Question Easy:
A 35-year-old woman presents with pain and swelling in her right ankle after twisting it while playing football. She is unable to bear weight immediately after the injury and has noticeable swelling. Which of the following is the most likely diagnosis?
A) Achilles tendon rupture
B) Ankle sprain
C) Fractured tibia
D) Gout
E) Septic arthritis
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: An ankle sprain is the most likely diagnosis given the mechanism of injury and the immediate swelling and pain. It is a common occurrence in sports activities where the ankle is twisted unnaturally. According to NICE guidelines, the initial management includes RICE (rest, ice, compression, and elevation) and analgesia, usually NSAIDs.
Question Medium:
A 55-year-old man presents with acute onset of severe pain in his great toe. The toe is swollen, red, and warm to touch. He has a history of hypertension and takes bendroflumethiazide. Which of the following is the most likely diagnosis?
A) Cellulitis
B) Septic arthritis
C) Gout
D) Pseudogout
E) Rheumatoid arthritis
Explanations & Answers:
Question Medium Answer: C
Question Medium Explanation: Gout is the most likely diagnosis given the acute presentation of a red, swollen, and painful joint, typically the first metatarsophalangeal joint. The patient’s use of thiazide diuretics, which can elevate serum uric acid levels, supports this diagnosis. NICE guidelines recommend NSAIDs or colchicine for acute attacks and allopurinol for long-term management after acute symptoms resolve.
Question Hard:
A 70-year-old woman presents with chronic, progressive pain in her right knee, which worsens with activity and improves with rest. Physical examination reveals crepitus and bony enlargements of the joint. Radiographs show joint space narrowing and osteophyte formation. What is the initial preferred pharmacologic treatment for this condition according to current guidelines?
A) Acetaminophen
B) NSAIDs
C) Opioids
D) Corticosteroid injections
E) Glucosamine
Explanations & Answers:
Question Hard Answer: B
Question Hard Explanation: NSAIDs are preferred for pain relief in osteoarthritis when simple analgesics like acetaminophen (paracetamol) are ineffective, as per NICE guidelines. Osteoarthritis management starts with patient education, weight loss, and exercise. When pharmacologic treatment is needed, NSAIDs are often used due to their effectiveness in reducing inflammation and pain.
Medical fact of the day: In the UK, osteoarthritis is the most common form of arthritis, affecting as many as 8.75 million people. It’s a leading cause of disability and often affects the knees, hips, and small joints of the hands.
Quote of the day: “In every moment of care given, no matter how small, there lies the power to make a profound impact on a patient’s journey to recovery.”