A patient with osteoarthritis of the knee experiences persistent pain and functional limitation despite conservative management. Which surgical procedure is commonly performed to alleviate symptoms and improve function in such cases?

Correct Answer: A

Rationale: Total knee arthroplasty (TKA), also known as total knee replacement, is a surgical procedure commonly performed to alleviate symptoms and improve function in patients with advanced osteoarthritis of the knee that has not responded to conservative management. During TKA, the damaged cartilage and bone in the knee joint are removed and replaced with prosthetic components. This procedure aims to reduce pain, restore function, and improve the quality of life for individuals with severe osteoarthritis of the knee. High tibial osteotomy (HTO) is typically performed in younger patients with unicompartmental osteoarthritis, while knee arthroscopy and meniscectomy are more targeted towards specific knee conditions and may not provide significant relief in cases of advanced osteoarthritis.

Correct Answer: A

Rationale: X-ray is the most appropriate imaging modality for evaluating wrist involvement in rheumatoid arthritis. It can show joint space narrowing, erosions, soft tissue swelling, and periarticular osteopenia. X-rays are readily available, cost-effective, and provide valuable information about joint damage and disease progression in rheumatoid arthritis. In this case, X-ray would be able to confirm the presence of erosions, joint deformities, and assess the severity of the disease in the wrist joint. While MRI and ultrasound can also be helpful in evaluating rheumatoid arthritis, X-ray remains the initial imaging modality of choice due to its convenience and ability to assess bony changes. Dual-energy X-ray absorptiometry (DEXA) scan is not indicated for evaluating wrist involvement in rheumatoid arthritis.

Correct Answer: C

Rationale: The given patient with chronic kidney disease (CKD) is likely experiencing uremic bleeding diathesis. Uremic bleeding diathesis is a complication of CKD characterized by abnormal platelet function, leading to a tendency for bleeding. The presence of anemia, thrombocytopenia (low platelet count), pale skin, easy bruising, and elevated blood urea nitrogen (BUN) and creatinine levels are all consistent with uremic bleeding diathesis.

Correct Answer: A

Rationale: The clinical presentation of urinary urgency, frequency, and nocturia along with prostate enlargement with a smooth, firm consistency on digital rectal examination (DRE) is classic for benign prostatic hyperplasia (BPH). BPH is a common condition in aging men characterized by non-malignant growth of the prostate gland, which can cause varying degrees of lower urinary tract symptoms due to obstruction of the urethra. In contrast, prostate cancer typically presents with findings like an asymmetric, hard, or nodular prostate on DRE, while prostatitis presents with symptoms like fever, perineal pain, and systemic symptoms. Urinary tract infection (UTI) may present with dysuria, frequency, urgency, and suprapubic pain, but it does not usually cause prostate enlargement.

Correct Answer: A

Rationale: Acute pyelonephritis is the most likely condition based on the patient presentation and urinalysis findings described. Acute pyelonephritis is an infection of the renal parenchyma and pelvis, typically caused by ascending bacteria from the lower urinary tract. The classic symptoms include fever, chills, flank pain, and costovertebral angle tenderness (tenderness over the kidneys). The presence of pyuria (pus in the urine) and bacteriuria (bacteria in the urine) on urinalysis further supports the diagnosis of acute pyelonephritis. It is crucial to diagnose and treat acute pyelonephritis promptly to prevent complications and recurrent infections.