case Study- 2- Richard, an impoverished university student, and his millionaire father enter into an arrangement where Richard agrees that he will keep the front- and backyards of the family property mowed, and he will 'do fa bit' to keep the gardens looking tidy. In return, his father agrees to pay him a weekly allowance of $200. His father had previously used a garden contractor to do the job and paid him $350. They live on a one-hectare property, and the mowing alone takes half a day a week. After four weeks, Richard's father tells him that he can't afford to pay $200 a week. He says that Richard should be doing the work for nothing, as it is the responsibility of the whole family to look after the property; besides, he says, Richard is getting free board and lodging. Advise Richard.

11 1. Is a local corticosteroid injection in the palm effective in the case of Dupuytren's contracture? 2. Can Dupuytren's contracture occur in early or well-controlled diabetes, or is it more likely to occur in uncontrolled diabetes?

12 Besides cirrhosis of the liver and diabetes mellitus (DM), what other causes of Dupuytren's contracture are there? What is the pathophysiology behind it?

13 According to one of my lecturers, who is a very well-qualified doctor and orthopaedic specialist, there is an indirect connection between osteoarthritis and subclinical local infections (such as periodontal abscesses), changing the pH of bodily fluids. Can you explain this mechanism?

14 What do you mean by saying that in nodal osteoarthritis each joint is affected one at a time? Is it that each proximal interphalangeal (PIP) or distal interphalangeal (DIP) joint is affected alone, or that at any one time PIP or DIP joints are affected together in one or both hands?

15 What are the criteria for diagnosing osteoarthritis (OA) of the knee joint radiologically? Are changes to be expected with advancing age? To what extent would I consider it significant in those below 50 years of age? Would you give me some X-ray examples if possible?

16 1. In a young patient with osteoarthritis, does long-term treatment with paracetamol (acetaminophen) 500 mg/day, rather than ibuprofen 600 mg/day, lower the incidence of renal toxicity? 2. How great is the risk of renal toxicity with both these treatments?

17 In India, total knee replacements are being recommended for every case of severe osteoarthritis, without considering factors such as age, weight or medical condition. What are the correct indications for surgery?

18 Methotrexate therapy is usually begun in rheumatoid arthritis that doesn't respond to NSAIDs plus 40-120 mg methylprednisolone depot. If a remission is then induced, how long should methotrexate therapy be continued? Will the patient (now in remission) be given maintenance therapy?

19 What is the dose and regimen for folinic acid rescue after methotrexate in rheumatoid arthritis?

20 1. What are the indicators of remission in rheumatoid arthritis? Is it normalization of erythrocyte sedimentation rate (ESR) or clinical improvement? 2. Does the rheumatoid factor disappear during a remission of rheumatoid arthritis?