Question Easy: A 65-year-old woman presents with a sudden onset of pain in her right big toe. The joint is swollen, red, and extremely tender to touch. She enjoys a glass of wine with dinner most nights. What is the most likely diagnosis? 🥂
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Septic arthritis
E) Psoriatic arthritis
Question Medium: A 35-year-old office worker presents with neck stiffness and pain radiating down the right arm. He also reports numbness in the thumb and difficulty in performing fine motor tasks. What is the most likely affected nerve root? 🧠
A) C5
B) C6
C) C7
D) C8
E) T1
Question Hard: A 28-year-old male marathon runner presents with anterior knee pain that worsens when he climbs stairs or sits for prolonged periods. He recently increased his running mileage. What is the most appropriate initial management for his condition? 🏃♂️
A) Surgical intervention
B) Corticosteroid injection
C) Physiotherapy and activity modification
D) Non-steroidal anti-inflammatory drugs (NSAIDs)
E) MRI of the knee
Explanations & Answers:
Question Easy Answer: C) Gout
Question Easy Explanation: The presentation described is classic for gout, which often affects the big toe (also known as podagra) and is associated with the consumption of alcohol. Gout is caused by the deposition of urate crystals in the joint and can be distinguished from other arthritic conditions by its acute onset and severe inflammation.
Question Medium Answer: B) C6
Question Medium Explanation: The C6 nerve root corresponds with symptoms of radiating pain, numbness in the thumb, and difficulty with fine motor activities. C6 radiculopathy can result from cervical spondylosis or disc herniation in the neck affecting the C6 nerve.
Question Hard Answer: C) Physiotherapy and activity modification
Question Hard Explanation: The scenario describes patellofemoral pain syndrome, also known as runner’s knee. According to NICE guidelines, initial management should include physiotherapy focusing on strengthening and stretching exercises, along with modifications to activity level to alleviate symptoms. Surgery and imaging are reserved for persistent cases where conservative measures have failed.
Medical fact of the day: In the UK, osteoarthritis is the most common form of arthritis, affecting approximately 8.75 million people. It is considered one of the leading causes of disability among adults.
Quote of the day: “Healing is not just a science, but the art of intuition, compassion, and perseverance.”