Question Easy:
A 25-year-old man presents to the A&E after injuring his right ankle while playing football. His ankle is swollen, bruised, and painful to move. 🤕 Which of the following is the most appropriate initial management step for this acute ankle sprain?
A) Surgical intervention
B) Physiotherapy referral
C) Rest, ice, compression, elevation (RICE)
D) Prescribe antibiotics
E) Use of a long leg cast
Question Medium:
A 50-year-old woman presents with gradual onset knee pain and stiffness, particularly in the mornings. The pain is exacerbated by activity and seems to improve slightly with rest. On examination, there are no significant joint deformities, but crepitus is felt over the knee joint. What is the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Psoriatic arthritis
E) Septic arthritis
Question Hard:
A 72-year-old man with a history of diabetes and hypertension presents with severe back pain radiating to his right leg. An MRI reveals an L4-L5 disc prolapse compressing the L5 nerve root. He is experiencing foot drop and sensory changes over the dorsum of the foot. Which of the following reflex changes would you expect to find?
A) Absent ankle jerk
B) Reduced knee jerk
C) Normal reflexes
D) Reduced ankle jerk
E) Hyperreflexia
Explanations & Answers:
Question Easy Answer: C) Rest, ice, compression, elevation (RICE)
Question Easy Explanation: Acute ankle sprains are best managed initially with the RICE method to reduce swelling and provide pain relief. This conservative treatment is aligned with NHS guidelines, which recommend avoiding surgery and antibiotics in the absence of severe injury or infection.
Question Medium Answer: B) Osteoarthritis
Question Medium Explanation: The description of knee pain with morning stiffness that improves with rest and crepitus is characteristic of osteoarthritis. NICE guidelines emphasize differentiating it from inflammatory conditions like rheumatoid arthritis, which would usually have more pronounced swelling and joint deformity.
Question Hard Answer: D) Reduced ankle jerk
Question Hard Explanation: Compression of the L5 nerve root by a disc prolapse would typically affect the L5 nerve root, which does not alter the ankle (S1) or knee (L4) reflexes directly. However, since the weakness predominantly affects ankle dorsiflexion and the sensory changes align with L5, a reduced ankle jerk (S1 reflex) can sometimes accompany multiple root involvement due to overlapping nerve supply.
Medical fact of the day: The term “tennis elbow” actually reflects lateral epicondylitis, a condition often found among manual workers and typists, rather than just tennis players.
Quote of the day: “In every wound lies a chance for renewed strength, and in every setback, a lesson for mastery.”