Question Easy:
A 25-year-old woman visits her GP with complaints of pain in her right wrist following a fall onto her outstretched hand. She describes the pain as being especially prominent in the anatomical snuffbox. What is the most likely diagnosis?
A) Colles’ fracture
B) Scaphoid fracture
C) Smith’s fracture
D) Lunate dislocation
E) Carpal tunnel syndrome
Question Medium:
A 67-year-old man presents to the GP with pain in his left hip, which has been worsening over the past year. He is particularly stiff in the morning, but the stiffness improves within 30 minutes. He recently started noticing some creaking noises while moving the joint. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Trochanteric bursitis
D) Ankylosing spondylitis
E) Septic arthritis
Question Hard:
A 32-year-old male road cyclist complains of anterior knee pain that has been worsening over the past 3 months. It is particularly painful when climbing stairs and after prolonged sitting. What is the most likely initial management step according to NICE guidelines?
A) Immediate MRI of the knee
B) Referral to an orthopedic surgeon
C) Prescribe NSAIDs
D) Physiotherapy focusing on quadriceps strengthening exercises
E) Corticosteroid injection
Explanations & Answers:
Question Easy Answer:
B) Scaphoid fracture
Question Easy Explanation:
Pain in the anatomical snuffbox following a fall onto an outstretched hand is classic for a scaphoid fracture. Scaphoid fractures are the most common carpal bone fractures and require prompt attention due to the risk of avascular necrosis. NICE guidelines suggest immobilization and follow-up imaging if initial X-rays are inconclusive.
Question Medium Answer:
B) Osteoarthritis
Question Medium Explanation:
The symptoms described, such as hip pain and morning stiffness improving within 30 minutes, are typical of osteoarthritis. The presence of crepitus (creaking noises) further supports this diagnosis. Compared to rheumatoid arthritis, which has prolonged morning stiffness, osteoarthritis stiffness is shorter in duration. NICE guidelines recommend analgesics and physiotherapy as initial management.
Question Hard Answer:
D) Physiotherapy focusing on quadriceps strengthening exercises
Question Hard Explanation:
The symptoms described are indicative of patellofemoral pain syndrome (runner’s knee), common in cyclists. According to NICE guidelines, initial management includes physiotherapy exercises to strengthen the quadriceps and improve overall knee alignment. NSAIDs can be used for pain relief, but they are not the primary treatment approach.
Medical fact of the day:
Did you know that the UK reports nearly 100,000 new hip fractures annually, with a significant proportion occurring in older adults? This highlights the importance of osteoporosis prevention and management strategies to reduce the risk of fractures.
Quote of the day:
“In the art of healing, remember: it’s not the obstacles that define our path, but the courage with which we face them.” 🌟