Question Easy:
A 45-year-old woman presents with pain and swelling in her right knee after twisting it awkwardly while descending stairs. On examination, there is tenderness over the medial joint line and a positive McMurray test. What is the most likely diagnosis?
A) Anterior cruciate ligament injury
B) Medial meniscus tear
C) Lateral meniscus tear
D) Patellar dislocation
E) Osteoarthritis
Question Medium:
A 60-year-old man complains of shoulder pain and stiffness that has progressively worsened over the past three months. Examination shows reduced active and passive range of motion in all planes. An X-ray of the shoulder is normal. What is the most likely diagnosis?
A) Rotator cuff tear
B) Adhesive capsulitis
C) Subacromial impingement
D) Osteoarthritis of the glenohumeral joint
E) Rheumatoid arthritis
Question Hard:
A 30-year-old male presents to the ED with acute onset back pain after lifting a heavy object. He has no history of trauma or previous back issues. MRI shows a prolapsed intervertebral disc at L4-L5, compressing the nerve root. Which of the following symptoms would most likely correlate with this finding?
A) Weakness in plantar flexion
B) Weakness in knee extension
C) Reduced ankle reflex
D) Weakness in dorsiflexion
E) Reduced patellar reflex
Explanations & Answers:
Question Easy Answer: B) Medial meniscus tear
Question Easy Explanation: The patient’s symptoms and the positive McMurray test suggest a medial meniscus tear, a common injury following rotational force applied to the knee. The medial meniscus is more frequently injured than the lateral due to its firm attachment to the tibial surface and joint capsule.
Question Medium Answer: B) Adhesive capsulitis
Question Medium Explanation: Adhesive capsulitis, also known as frozen shoulder, presents with pain and gradual loss of both active and passive range of motion. Risk factors include diabetes and prolonged immobilization. Treatment typically involves physical therapy and, in some cases, corticosteroid injections as per NICE guidelines.
Question Hard Answer: D) Weakness in dorsiflexion
Question Hard Explanation: A prolapsed disc at L4-L5 commonly compresses the L5 nerve root, which affects dorsiflexion of the foot. This is because the L5 nerve root innervates the muscles responsible for this action, leading to foot drop if severely affected. According to NHS guidelines, conservative management including pain relief and physiotherapy is recommended initially unless there are red flag symptoms.
Medical fact of the day: Did you know that rheumatoid arthritis can affect the cervical spine, leading to potential neurological complications? The atlantoaxial joint can become unstable, necessitating careful monitoring, particularly during anesthesia and intubation procedures.
Quote of the day: “In the midst of the chaos of healthcare, remember that each act of compassion heals both the giver and the receiver 🩺💙.”