Question Easy:
A 25-year-old rugby player presents to the clinic with acute swelling, pain, and limited movement in his right knee after a match injury. On examination, there is a palpable defect and weakness in knee extension. What is the most likely diagnosis?
A) Meniscal tear
B) ACL rupture
C) Quadriceps tendon rupture
D) Patellar tendon rupture
E) Medial collateral ligament sprain
Question Medium:
A 67-year-old woman presents with pain and stiffness in her shoulders and hips, accompanied by systemic symptoms such as fatigue and low-grade fever. Blood tests reveal elevated inflammatory markers. Which condition is most likely?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Polymyalgia rheumatica
D) Fibromyalgia
E) Septic arthritis
Question Hard:
A 32-year-old office worker consults the GP for chronic lower back pain that is worse in the morning and improves with activity. He describes feeling stiff when rising from bed. His father has a history of similar symptoms. Which of the following is the most appropriate initial investigation?
A) MRI of the spine
B) HLA-B27 blood test
C) Rheumatoid factor
D) Lumbar spine X-ray
E) CRP level
Explanations & Answers:
Question Easy Answer: D) Patellar tendon rupture
Question Easy Explanation: The key features here are the acute nature of the injury, the palpable defect, and the weakness in knee extension, all suggestive of a patellar tendon rupture. According to NHS guidelines, quick surgical intervention may be necessary to restore full function.
Question Medium Answer: C) Polymyalgia rheumatica
Question Medium Explanation: Polymyalgia rheumatica is characterized by bilateral pain and stiffness in the shoulders and hips, especially in the morning, accompanied by systemic symptoms and elevated inflammatory markers. NICE recommends corticosteroids for treatment, which usually results in rapid symptom relief.
Question Hard Answer: D) Lumbar spine X-ray
Question Hard Explanation: The symptoms described are suggestive of ankylosing spondylitis, which typically presents with morning stiffness and is more prevalent if there is a family history. A lumbar spine X-ray can show characteristic changes such as sacroiliitis and can be used as a first-line investigation. HLA-B27, while indicative, is not diagnostic.
Medical fact of the day: Ankylosing spondylitis is a type of axial spondyloarthritis, predominantly affecting young males in the UK. Early diagnosis and management can prevent significant disability.
Quote of the day: “In every patient encounter, we hold the potential for healing, learning, and growth. Let’s embrace it with compassion and curiosity.”