QuestionSBA
QuestionChoice
Gout is usually an acute presentation of sudden, severe attacks of pain, swelling and tenderness of one or more joints.

Common joints affected tend to be those in the lower limb such as toes, feet, ankles and knees.

Diagnosis is done by aspirating the affected joint. Microscopy identifies negatively bifringent, needle shaped crystals.

Xrays are not crucial for diagnosis but will show soft tissue swelling and bony erosions.
10005968
c
Gout
QuestionChoice
NICE guidelines state that adults over the age of 45 can be diagnosed clinically with osteoarthritis.

They do not require investigations if they have no joint-related morning pain or stiffness or have joint-related morning pain and stiffness that does not persist longer than 30 minutes.

An X-ray would demonstate subchondral sclerosis, cyst formation, loss of joint space and osteophyte formation.
10005966
a
Osteoarthritis
QuestionChoice
This is an auto-inflammatory disease so is associated with pain and stiffness in the morning that lasts for longer than 30 minutes.

Activity tends to relieve the pain, whilst rest can exacerbate it.

Patients tend to present with 3 or more tender, warm, swollen joints bilaterally with systemic features such as fatigue and fevers.

Diagnosis is made with a combination of the clinical picture and MRI or ultrasound scan of joints.
10005970
e
Rheumatoid arthritis
QuestionChoice
This is an auto-inflammatory condition which is associated with the HLA-B27 gene.

This condition tends to present in young men under 45 years of age. They have morning pain and stiffness that persists over 30 minutes and is relieved by exercise.

Inflammation in the axial skeleton can cause new bone formation and fusion of the bones in the spine - known as a bamboo spine.

Sacroilitis is seen on Xray which is part of the diagnostic New York criteria.
10005967
b
Ankylosing spondylitis
QuestionChoice
Osteoporosis refers to thinning of the bone. Bone density measurement by a DEXA scan at the hip and spine is generally considered the most reliable way to diagnose the condition.

Osteoporosis has no clinical features until there is a fracture and tends to be an incidental finding.
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Osteoporosis
Concept
Chapter
2693
3766
Osteoarthritis
Topic
145
Orthopaedics
13740
70 year old male attends the orthopaedic clinic complaining of pain and stiffness in his left hip that has gradually worsened over 6 months.

He says that he wakes up feeling pain-free with no morning stiffness. However, as he carries out activities such as walking for his newspaper the pain and stiffness worsen.

Which od the following is the most likely diagnosis?
a