Question Easy: A 25-year-old patient presents with pain and swelling in their right knee after twisting it during a football match. They recall hearing a “pop” at the time of injury. What is the most likely diagnosis? ⚽️
A) Anterior cruciate ligament (ACL) injury
B) Meniscal tear
C) Patellar dislocation
D) Medial collateral ligament (MCL) sprain
E) Osteoarthritis
Question Medium: A 68-year-old male presents with a swollen, painful knee with decreased range of motion. Joint aspiration reveals cloudy synovial fluid with high neutrophil count. What is the most appropriate initial management step? 🚑
A) Start intravenous antibiotics
B) Initiate oral NSAIDs
C) Perform joint lavage
D) Prescribe a steroid injection
E) Schedule immediate physiotherapy
Question Hard: A 70-year-old woman with osteopenia is starting on bisphosphonate therapy to reduce fracture risk. What advice should you provide regarding the administration of this medication to optimize its absorption? 📚
A) Take with a full glass of orange juice
B) Take with all meals
C) Take at bedtime
D) Take on an empty stomach at least 30 minutes before breakfast
E) Take alongside calcium and vitamin D supplements
Explanations & Answers:
Question Easy Answer: A
Question Easy Explanation: An acute ACL injury is associated with a “pop” sensation and immediate swelling. It commonly occurs in athletes after sudden twisting motions, aligning with the patient’s football injury described.
Question Medium Answer: A
Question Medium Explanation: Cloudy synovial fluid with a high neutrophil count is suggestive of septic arthritis, which can rapidly damage the joint. Intravenous antibiotics should be commenced promptly to manage the infection, following NICE guidelines for the treatment of septic arthritis.
Question Hard Answer: D
Question Hard Explanation: Bisphosphonates should be taken on an empty stomach with a full glass of water at least 30 minutes before food to ensure optimal absorption. Drinking orange juice or taking calcium supplements at the same time can reduce the absorption of bisphosphonates, so this should be avoided as per BNF guidelines.
Medical fact of the day: In the UK, osteoarthritis affects around 8 million people and is one of the leading causes of pain and disability amongst the elderly population.
Quote of the day: “Compassion is the key to healing; let it guide your hands and your heart in every patient encounter.”