Question Easy:
A 27-year-old rugby player presents to the A&E department with an injury sustained to his right shoulder after a game. He describes a popping sensation followed by intense pain and an inability to move his arm. On examination, the right shoulder appears squared off compared to the left, and there is a loss of normal shoulder contour. What is the most likely diagnosis? 🏉
A) Clavicle fracture
B) Acromioclavicular joint dislocation
C) Anterior shoulder dislocation
D) Rotator cuff tear
E) Biceps tendon rupture
Question Medium:
A 45-year-old woman visits her GP with chronic lower back pain that has been persistent for the last 3 months. The pain is described as a deep ache, radiating to her buttocks but not below the knee, and worsens after long periods of sitting. She has a history of significant stress at work but denies any recent trauma or systemic symptoms. What is the most probable diagnosis? 🌿
A) Lumbar disc herniation
B) Sciatica
C) Mechanical back pain
D) Ankylosing spondylitis
E) Osteoarthritis of the hip
Question Hard:
A 65-year-old man is evaluated in the rheumatology clinic for joint pain and stiffness in his hands, particularly in the morning and lasting more than 2 hours. Blood tests reveal elevated inflammatory markers, and X-rays show periarticular osteopenia and marginal erosions. What is the most appropriate treatment to initiate after confirming the diagnosis? 🤔
A) Paracetamol
B) Prednisolone
C) Methotrexate
D) Ibuprofen
E) Naproxen
Explanations & Answers:
Question Easy Answer: C) Anterior shoulder dislocation
Question Easy Explanation: The symptoms of a popping sensation, intense pain, and squared off appearance are classic for an anterior shoulder dislocation. It is the most common type of shoulder dislocation and often occurs in sports. Reduction should be performed as soon as possible by a qualified medical professional.
Question Medium Answer: C) Mechanical back pain
Question Medium Explanation: In the UK, mechanical back pain is one of the most common causes of chronic back pain. It typically worsens with certain positions and movement, such as prolonged sitting, as described by the patient. There is no radicular leg pain which makes conditions like sciatica or lumbar disc herniation less likely.
Question Hard Answer: C) Methotrexate
Question Hard Explanation: The patient’s symptoms and imaging findings are indicative of rheumatoid arthritis. According to NICE guidelines, methotrexate is often the first-line disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis due to its efficacy in controlling disease progression.
Medical fact of the day: Did you know that osteoarthritis is the most common form of arthritis in the UK? It affects around 8.5 million people, primarily impacting the knees, hips, and small joints of the hands. Early intervention with lifestyle modifications and treatment can significantly improve quality of life.
Quote of the day: “Let your passion for healing light the way, turning challenges into stepping stones for growth.” 🌟