Question Easy: A 28-year-old marathon runner comes to the GP complaining of pain along the front of her shin, specifically worsening during runs. She mentions increasing her running intensity recently. What is the most likely diagnosis? 🏃♀️
A) Stress fracture of the tibia
B) Compartment syndrome
C) Shin splints (medial tibial stress syndrome)
D) Achilles tendonitis
E) Plantar fasciitis
Question Medium: A 46-year-old office worker presents with pain and swelling in the right knee for the past three days. He recalls twisting his knee awkwardly while getting out of his car. On examination, there is tenderness on the joint line and a positive McMurray test. What is the most likely injury?
A) Anterior cruciate ligament tear
B) Medial meniscus tear
C) Lateral collateral ligament sprain
D) Patellar dislocation
E) Osteoarthritis
Question Hard: A 65-year-old woman with a history of rheumatoid arthritis is scheduled for a total hip replacement. During the pre-operative assessment, she mentions recent pain and stiffness in her hands and fingers, making daily tasks difficult. What is the most appropriate pre-operative management for her RA symptoms according to current guidelines?
A) Initiate oral corticosteroids
B) Start methotrexate immediately
C) Increase her physiotherapy sessions
D) Consult rheumatology for possible use of biologics
E) Advise over-the-counter NSAIDs for pain
Explanations & Answers:
Question Easy Answer: C) Shin splints (medial tibial stress syndrome)
Question Easy Explanation: Shin splints are common in runners, especially when they increase the intensity or duration of their runs, causing muscle inflammation and pain along the shin. NICE guidelines suggest rest and modification of activities as primary steps in management.
Question Medium Answer: B) Medial meniscus tear
Question Medium Explanation: The clinical presentation of joint line tenderness and positive McMurray test strongly suggests a meniscal tear, particularly since the injury occurred with a twisting motion. According to the NHS, conservative management or referral to orthopaedic surgeons are possible treatments, depending on severity.
Question Hard Answer: D) Consult rheumatology for possible use of biologics
Question Hard Explanation: Managing rheumatoid arthritis in the peri-operative period can be complex, as it involves balancing the patient’s disease control with the risk of infection. According to NICE guidance, patients on disease-modifying drugs or biologics should be reviewed by rheumatology prior to surgery for optimal management.
Medical fact of the day: Osteoporosis is often referred to as a “silent disease” because it typically doesn’t show symptoms until a fracture occurs, which can severely impact mobility and quality of life, particularly in the aging population.
Quote of the day: “In the care of others, we find the true measure of our own strength, resilience, and compassion.”