Question Easy:
A 55-year-old woman presents to the GP with pain and stiffness in her hands, particularly in the morning. On examination, there is evidence of swelling in the proximal interphalangeal joints of both hands. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Psoriatic arthritis
E) Ankylosing spondylitis
Question Medium:
A 67-year-old man presents to the A&E with severe pain in his right hip following a fall in his home. X-ray imaging reveals an intracapsular fracture of the right femur. Which of the following is the preferred initial management for this type of fracture in the elderly according to NICE guidelines?
A) Total hip replacement
B) Hemiarthroplasty
C) Hip resurfacing
D) Dynamic hip screw
E) Conservative management
Question Hard:
A 25-year-old male rugby player presents with acute knee pain after twisting during a game. He describes a “popping” sensation followed by swelling and instability. On examination, there is a positive anterior drawer test. What is the most likely diagnosis?
A) Medial collateral ligament tear
B) Anterior cruciate ligament tear
C) Posterior cruciate ligament tear
D) Meniscus tear
E) Patellar dislocation
Explanations & Answers:
Question Easy Answer: B) Rheumatoid arthritis
Question Easy Explanation: The symptoms describe classic features of rheumatoid arthritis, characterized by symmetrical joint swelling, particularly affecting the proximal interphalangeal (PIP) joints and marked morning stiffness. Osteoarthritis typically affects the distal interphalangeal and carpometacarpal joints and has less morning stiffness.
Question Medium Answer: B) Hemiarthroplasty
Question Medium Explanation: For an elderly patient with an intracapsular hip fracture, NICE guidelines recommend hemiarthroplasty as the preferred initial management due to lower rates of dislocation and functional outcomes comparable to total hip replacement, which is more suitable for younger, more active patients.
Question Hard Answer: B) Anterior cruciate ligament tear
Question Hard Explanation: The mechanism of injury (twisting), the “popping” sensation, the swelling (hemarthrosis), and the positive anterior drawer test are indicative of an anterior cruciate ligament (ACL) tear, a common sports-related knee injury.
Medical fact of the day: Did you know that low back pain is one of the most common reasons for GP consultations in the UK, accounting for a significant proportion of chronic pain cases and work absences? It highlights the importance of effective management strategies tailored to individual needs.
Quote of the day: “In the tapestry of healthcare, every thread of compassion, every stitch of care, holds the promise of healing.”