Question Easy: A 65-year-old woman presents to her GP complaining of pain and stiffness in the joints of her fingers that worsens with activity and improves with rest. An X-ray of her hands shows the presence of osteophytes at the distal interphalangeal joints. What is the most likely diagnosis? 🖐️
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Psoriatic arthritis
E) Systemic lupus erythematosus
Explanations & Answers:
Question Easy Answer: B) Osteoarthritis
Question Easy Explanation: The clinical presentation and X-ray findings described are indicative of osteoarthritis. Osteophytes (bony spurs), particularly in the distal interphalangeal joints (Heberden’s nodes), alongside pain that worsens with activity and improves with rest, suggest osteoarthritis, which is common in this demographic.
Question Medium: A 34-year-old man presents to the emergency department after a football injury. He has a swollen, painful ankle and is unable to bear weight. An X-ray is carried out. Which feature would suggest a Maisonneuve fracture, a specific type of injury associated with ankle trauma? ⚽
A) Medial malleolar fracture
B) Fracture of the lateral malleolus
C) Tenderness in the proximal fibula
D) Avulsion injury of the base of the fifth metatarsal
E) Osteochondral defect in the talar dome
Explanations & Answers:
Question Medium Answer: C) Tenderness in the proximal fibula
Question Medium Explanation: A Maisonneuve fracture involves a fracture of the proximal fibula due to a syndesmosis injury associated with a spiral fracture of the proximal fibula and an associated ankle injury. Tenderness in the proximal fibula in the context of an ankle injury should raise suspicion for this type of fracture. According to NICE guidelines, appropriate imaging and assessment are crucial for diagnosis.
Question Hard: A 23-year-old male presents with back pain and stiffness that is worse in the morning and improves with activity. He also reports episodes of eye redness and discomfort. What is the most likely investigation to confirm the suspected diagnosis? 👀📋
A) MRI of the sacroiliac joints
B) X-ray of the lumbar spine
C) HLA-B27 genetic testing
D) ESR and CRP blood tests
E) CT scan of the thoracic spine
Explanations & Answers:
Question Hard Answer: A) MRI of the sacroiliac joints
Question Hard Explanation: The symptoms suggest ankylosing spondylitis, a form of inflammatory arthritis affecting the spine. MRI of the sacroiliac joints is recommended as it can detect early sacroiliitis (inflammation of the sacroiliac joints), which is a hallmark of the disease. Eye symptoms may indicate uveitis, a common extra-articular manifestation. This approach aligns with both NHS and NICE guidelines on diagnosing and managing axial spondyloarthritis.
Medical fact of the day: The flexor tendon in the finger can bear up to 9 kg of weight before failing, making it one of the strongest tendons relative to its size in the human body!
Quote of the day: “In the rhythm of caring, each beat of compassion heals more than one heart.”