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Rheumatology Case Scenarios
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A 60-year-old female complains of bilateral shoulder pain and stiffness, which is worse in the mornings and after periods of inactivity. She also reports experiencing recent unintentional weight loss and fatigue.
Likely diagnosis: Polymyalgia Rheumatica. Rationale: The combination of bilateral shoulder pain, stiffness, systemic symptoms, and age are very suggestive of polymyalgia rheumatica.
A 75-year-old man comes with sudden onset of severe pain in the right big toe. He mentions he had a lavish meal with red meat and alcohol the previous night.
Likely diagnosis: Gout. Rationale: Acute monoarthritis, especially in the big toe, associated with dietary triggers suggest a gout flare.
A 20-year-old female has been experiencing episodes of severe palpitations, diarrhea, and tremors. Her blood pressure is also noted to be high during these spells.
Likely diagnosis: Pheochromocytoma. Rationale: The episodic nature of symptoms along with hypertension is suggestive of a catecholamine-secreting tumor.
A 30-year-old female presents with a 6-month history of symmetrical joint pain and swelling, particularly in her hands and feet. Morning stiffness lasts for more than an hour.
Likely diagnosis: Rheumatoid arthritis. Rationale: Symmetrical polyarthritis and prolonged morning stiffness are characteristic of rheumatoid arthritis.
A 23-year-old male presents with recurrent mouth ulcers, genital ulcers, and painful red eye.
Likely diagnosis: Behçet's disease. Rationale: The combination of recurrent oral and genital ulceration along with ocular involvement is indicative of Behçet's disease.
A 42-year-old man with known hepatitis B infection presents with joint pain, abdominal discomfort, and a purpuric rash on his lower extremities.
Likely diagnosis: Polyarteritis nodosa. Rationale: Hepatitis B infection can be associated with polyarteritis nodosa, a systemic vasculitis, presenting with the described symptoms.
A 45-year-old woman presents with dry eyes and a dry mouth. She also mentions having difficulty swallowing and dental caries.
Likely diagnosis: Sjögren's syndrome. Rationale: Xerophthalmia (dry eyes) and xerostomia (dry mouth) are hallmark signs of Sjögren's syndrome.
A 70-year-old man with a 50-pack-year smoking history complains of worsening cough and has noted blood in his sputum. He has lost 10 kg of weight over the past 2 months without trying.
Likely diagnosis: Lung Cancer. Rationale: The history of significant smoking, hemoptysis, weight loss, and chronic cough are classic clinical pointers towards lung cancer.
A 38-year-old woman presents with palpable purpura on her legs and arthralgia. She mentions a recent upper respiratory tract infection.
Likely diagnosis: IgA vasculitis (Henoch-Schönlein purpura). Rationale: The presence of palpable purpura, recent infection, and arthralgia point towards IgA vasculitis, especially in the absence of other systemic symptoms.
A 32-year-old woman presents with a malar rash, photosensitivity, and joint pain. She also reports a recent unexplained fever and hair loss.
Likely diagnosis: Systemic Lupus Erythematosus (SLE). Rationale: The combination of malar rash, photosensitivity, non-erosive arthritis, and systemic symptoms suggest SLE.
A 50-year-old female presents with a purple lace-like rash on her lower legs and a history of hepatitis C.
Likely diagnosis: Livedo reticularis associated with cryoglobulinemia. Rationale: The classic rash in the context of hepatitis C suggests a vasculitis due to mixed cryoglobulinemia.
A 35-year-old woman presents with a history of recurrent miscarriages and a recent deep vein thrombosis. She also has a rash in the shape of a net on her arms that worsens with sun exposure.
Likely diagnosis: Antiphospholipid syndrome. Rationale: The history of thrombosis, miscarriages, and livedo reticularis rash suggests antiphospholipid syndrome.
A 48-year-old woman with long-standing rheumatoid arthritis complains of sudden visual loss in her left eye with associated pain on eye movement.
Likely diagnosis: Optic neuritis. Rationale: Sudden vision loss and pain with eye movement in a patient with autoimmune disease suggests optic neuritis, which is an inflammatory eye condition.
A 25-year-old male complains of lower back pain and stiffness for more than 3 months, which improves with exercise but not with rest. He also has a history of psoriasis.
Likely diagnosis: Ankylosing Spondylitis. Rationale: Chronic back pain with inflammatory characteristics and association with psoriasis suggests a spondyloarthropathy, such as ankylosing spondylitis.
A 44-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. On examination, she has a slow heart rate and dry skin.
Likely diagnosis: Hypothyroidism. Rationale: The clinical symptoms of metabolism slowing down suggest thyroid underactivity or hypothyroidism.
A 27-year-old male presents with a floppy mitral valve found incidentally on echocardiogram and a family history of similar findings.
Likely diagnosis: Marfan syndrome. Rationale: Aortic and mitral valve abnormalities in the context of familial history suggest a connective tissue disorder like Marfan syndrome.
A 55-year-old man presents with a 5-year history of recurrent oral and genital ulcers. He also mentions experiencing episodes of uveitis.
Likely diagnosis: Behçet's disease. Rationale: The triad of recurrent oral and genital ulcers along with uveitis is characteristic of Behçet's disease.
A 60-year-old man presents with bone pain, high calcium levels, and a high total protein level in his blood tests.
Likely diagnosis: Multiple Myeloma. Rationale: The classic triad of bone pain, hypercalcemia, and elevated total protein level often points to multiple myeloma.
A 30-year-old male presents with recurrent episodes of abdominal pain, fever, and migratory arthralgia. He has a past medical history of Crohn's disease.
Likely diagnosis: Erythema nodosum. Rationale: The triad of symptoms along with a background of inflammatory bowel disease suggests erythema nodosum, which is a panniculitis associated with Crohn's disease.
A 68-year-old woman complains of headache, jaw claudication, and blurred vision. On examination, her temporal artery is tender and swollen.
Likely diagnosis: Giant Cell Arteritis (Temporal Arteritis). Rationale: The symptoms and physical findings are suggestive of temporal arteritis, a form of vasculitis that commonly affects the elderly.
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