Question Easy: A 67-year-old woman comes to the GP with pain in her knees, worse on activity, and improved with rest. She describes a grating sensation when moving the joint. On examination, there is tenderness and some effusion but no warmth or significant redness around the knee. What is the most likely diagnosis? 🤔
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
E) Psoriatic arthritis
Question Medium: A 45-year-old man presents to A&E with acute lower back pain radiating down the left leg following a day of heavy lifting. He has difficulty straightening up and describes a burning sensation in the posterior thigh and calf. Knee and ankle reflexes are normal, but he has a positive straight leg raise test on the left. What is the most likely diagnosis? 🚑
A) Lumbar disc herniation – L5/S1
B) Hip osteoarthritis
C) Spinal stenosis
D) Cauda equina syndrome
E) Sciatica due to piriformis syndrome
Question Hard: A 23-year-old male presents to the orthopaedic clinic with progressive stiffness and discomfort in his lower back and hips over several months. He has morning stiffness lasting several hours and feels better after exercise. On examination, there is reduced spinal flexion. An X-ray shows sacroiliitis. What is the most likely diagnosis? 🔍
A) Ankylosing spondylitis
B) Fibromyalgia
C) Lumbar spondylosis
D) Rheumatoid arthritis
E) Spondylolisthesis
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: This patient’s clinical presentation is classic for osteoarthritis, which typically presents with joint pain that worsens with activity and improves with rest. The grating sensation, or crepitus, is characteristic as well. NICE guidelines emphasize these symptoms in osteoarthritis diagnosis.
Question Medium Answer: A
Question Medium Explanation: The symptoms suggest lumbar disc herniation at L5/S1, leading to radicular pain along the sciatic nerve path, common following heavy lifting. A positive straight leg raise test is indicative of nerve root irritation, aligning with this condition.
Question Hard Answer: A
Question Hard Explanation: The symptoms and radiological findings are indicative of ankylosing spondylitis, characterized by morning stiffness and improvement with exercise, along with sacroiliitis visible on X-ray. The pattern fits the chronic inflammatory presentation of this condition per NICE guidelines.
Medical fact of the day: Did you know that ankylosing spondylitis is more common in young men and can lead to a characteristic “bamboo spine” appearance on X-rays due to vertebral fusion?
Quote of the day: “In the healing journey, every step taken with empathy illuminates the path to recovery, one patient at a time.” 🌟