19/09/2024 – MSK and Ortho

Question Easy:
A 25-year-old woman presents to the GP with pain and swelling in her right knee following a hiking trip. She’s able to bear weight but feels discomfort. Which is the most likely diagnosis? 🏞️

A) Torn meniscus
B) ACL tear
C) Patellar dislocation
D) Bursitis
E) Knee sprain

Explanations & Answers:

Question Easy Answer:
E) Knee sprain

Question Easy Explanation:
A knee sprain is a common injury especially following physical activities like hiking. The ability to bear weight and mild discomfort without significant instability typically points toward a sprain. According to NICE guidelines, rest, ice, compression, and elevation (RICE) are initial treatments, followed by a gradual return to activity.

Question Medium:
A 30-year-old patient complains of chronic lower back pain radiating to the left leg, which is exacerbated by prolonged sitting and relieved upon standing or walking. The pain is associated with numbness in the left foot. Which of the following is the most likely diagnosis? 🧑‍🦽

A) Ankylosing spondylitis
B) Lumbar spinal stenosis
C) Sciatica
D) Herniated lumbar disk
E) Sacroiliac joint dysfunction

Explanations & Answers:

Question Medium Answer:
C) Sciatica

Question Medium Explanation:
Sciatica is characterized by radiating pain from the lower back down to the leg, which worsens with sitting and is relieved by walking or standing. The numbness in the foot indicates nerve involvement. NICE recommends conservative management initially, such as NSAIDs for pain relief and physiotherapy.

Question Hard:
An elderly patient presents to the Emergency Department with a displaced femoral neck fracture after a fall at home. Which surgical intervention is preferred if the patient is an active individual with good pre-injury mobility and minimal comorbidities? 🏥

A) Hemiarthroplasty
B) Total hip replacement (THR)
C) Dynamic hip screw (DHS)
D) Intramedullary nailing
E) External fixation

Explanations & Answers:

Question Hard Answer:
B) Total hip replacement (THR)

Question Hard Explanation:
In an active elderly patient with good pre-injury mobility and minimal comorbidities, a total hip replacement (THR) is often preferred. NICE guidelines suggest THR can provide better functional outcomes and quality of life compared to hemiarthroplasty in such patients.

Medical fact of the day:
Rheumatoid arthritis increases the risk of osteoporosis due to chronic inflammation and the use of corticosteroids. Monitoring bone density and considering prophylactic measures is essential in the care of these patients.

Quote of the day:
“Small acts, when multiplied by millions of people, can transform the world. Remember, each patient you heal is a step towards a better tomorrow.” 🌟