Question Easy:
A 72-year-old woman presents to the GP with sudden onset of right shoulder pain after falling on an outstretched hand. On examination, there is tenderness over the acromioclavicular joint and limited shoulder movement. X-ray shows no fractures. What is the most likely diagnosis?
A) Rotator cuff tear
B) Anterior shoulder dislocation
C) Acromioclavicular joint sprain
D) Proximal humerus fracture
E) Clavicle fracture
Question Medium:
A 30-year-old man presents to A&E after his knee suddenly “gave way” while playing football. He describes a popping sensation and immediate swelling. On examination, he has anterior knee tenderness and a positive Lachman test. What is the likely injury?
A) Medial meniscus tear
B) Anterior cruciate ligament (ACL) tear
C) Lateral collateral ligament injury
D) Patellar dislocation
E) Quadriceps tendon rupture
Question Hard:
A 65-year-old man with a history of rheumatoid arthritis presents with severe pain in his left hip. He is unable to bear weight after a minor fall at home. His medications include methotrexate and prednisolone. X-ray reveals loss of joint space and subchondral sclerosis. What is the most appropriate next step in management according to NICE guidelines?
A) Start physiotherapy
B) Increase methotrexate dose
C) Hip joint injection
D) Total hip replacement
E) Long-term antibiotics
Explanations & Answers:
Question Easy Answer: C) Acromioclavicular joint sprain
Question Easy Explanation: An acromioclavicular joint sprain often follows a fall on an outstretched hand, leading to pain and tenderness over the AC joint. The absence of fractures on the X-ray supports this diagnosis. The management typically involves rest, ice, and pain control.
Question Medium Answer: B) Anterior cruciate ligament (ACL) tear
Question Medium Explanation: A positive Lachman test, immediate swelling, and the sensation of the knee “giving way” are classical signs of an ACL tear. This injury is common in sports involving sudden changes in direction.
Question Hard Answer: D) Total hip replacement
Question Hard Explanation: In a patient with significant joint damage and functional impairment, particularly with underlying conditions like rheumatoid arthritis, NICE guidelines recommend considering total hip replacement as it significantly improves pain and function.
Medical fact of the day: Osteoarthritis (OA) is the most common joint disorder in the UK, affecting more than 8 million people. Managing OA involves a combination of lifestyle modifications, physical therapy, and pharmacological treatment, reflecting the importance of multimodal care strategies in chronic conditions.
Quote of the day: “The essence of medicine is caring for one another. Every little act of kindness you offer as a healthcare professional sows the seeds of hope.”