Question Easy:
💪 A 50-year-old woman presents with sudden onset pain and swelling in her right knee after gardening. On examination, the knee is warm and tender with decreased range of motion. What is the most likely initial investigation to confirm the diagnosis of a suspected knee effusion?
A) Ultrasound
B) X-ray
C) MRI
D) Joint aspiration
E) CT scan
Question Medium:
🦴 A 70-year-old man with a known history of osteoporosis presents with sudden lower back pain after lifting a heavy box. He is in significant discomfort but can still ambulate. What is the most appropriate initial management according to NICE guidelines?
A) Bed rest for two weeks
B) Immediate surgery
C) Strong opioids
D) Oral bisphosphonates
E) Paracetamol and continue activity as tolerated
Question Hard:
👨⚕️ A 28-year-old man presents with severe pain in his right wrist after a fall from his bicycle. Examination reveals tenderness over the anatomical snuffbox. What is the most appropriate management if the initial X-ray is normal?
A) Discharge with reassurance
B) Immediate surgical referral
C) Splint and refer for MRI
D) Re-X-ray in 4 weeks
E) Start physiotherapy immediately
Explanations & Answers:
Question Easy Answer: D) Joint aspiration
Question Easy Explanation: Joint aspiration is indicated to confirm the diagnosis and to analyse the synovial fluid, especially in cases of suspected effusion or infection. It can help differentiate between inflammatory causes, crystal arthropathy, and septic arthritis, which is in line with NICE guidelines.
Question Medium Answer: E) Paracetamol and continue activity as tolerated
Question Medium Explanation: According to NICE guidelines for managing acute lower back pain, initial treatment should focus on pain management with paracetamol or NSAIDs and maintaining as much activity as tolerated to promote recovery, rather than bed rest or immediate surgical intervention.
Question Hard Answer: C) Splint and refer for MRI
Question Hard Explanation: The clinical suspicion of a scaphoid fracture is high given the tenderness over the anatomical snuffbox. If the initial X-ray is normal but clinical suspicion remains, immobilising the wrist with a splint and referring for further imaging, such as an MRI, is appropriate to confirm the fracture, as per NHS guidelines.
Medical fact of the day: The wrist pain known as “Kienböck’s disease” is a rare condition where the blood supply to one of the small bones in the wrist, the lunate, is interrupted, causing bone death. It’s more common in men between 20 and 40 years old.
Quote of the day: “In the world of medicine, compassion may be the best prescription. Remember, you have the power to heal beyond just science.”