Question Easy:
A 35-year-old office worker presents with pain in the right shoulder after increasing his weightlifting regimen. The pain is most significant in the supraspinatus region when he tries to lift his arm sideways. There is localized tenderness and a painful arc between 60-120 degrees of abduction. What is the most likely diagnosis?
A) Frozen shoulder
B) Rotator cuff impingement
C) Biceps tendinitis
D) Glenohumeral osteoarthritis
E) Acromioclavicular joint arthritis
Question Medium:
A 22-year-old football player presents with pain and swelling in the right knee after an awkward twist during a match. On examination, there is a positive anterior drawer test. What is the most likely diagnosis?
A) Medial collateral ligament tear
B) Lateral collateral ligament tear
C) Anterior cruciate ligament rupture
D) Posterior cruciate ligament rupture
E) Meniscal tear
Question Hard:
A 62-year-old woman with a history of osteoporosis presents with sudden severe lower back pain after slipping in her kitchen. She denies any pain radiating to the legs or any change in bowel or bladder function. Which of the following is the most appropriate initial imaging modality to confirm compression fracture due to osteoporosis?
A) X-ray
B) CT scan
C) MRI
D) DEXA scan
E) Bone scan
Explanations & Answers:
Question Easy Answer: B) Rotator cuff impingement
Question Easy Explanation: Rotator cuff impingement is characterized by shoulder pain, especially when lifting the arm. The painful arc between 60-120 degrees of abduction is typical, along with tenderness around the supraspinatus tendon. NICE guidelines recommend conservative management with physiotherapy.
Question Medium Answer: C) Anterior cruciate ligament rupture
Question Medium Explanation: A positive anterior drawer test suggests an anterior cruciate ligament (ACL) rupture. The test checks for forward shifting of the tibia relative to the femur. Immediate management includes RICE (rest, ice, compression, elevation) and referral to orthopedics as per NHS guidelines.
Question Hard Answer: A) X-ray
Question Hard Explanation: In the context of suspected vertebral compression fractures in osteoporosis, an X-ray is the initial imaging modality. It can confirm the presence of a fracture. MRI may be used subsequently for further assessment if needed. According to NICE, X-rays are crucial for initial assessment in acute fractures.
Medical fact of the day: In the UK, Vitamin D deficiency is a growing concern, especially in the management of osteoporosis. The NHS recommends supplements for individuals at risk of low sun exposure to mitigate complications such as hip fractures.
Quote of the day: “Empathy in practice is the stethoscope of the compassionate physician—listen deeply, it may reveal the unspoken fears beneath the symptoms.”