Q. A 50 year old male presented with persistent morning stiffness for at least 1 hour everyday for the past 6 weeks, swelling of metacarpophalangeal joints on both sides, with ulnar deviation of the fingers. Radiographically, there is erosion of the articular surfaces of the matacarpophalangeal joints. Serum analysis showed high amount of rheumatoid factor.
a) What is your best diagnosis?
b) What are the clinical features of this condition?
c) What are the treatment options?
A. The patient is obviously suffering from a 'morning boner' aka 'morning glory' aka 'morning wood' because he presented with morning stiffness of more than one hour. I regularly have morning stiffness of several hours every morning. It was quite embarrassing when I was younger and my mother would come to wake me up but now I sometimes accidentally poke my girlfriend and wake her up, then she gives me a treat in the morning.

The aetiology of this condition is unknown. One predisposing factor is the urge to pee. For example, a person with a full bladder is more likely to get a morning stiffness and that will prevent him from wetting his bed because people generally don't pee when they have an erection. It really is difficult to pee with an erect penis, as proven by this clip.
Besides preventing bed wetting, morning stiffness can also act as a signal to wake up the patient and instruct him to go to the toilet. For example, patients who lie face down on the mattress are more likely to be woken up when they press their 'morning glory' against the mattress and they will then proceed to the toilet to relieve themselves. Patients who sleep on their back are less likely to wake up and might wet themselves. This system is a double edged sword because it does alert you that your bladder is full but it's also difficult to pee with an erect penis.
The pathognomonic clinical feature of morning stiffness is an unusually erect penis that will not go away no matter how hard (pun intended) the patient tries.
Morning stiffness is not a serious problem and doesn't need to be treated. However, if it happens in an awkward situation, such as when you really want to pee or when you are having a sleepover with some friends or when you're at the swimming pool, no amount of thinking about baseball will help. What will help is having sex or masturbating.

In conclusion, the patient has morning stiffness, which is characterized by an unusually erect penis and is treated with sex or masturbation.
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That was the student's answer. Now here's the LECTURER'S COMMENTS:
You moron! What you just described was 'nocturnal penile tumescence' aka 'morning boner', not 'morning stiffness'! I'm glad you're going to be a dentist and not a medical doctor. And how on earth could you have missed that the patient presented with RHEUMATOID FACTORS in his serum? Besides, when the f*ck did I teach you about this stuff? Morning boner is not a part of any syllabus for any dental student in the world. I guess Robin Williams was right when he said that god gave man a brain and a penis but not enough blood to run both at the same time. STOP THINKING WITH YOUR PENIS!
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There you go kids, another rejected exam question. Please avoid this question at all costs, don't bother studying about morning boners and please don't get confused between morning boners and morning stiffness.



































