Question Easy:
A 45-year-old male presents to the GP with pain and stiffness in the lower back for the past few months. He reports the stiffness is worse in the morning and improves with exercise. He also mentions some swelling in his left knee. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Ankylosing spondylitis
D) Psoriatic arthritis
E) Fibromyalgia
Question Medium:
A 30-year-old woman presents with pain and swelling in her right knee after a twisting injury while playing football. On examination, there is a positive anterior drawer test. What is the most likely injury?
A) Medial meniscus tear
B) Anterior cruciate ligament tear
C) Posterior cruciate ligament tear
D) Lateral collateral ligament tear
E) Patellar tendon tear
Question Hard:
A 50-year-old man presents to the emergency department with severe pain in the left calf, inability to move the ankle, and a palpable gap in the Achilles tendon area after hearing a “pop” while playing tennis. What is the most appropriate initial management?
A) Apply a cast in the plantar flexed position
B) Immediate surgical repair
C) Prescribe NSAIDs and rest
D) Physiotherapy referral
E) R.I.C.E (Rest, Ice, Compression, Elevation)
Explanations & Answers:
Question Easy Answer: C) Ankylosing spondylitis
Question Easy Explanation: The symptoms are characteristic of ankylosing spondylitis, a condition often presenting with lower back pain and stiffness that improves with exercise, and peripheral joint involvement like knee swelling. NICE guidelines support these findings in the diagnosis of spondyloarthropathies.
Question Medium Answer: B) Anterior cruciate ligament tear
Question Medium Explanation: A positive anterior drawer test is indicative of an anterior cruciate ligament (ACL) tear, common in sports-related injuries due to sudden changes in direction or improper landings, as per NHS guidelines on sports injuries.
Question Hard Answer: A) Apply a cast in the plantar flexed position
Question Hard Explanation: In cases of Achilles tendon rupture, immediate management involves immobilization with a cast or brace in the plantar flexed position to facilitate healing, as recommended by NICE guidelines. Surgical repair may be considered later depending on the severity and patient factors.
Medical fact of the day: Did you know that Ankylosing spondylitis is more common in young men and can lead to a condition known as “bamboo spine,” where the spine becomes rigid? Early diagnosis and treatment can help manage symptoms and improve quality of life.
Quote of the day: “Every step taken with compassion and care is a stitch in the fabric of humanity, holding us all together in health and hope.”