

A 42-year-old Malay woman presents to your clinic with a 9-month history of gradually tightening skin over her fingers and forearms. She reports episodes of fingertips turning white then blue on exposure to cold, accompanied by numbness and tingling. Over the past 3 months, she has developed increasing difficulty swallowing solid food and a persistent heartburn, particularly at night. On examination, there is thickened, shiny skin over the hands with decreased range of motion in the fingers, and capillary change at the nail folds. Cardiovascular and respiratory examination is unremarkable. Investigation reveals: ANA positive with a centromere pattern, Renal function is normal. Esophageal manometry: low amplitude peristalsis in the lower two-thirds of the esophagus. High-resolution CT (HRCT) of the chest: early reticular changes at the lung bases. Which of the following is the most appropriate next step in management for this patient’s condition?

A 62-year-old woman presents after sustaining a wrist fracture following a fall from standing height. She reached menopause at age 51. She has a history of rheumatoid arthritis for 12 years and has been taking oral prednisolone 10–15 mg daily for the past 5 years. She does not smoke or drink alcohol. On examination, she has a rounded face, supraclavicular fullness, proximal muscle weakness, and thinning of the skin with easy bruising.

Investigations show: Serum calcium: normal; serum phosphate: normal, alkaline phosphatase: normal, 25-hydroxyvitamin D: low, DEXA scan: T-score −2.9 (≥-1.0).

Which of the following is the most likely cause of this patient’s osteoporosis?

A 62-year-old man with stage 3 CKD presents with an acute gout attack for the 2nd time in 12 months. His serum uric acid is 590 umol/L. Which of the following is the most appropriate management strategy in this patient?

A 42-year-old woman presents with progressive tightening of the skin over her fingers and face for the past 1 year. She also complains of cold-induced color changes in her fingers, dysphagia, and exertional dyspnea. On examination, she has sclerodactyly, digital pitting scars, and telangiectasia. Chest auscultation reveals fine bibasal crackles. Which of the following laboratory investigations is most specific for confirming the underlying diagnosis?

A 65-year-old man presents to his GP with a 3-day history of severe pain, swelling, and redness affecting his right wrist. The symptoms developed rapidly overnight after a dinner with friends where he consumed several glasses of wine. He has a past medical history of hypertension and type 2 diabetes. On examination, his right wrist is warm, erythematous, and exquisitely tender to touch with limited range of movement. His temperature is 37.8°C. Which radiological feature would be most consistent with the likely diagnosis?

A 68-year-old postmenopausal woman presents to the clinic after sustaining a low-impact fall at home. She complains of acute back pain. She has no history of trauma. She is thin, does not smoke, and has been on long-term oral prednisolone for rheumatoid arthritis. Examination reveals thoracic kyphosis and localized spinal tenderness. A lateral spine X-ray shows a wedge compression fracture of T12. Which of the following is the most appropriate long-term management to reduce her future fracture risk?

A 62-year-old man presents with a first acute gout attack of the big toe. He has CKD stage 3 and mild gastritis. Which acute therapy is safest?

A 26 year old man presents with acute asymmetric knee arthritis 2 weeks after dysentery. What is the most likely synovial fluid finding?

A 25-year-old man presents with asymmetric ankle arthritis 2 weeks after urethral discharge. Which additional combination of features is most characteristic of this condition?