Question Easy:
A 45-year-old woman presents with pain and swelling in her left knee following a fall. She is unable to fully extend the knee and there is tenderness over the medial joint line. What is the most likely diagnosis?
A) Medial collateral ligament injury
B) Lateral collateral ligament injury
C) Anterior cruciate ligament injury
D) Meniscal tear
E) Patellar dislocation
Question Easy Answer:
D) Meniscal tear
Question Easy Explanation:
A meniscal tear is commonly caused by a twisting injury and often presents with joint line tenderness and an inability to fully extend the knee. This diagnosis aligns with NICE guidelines for managing knee injuries. The medial joint line tenderness and mechanism of injury make a meniscal tear the most likely diagnosis in this scenario.
Question Medium:
A 60-year-old man complains of gradually worsening pain and stiffness in both hips, which is worse in the mornings and after prolonged activity. He has difficulty walking long distances and climbing stairs. What is the most appropriate initial management?
A) Paracetamol
B) Ibuprofen
C) Physiotherapy
D) Referral to orthopaedic surgeon
E) Total hip replacement
Question Medium Answer:
A) Paracetamol
Question Medium Explanation:
According to NICE guidelines, the first-line pharmacological treatment for osteoarthritis, which is the likely diagnosis given the patient’s age and symptoms, is paracetamol. Non-pharmacological treatments, such as physiotherapy, should also be considered, but initial pharmacological management should start with paracetamol.
Question Hard:
A 33-year-old man presents with severe lower back pain radiating down his right leg after lifting a heavy object at work. He has new-onset urinary incontinence and weakness in his right foot. What is the most appropriate next step?
A) NSAIDs and rest
B) MRI of the lumbar spine
C) Referral to physiotherapy
D) Lumbar steroid injection
E) Emergency surgical referral
Question Hard Answer:
E) Emergency surgical referral
Question Hard Explanation:
The presentation of severe lower back pain with radicular symptoms, new-onset urinary incontinence, and foot weakness is highly suggestive of cauda equina syndrome, which is a surgical emergency. According to NHS and NICE guidelines, immediate surgical referral is required to prevent permanent neurological damage.
Medical fact of the day:
Did you know that the most common type of joint disorder in the UK is osteoarthritis, affecting approximately 8.75 million people? It is more prevalent among older individuals, women, and those with a history of joint injury.
Quote of the day:
“𝐇𝐞𝐚𝐥𝐢𝐧𝐠 𝐢𝐬 𝐚 𝐣𝐨𝐮𝐫𝐧𝐞𝐲, 𝐧𝐨𝐭 𝐚 𝐝𝐞𝐬𝐭𝐢𝐧𝐚𝐭𝐢𝐨𝐧. 𝐄𝐯𝐞𝐫𝐲 𝐝𝐚𝐲, 𝐲𝐨𝐮 𝐦𝐚𝐤𝐞 𝐚 𝐩𝐨𝐬𝐢𝐭𝐢𝐯𝐞 𝐢𝐦𝐩𝐚𝐜𝐭 𝐢𝐧 𝐬𝐨𝐦𝐞𝐨𝐧𝐞’𝐬 𝐥𝐢𝐟𝐞. 𝐊𝐞𝐞𝐩 𝐬𝐡𝐢𝐧𝐢𝐧𝐠 𝐲𝐨𝐮𝐫 𝐥𝐢𝐠𝐡𝐭. 🌟”