**Question Easy:**
A patient presents with pain and swelling in their right knee after a minor fall. There is no obvious deformity, but they are unable to bear weight on the affected leg. Which of the following is the most appropriate initial imaging modality?
A) X-ray
B) CT scan
C) MRI
D) Ultrasound
E) Bone scan
**Question Medium:**
A 45-year-old woman reports shoulder pain that has progressively worsened over six months. She describes the pain as a dull ache, exacerbated by overhead activities, and has a limited range of motion. What is the most likely diagnosis?
A) Rotator cuff tear
B) Frozen shoulder (Adhesive capsulitis)
C) Subacromial bursitis
D) Glenohumeral osteoarthritis
E) Bicipital tendinitis
**Question Hard:**
A 30-year-old marathon runner presents with pain and a palpable lump on the distal thigh. MRI reveals a mass with heterogeneous signal intensity and areas of necrosis. Which of the following is the most likely diagnosis?
A) Osteosarcoma
B) Ewing’s sarcoma
C) Chondrosarcoma
D) Liposarcoma
E) Synovial sarcoma
**Explanations & Answers:**
**Question Easy Answer:**
A) X-ray
**Question Easy Explanation:**
In cases of acute knee injury with pain and swelling, radiography (X-ray) is the most appropriate initial imaging modality. It helps rule out fractures or dislocations. According to NICE guidelines, plain radiographs are recommended as the first line of investigation in acute knee injuries.
**Question Medium Answer:**
B) Frozen shoulder (Adhesive capsulitis)
**Question Medium Explanation:**
Adhesive capsulitis, or frozen shoulder, is characterized by gradual onset shoulder pain and significantly reduced range of motion, particularly in abduction and external rotation. This condition typically follows a progressive course with pain initially followed by stiffness and then gradual recovery. NHS guidelines indicate a clinical diagnosis based on history and examination, and imaging may not be necessary unless ruling out other conditions.
**Question Hard Answer:**
A) Osteosarcoma
**Question Hard Explanation:**
Osteosarcoma is a primary bone malignancy often presenting in young adults as pain and swelling, sometimes with a palpable mass. MRI characteristics of a heterogeneous signal with areas of necrosis are indicative of osteosarcoma. NICE guidelines recommend MRI for detailed imaging before biopsy and staging work-up.
**Medical fact of the day:**
Did you know that Vitamin D deficiency is an important contributing factor to musculoskeletal pains in the UK? Ensuring adequate sunlight exposure and dietary intake can play a crucial role in maintaining bone health.
**Quote of the day:**
“Empathy is the heartbeat of healthcare. Each patient is more than a case; they are a story of hope and healing.”