Question Easy:
A 55-year-old female presents with pain and swelling in her right knee, which started suddenly while she was gardening. On examination, there is tenderness and limited range of motion. Radiographs of the knee show calcium pyrophosphate crystal deposition. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Pseudogout
E) Septic arthritis
Question Medium:
A 32-year-old male cyclist presents with anterior knee pain that worsens on climbing stairs. He has no history of trauma and recalls the pain developing gradually over the past few months. On physical examination, there is tenderness over the patellar tendon, and the “squat” test reproduces the pain. What is the most likely diagnosis?
A) Osgood-Schlatter disease
B) Patellar tendinopathy
C) Iliotibial band syndrome
D) Prepatellar bursitis
E) Meniscal tear
Question Hard:
A 68-year-old woman with a history of osteoporosis presents following a fall. She reports pain in her hip and is unable to bear weight. A DEXA scan performed previously showed a T-score of -2.8. X-ray of the pelvis shows a subcapital hip fracture. What is the most appropriate initial management?
A) Conservative management with bed rest
B) Total hip replacement
C) Dynamic hip screw
D) Intramedullary nail fixation
E) External fixation
Explanations & Answers:
Question Easy Answer: D) Pseudogout
Question Easy Explanation: Pseudogout, or calcium pyrophosphate dihydrate crystal deposition disease (CPPD), often presents with acute monoarthritis, similar to gout but typically affects the larger joints like the knee. Radiographs showing chondrocalcinosis are diagnostic.
Question Medium Answer: B) Patellar tendinopathy
Question Medium Explanation: Patellar tendinopathy, commonly known as “jumper’s knee,” presents with anterior knee pain exacerbated by activities like climbing stairs or squatting. The overuse injury is commonly seen in athletes and involves the tendon connecting the patella to the tibia.
Question Hard Answer: C) Dynamic hip screw
Question Hard Explanation: A subcapital hip fracture in an osteoporotic patient is typically managed surgically, with the dynamic hip screw being a common option for stable fracture patterns. It provides adequate stability for healing and early mobilization, consistent with NICE guidelines.
Medical fact of the day: The human foot and ankle complex has 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments, exemplifying the intricate design required for stability, balance, and mobility.
Quote of the day: “In the corridors of healing, every small act of care can echo beyond the walls, uplifting not just the patient, but the soul of medicine itself.”