A CME initiative... Please discuss the drug you would give and why..

· 2 min read

A CME initiative… Please discuss the drug you would give and why..
A 19-year-old man presents to his primary care provider with a 2-month history of lower back pain and stiffness. The pain is intermittent, achy, and usually worse in the morning than it is later in the day or evening. He has also noticed a progressive inability to perform activities that require flexibility in the back, such as bending down to pull on his pants or tying his shoelaces. The pain sometimes awakens him at night. It is improved with exercise. He also reports a several-month history of low-grade fever, malaise, and anorexia, as well as an unintended weight loss of 10 lb (4.5 kg). He has not noted any masses on his testicles with self-examination. The patient has no history of rash. He does not have any known chronic medical conditions. He takes one multivitamin per day. He has never smoked, but he does drink an occasional glass of wine with dinner. There is no significant family history of disease.
On physical examination, the patient has a blood pressure of 125/67 mm Hg and a heart rate of 60 bpm. His respiratory rate is 8 breaths/min and his temperature is normal at 98.0°F (36.7°C). The cardiovascular and respiratory portions of the examination are normal; specifically, no murmurs or rubs are detected. The patient has no photophobia, eye redness, or decreased visual acuity. On examination of the back, flexion of the lumbar spine is clearly decreased when the patient attempts to bend down to touch his toes. He also has pain and limited range of motion with rotation and lateral flexion at the lumbar spine. His chest expansion is mildly diminished. The remainder of the physical examination is within normal limits.
As part of the initial workup of the findings on physical examination, routine laboratory investigations, including a complete blood cell (CBC) count and a basic electrolyte panel, as well as plain radiographs of the back, are performed. The chemistry panel is unremarkable, and the CBC reveals a white blood cell (WBC) count of 4.6 ├âÔÇö 103/├Ä┬╝L (4.6 ├âÔÇö 109/L), a hemoglobin of 13.7 g/dL (137 g/L), a hematocrit of 43% (0.43), and a platelet count of 120 ├âÔÇö 103/├Ä┬╝L (120 ├âÔÇö 109/L). The electrolytes are within normal limits. A rheumatoid factor test is negative, and the erythrocyte sedimentation rate is 64 mm/hr (normal range, <10 mm/hr for men). The patient has a positive finding for human leukocyte antigen (HLA)├óÔé¼ÔÇ£B27.

Related Articles

Whats the plant?
· 1 min read
What's the Remedy
· 1 min read

WTF 20150716

Who am I? I can help a troublesome child with fever, who vomits everything she eats and has dysentery. I

· 1 min read

WTP 20150730

Who am I? I am indicated in some kinds of sore throats. The berries my cousins are used in Mexico

· 1 min read

WTP 20150810

Who am I? I am indicated when you crave for buttermilk, hemorrhage from uterine fibroid with cramps and expulsion of

· 1 min read